Dweck, Marc R.

Abstract The persistent global rise in atherosclerotic cardiovascular disease (ASCVD) challenges the effectiveness of current risk factor-based algorithms in primary prevention. Most myocardial infarctions occur in individuals without prior symptoms or recognized standard modifiable risk factors, underscoring the need to improve risk stratification. Coronary CT imaging, including coronary artery calcium scoring (CACS) and coronary computed tomography angiography (CCTA), enables direct non-invasive visualization of coronary atherosclerosis, supporting a shift from population-based prevention towards personalized, disease-based risk assessment and targeted preventive treatment. CCTA provides comprehensive evaluation of plaque burden, composition, stenosis severity, and high-risk plaque (HRP) features, thereby refining risk stratification and guiding personalized treatment decisions. The presence and total burden of coronary atherosclerotic plaque are considered the primary CCTA-derived markers for guiding preventive therapy, while noncalcified plaque burden and HRP features may support treatment intensification. Advances in CT technology, including photon-counting CT, and the application of artificial intelligence-based tools may further refine risk assessment by enabling accurate and reproducible plaque quantification and characterization. Although no randomized trials have yet demonstrated that CCTA-based screening improves clinical outcomes in asymptomatic individuals compared with standard care, the same is true of traditional cardiovascular risk scores. Three large ongoing randomized trials are currently evaluating whether CCTA-guided, personalized prevention strategies can reduce ASCVD events. The results are eagerly awaited and may redefine the role of CCTA in asymptomatic individuals.

Abstract Heart involvement in eosinophilia represents a rare entity with substantial cardiac morbidity and mortality. This disorder is often overlooked and diagnosed in its advanced stages. In a subgroup of patients with eosinophilic heart disease, peripheral blood eosinophilia may not be present, and the biopsy of the affected organ or tissue is essential to establish the correct diagnosis. In this clinical consensus statement, an expert consensus group reviews the epidemiology, aetiology, diagnosis, and management of eosinophilic heart disease. The aim of the document is to increase awareness about the cardiac involvement associated with eosinophilia in order to diagnose the disease in early phases and prevent deleterious heart damage and adverse outcomes of affected individuals. The spectrum of physiological and immunological derangements requires a multidisciplinary approach for optimal management of affected individuals.