Detection of Subclinical Atherosclerosis in Asymptomatic Individuals

Inclusion Criteria: * Males between ages 35-90 or females between ages 40-90 * No known coronary artery disease * no prior coronary disease by cardiac catheterization (no more than 40% in any major epicardial vessel) * no prior myocardial infarction * no prior ST-elevation myocardial infarction (1 mm ST-elevation in 2 contiguous leads) * no prior non-ST-elevation myocardial infarction (CK-MB \> 2x ULN or elevated troponin that is indicative of myocardial necrosis based on local institutional cutpoints) * no prior coronary revascularization procedure * Aymptomatic * no chest pain, shortness of breath, angina or angina-equivalent that is assumed to be related to myocardial ischemia * Presence of a high-risk feature (at least one of the following four will quality) * High FRS ≥20% (http://hp2010.nhlbihin.net/atpiii/calculator.asp) * Diabetes Mellitus * Premature CAD in a first-degree relative * High Risk Lipid Profile (must meet one of the following laboratory criteria) 1. LDL \> 250 mg/dL 2. HDL \< 20 mg/dL 3. Triglycerides \> 1000 mg/dL 4. LP(a) \> 80 mg/dL * Provide written informed consent and Authorization for Use/Disclosure of PHI Exclusion Criteria: * Known genetic form of hypercholesterolemia based on clinical criteria (e.g. familial hypercholesterolemia, etc.) * Creatinine 1.5 mg/dL or greater * Irregular rhythm precluding cardiac CT examination * Uncontrolled hypertension (SBP\>210 mmHg or DBP\>140 mmHg on treatment) * Known moderate or severe allergy to iodine-based contrast agents (mild prior reactions that could be treated as an outpatient or that could be prevented by pre-medication in the past do not constitute exclusion) * Known Pregnancy * Unwilling or unable to consent * Presence of any co-morbidity that makes life expectancy less than 24 months * Unwilling or unable to complete follow-up * Unwilling or unable to provide written informed consent and Authorization for Use/Disclosure of PHI