In the second half of the 20th century significant advances were made in the primary prevention of atherosclerotic cardiovascular disease. This progress was a result of the discovery of atherosclerotic risk factors and implementation of population-based risk assessment and risk reduction strategies. Nonetheless, cardiovascular disease has remained the number 1 killer in most developed countries, and it is increasingly threatening populations in the developing world. More specifically, little progress has been made in the identification of high-risk asymptomatic individuals who could benefit from aggressive preventive therapies but who are unaware of the presence and the severity of their disease. The hidden nature of the disease has made the battle against heart attack and stroke much more difficult than the fight against other diseases.
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