Artificial Intelligence for Risk Assessment on Primary Prevention of Coronary Artery Disease

Abstract Purpose of Review Coronary artery disease (CAD) is a common and etiologically complex disease worldwide. Current guidelines for primary prevention, or the prevention of a first acute event, include relatively simple risk assessment and leave substantial room for improvement both for risk ascertainment and selection of prevention strategies. Here, we review how advances in big data and predictive modeling foreshadow a promising future of improved risk assessment and precision medicine for CAD. Recent Findings Artificial intelligence (AI) has improved the utility of high dimensional data, providing an opportunity to better understand the interplay between numerous CAD risk factors. Beyond applications of AI in cardiac imaging, the vanguard application of AI in healthcare, recent translational research is also revealing a promising path for AI in multi-modal risk prediction using standard biomarkers, genetic and other omics technologies, a variety of biosensors, and unstructured data from electronic health records (EHRs). However, gaps remain in clinical validation of AI models, most notably in the actionability of complex risk prediction for more precise therapeutic interventions. Summary The recent availability of nation-scale biobank datasets has provided a tremendous opportunity to richly characterize longitudinal health trajectories using health data collected at home, at laboratories, and through clinic visits. The ever-growing availability of deep genotype-phenotype data is poised to drive a transition from simple risk prediction algorithms to complex, “data-hungry,” AI models in clinical decision-making. While AI models provide the means to incorporate essentially all risk factors into comprehensive risk prediction frameworks, there remains a need to wrap these predictions in interpretable frameworks that map to our understanding of underlying biological mechanisms and associated personalized intervention. This review explores recent advances in the role of machine learning and AI in CAD primary prevention and highlights current strengths as well as limitations mediating potential future applications.