Coronary risk factors are poor at predicting adverse cardiac events in the individual patient, with more than 75% of all hard coronary events occurring in persons classified as low or intermediate risk. Myocardial ischaemia testing of asymptomatic persons is an inappropriate measure of myocardial infarction risk, and is plagued by a preponderance of false positive and false negative tests. Total coronary atheromatous burden as measured by non-invasive CT coronary calcium scoring, may provide the best contemporary measure of coronary risk, and offer a rational cost-effective approach to long-term management.
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