The diagnosis of high risk of cardiovascular disease (CVD) in subjects without clinically overt CVD has been somewhat improved by integrating multiple traditional risk factors via appropriate risk score programs. Nevertheless, novel measures of CVD risk are being proposed and debated to further improve high-risk detection by their addition to, or their use in place of, traditional risk factors. Among such measures, non-invasive detection of subclinical arterial disease is a subject of growing interest. It may improve CVD risk evaluation and enable more intensive risk-reduction therapy in subjects judged to be at intermediate risk after preliminary risk factor assessment. However, the clinical utility and cost-effectiveness of high-risk diagnostic and therapeutic strategy guided by subclinical arterial disease remain untested. This uncertainty precludes systematic detection of subclinical arterial disease in routine clinical management for primary prevention, but such detection may be used at the discretion of the physician as a part of CVD risk assessment.