Abstract
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.
Recommended Citation
Alhabeeb, Waleed; Almoghairi, Abdelrahaman; Kinsara, Abdulhalim; and Khoja, Abdullah
(2025)
"Saudi Heart Association Position Statement on Early Detection of Subclinical Atherosclerosis in Clinical Practice,"
Journal of the Saudi Heart Association: Vol. 37
:
Iss.
4
, Article 17.
Available at: https://doi.org/10.37616/2212-5043.1455
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