Cardiovascular disease is the leading cause of death in the United States. Cardiovascular disease is, for the most part, attributable to modifiable risk factors such as smoking, hypertension, unhealthy diet, and sedentary lifestyle. Consequently, current treatment guidelines for cardiovascular disease focus on reducing risk through healthy lifestyle practices, such as smoking cessation and blood pressure control coupled with dietary changes and a regime of regular physical activity, weight control, and diabetes management. Physicians and patients alike have less control over factors such as age, genetic background, and measurements of homocysteine or C-reactive protein, all of which add considerable risk. Early detection and treatment of subclinical coronary artery disease has the potential to decrease risk over the long term.

The field of nuclear cardiology has grown steadily over the past few decades. A wide spectrum of new tools are now available for the diagnosis and management of patients with cardiovascular disease. Some experts think that the advent of new diagnostic tools demands that traditional screening methods be revamped. The Screening for Heart Attack Prevention and Education guidelines, for example, were developed to reevaluate the conventional approach to heart attack prevention. The opinion leaders of the Screening for Heart Attack Prevention and Education concluded that reliance solely on traditional risk factors for identifying at-risk individuals is flawed and outdated. They recommended a new approach to screening that relied on the traditional risk factors, but also included a comprehensive vascular health assessment.

Although there are many challenges in the treatment of coronary artery disease, there are also new technological advances that present the practitioner with many new diagnostic options. The articles presented here discuss the importance of accurate assessment of cardiac risk and the optimal use of new imaging techniques, with their advantages and disadvantages. Criteria for choosing the appropriate test are reviewed, and prognostic data for determining an appropriate treatment plan according to level of risk are discussed. The major tests currently used for evaluation of coronary artery disease are reviewed in detail.

D. Douglas Miller, MD, MBA, CM, FACC

Dean, Medical College of Georgia School of Medicine,

Medical College of Georgia, Augusta, Ga

Leslee J. Shaw, PhD

Professor of Medicine, Emory University

School of Medicine, Atlanta, Ga