The Saudi Heart Association recommends systematic screening for subclinical atherosclerosis in individuals aged 35+ with 10-year ASCVD risk of 5–20%.
Does systematic screening for subclinical atherosclerosis using non-invasive imaging improve risk stratification and primary prevention in individuals aged 35 years or older with borderline or intermediate 10-year ASCVD risk?
The Saudi Heart Association recommends systematic screening for subclinical atherosclerosis using non-invasive imaging in individuals aged 35 years or older with borderline or intermediate ASCVD risk to guide primary prevention.
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Background: Atherosclerosis is the leading underlying cause of cardiovascular disease (CVD), which remains the primary cause of mortality in Saudi Arabia. Saudi patients experience CVD events nearly a decade earlier than their Western counterparts. Given the limitations of traditional risk assessment tools, there is a growing need to detect subclinical atherosclerosis to refine risk stratification and improve primary prevention strategies, particularly in younger and asymptomatic individuals. Methods: The Saudi Heart Association (SHA) developed this position statement through a structured, multistep process that included a comprehensive literature review and two expert panel meetings. Recommendations were formulated based on current evidence, expert consensus, and consideration of population-specific characteristics and healthcare infrastructure in Saudi Arabia. The final recommendations were reviewed by the expert panel to ensure scientific accuracy and relevance to local practice. Results and conclusions: The SHA recommends systematic screening for subclinical atherosclerosis in individuals aged 35 years or older with borderline or intermediate 10-year ASCVD risk (5–20%). Subclinical atherosclerosis can be assessed using validated non-invasive imaging modalities: coronary artery calcium (CAC) scoring, coronary computed tomography angiography (CCTA), carotid ultrasound, or ankle-brachial index (ABI). CAC scoring is the most validated modality, especially in individuals aged ≥40 years, while CCTA offers the advantage of detecting both calcified and non-calcified plaques. Carotid ultrasound can be advantageous in younger adults, and ABI is useful in older adults. Management should be tailored to disease burden: lifestyle modification is advised for individuals with minimal disease, while moderate- to high-intensity statin therapy is recommended in those with mild or moderate to severe subclinical disease. These recommendations aim to support evidence-based integration of subclinical atherosclerosis screening into routine clinical practice, facilitating earlier interventions and reducing the burden of cardiovascular disease in Saudi Arabia.
Alhabeeb et al. (Mon,) reported a other. The Saudi Heart Association recommends systematic screening for subclinical atherosclerosis in individuals aged 35+ with 10-year ASCVD risk of 5–20%.