Q1: Global risk assessment using PROCAM, SCORE, FRAMINGHAM or REYNOLDS ecc is sufficient YES NO NEED MORE DATA DISCUSS within Taskforce Your Comments

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1 Site ID: Q1: Global risk assessment using PROCAM, SCORE, FRAMINGHAM or REYLDS ecc is sufficient Q2: The value of an emerging test is best assessed using C - statistics Q3: Atherosclerosis imaging may be useful, if reclassification using hscrp or other emerging biomarkers do not help further Q4: Ultrasound plaque imaging is preferable over IMT measurements Q5: Everybody having intermediate or high risk should receive a statin Q6: Lifetime risk assessment makes atherosclerosis imaging unnecessary (pdf)

2 Q7: Every person with intermediate risk should receive atherosclerosis imaging Q8: Every person with low but not very low risk should receive atherosclerosis imaging Q9: Atherosclerosis imaging has to be standardized better, but then could be used in clinical practice Q10: Invasive risk assessment tools such as IVUS should be used in selected asymptomatic subjects to assess risk for a first heart attack Q11: Plaque imaging should always be integrated into global risk as the pretest probability Q12: Calculation of posttest risk using the Bayes formula, sensitivity, and specificity is a valuable method to integrate findings from atherosclerosis imaging into a posttest risk estimate

3 Q13: Calcium scoring should be used in all subjects at intermediate risk Q14: Calcium scoring should never be used for risk assessment in asymptomatic subjects Q15: Calcium scoring may be used in selected subjects, where risk estimates from global risk and ultrasound plaque imaging is felt to underestimate true risk Q16: Atherosclerosis imaging has not proven to be superior in risk management above global risk assessment tools Q17: Everybody with plaque identified by ultrasound or computed tomography, with a low ABI <0.9 or any other finding of subclinical atherosclerosis should receive a statin Q18: Life style changes are much more important than a statin in all subjects not at high risk for a vascular event

4 Q19: Atherosclerosis Imaging helps subjects to perceive their effective risk better Q20: Posttest risk based on atherosclerosis imaging should also guide the clinician to decide, which risk factors of his patient are most likely to reduce vascular risk (expressed in 10 year percent risk reduction estimates, e.g. for smoking, targeting blood pressure, cholesterol goals, increased physical exercise) Q21: The taskforce should express itself about a standardization of ultrasound based atherosclerosis imaging tools Q22: Contrast enhanced coronary imaging with computed tomography (CE-MSCT) should be used to rule out coronary artery disease in asymptomatic subjects with low or intermediate risk for a coronary stenosis > 50% Q23: CE-MSCT should be used in subjects with a low to intermediate risk for coronary artery disease based on age, gender, and symptoms

5 Q24: The taskforce should express itself about the radiation burden with calcium scoring, CE- MSCT and invasive cardiology for different wendors of machines Q25: Coronary artery disease risk is better defined by ischemia testing than by a coronary stenosis of > 50% defined by an invasive coronary angiogram Q26: CE-MSCT overestimates coronary stenosis defined by an invasive coronary angiogram Q27: Plaque sealing of non flow-limiting coronary stenoses using PTCA or eventually a coronary stent helps to prevent myocardial infarction Q28: Ankle Brachial Index (ABI) is underused to detect high risk subjects in clinical practice Q29: ABI has a low sensitivity to detect high risk in asymptomatic primary care individuals

6 Q30: MSCT is definitively too expensive for prevention issues in primary care Q31: Ultrasound based plaque imaging should be available for < 100 CHF per screened primary care subjects Q32: Atherosclerosis imaging should be used only in subjects aged 65 or less Q33: This questionnaire is helpful for the Taskforce