The Multi-Ethnic Study of Atherosclerosis was initiated in July 2000 to investigate the prevalence, correlates, and progression of subclinical cardiovascular disease (CVD) in a population-based sample of 6,500 men and women aged 45-84 years. The cohort will be selected from six US field centers. Approximately 38% of the cohort will be White, 28% African-American, 23% Hispanic, and 11% Asian (of Chinese descent). Baseline measurements will include measurement of coronary calcium using computed tomography; measurement of ventricular mass and function using cardiac magnetic resonance imaging; measurement of flow-mediated brachial artery endothelial vasodilation, carotid intimal-medial wall thickness, and distensibility of the carotid arteries using ultrasonography; measurement of peripheral vascular disease using ankle and brachial blood pressures; electrocardiography; and assessments of microalbuminuria, standard CVD risk factors, sociodemographic factors, life habits, and psychosocial factors. Blood samples will be assayed for putative biochemical risk factors and stored for use in nested case-control studies. DNA will be extracted and lymphocytes will be immortalized for genetic studies. Measurement of selected subclinical disease indicators and risk factors will be repeated for the study of progression over 7 years. Participants will be followed through 2008 for identification and characterization of CVD events, including acute myocardial infarction and other coronary heart disease, stroke, peripheral vascular disease, and congestive heart failure; therapeutic interventions for CVD; and mortality.

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HE FRAMINGHAM RISK SCORE (FRS) is a multivariable statistical model that uses age, sex, smoking history, blood pressure, cholesterol, high-density lipoprotein cholesterol (HDL-C), and blood glucose levels or history of diabetes to estimate coronary event risk among individuals without previously diagnosed coronary heart disease (CHD). 1 Although coronary risk stratification is widely recommended, 2-4 prediction models based on CHD risk factors, such as the FRS, have limitations in their ability to discriminate individuals who will or will not experience CHD. 1,5 Given the uncertainty of current predictive models, 5 the search for new strategies to discriminate patients who would benefit most from intensive primary prevention efforts is a clinically important objective. 3,6 One suggested approach to improve risk prediction over the FRS is the quantification of coronary artery calcium score (CACS), most commonly using computed tomography (CT). 7-13 The objective of this study was to determine whether CACS assessment combined with FRS among asymptomatic adults provides prognostic information superior to either method alone and whether the combined approach can more accurately guide primary preventive strategies for patients with CHD risk factors.

Abstract-Atherosclerotic cardiovascular disease results in Ͼ19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs. The recognition of the role of the vulnerable plaque has opened new avenues of