Mortality of cardiovascular diseases is still at the top list of the WHO. Every year 19 million people die from acute myocardial infarction (AMI). The biggest problem is that 60 % of all deaths from MI occur outside the hospital. Therefore improved risk assessment is the primary topic of cardiovascular prevention. Prof. Raimund Erbel from University Duisburg-Essen， Germany introduced the update on management of coronary risk factors at opening ceremony.
     First， Framingham， PROCAM or other Scores are used to assess risk. In Germany 30% of men are at low， 39% are at intermediate and 31% are at high risk. In women the distribution is 31 %， 20 % and 9 % respectively for AMI or sudden death in population between 45 and 75 years. Low risk means less than 10 % fatal or non fatal MI in 10 years， intermediate means 10-20 % and high risk means > 20 % risk. In individuals at low risk， a healthy lifestyle is recommended， whereas in high risk individuals intensive therapy and risk factor modification is needed. In those with intermediate risk， imaging and non imaging techniques are used to detect signs of subclinical atherosclerosis.
     Using the Framingham score， the 10 year event rate in Germany for those at low risk is 2.4 %， intermediate risk 5.6 % and high risk 10.1 %. Using calcium scoring， this differentiation can be improved which means that risk prediction is improved. In those with intermediate risk 14.1 % are shifted to high risk and 62.9 % to low risk so that only less than 10 % are not reclassified. The net reclassification rate is 30.6 % using coronary calcium in addition to the Framingham risk assessment of individuals coming for a check-up. This is the best result when compared to the resting heart rate， to HbA1c， and the use of multiple biomarkers. Coronary artery calcium is able to help in preventing fatal and non fatal MI in the long run.