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Introduction: Patients with family history of premature coronary artery disease (CAD) are at risk of CAD events at younger age. Risk factor based approaches and clinical evaluation are the commonly used methods of assessment. Recently it was shown up to 50% of individual presenting with their first myocardial infarction (MI) were considered "low risk" prior to that event. MI is often a result of plaque rupture preceded by progression of subclinical atherosclerosis. Therefore, detection of subclinical atherosclerosis may help target prevention of plaque progression. In this study, we assessed the predictive value of clinical risk factor, biomarkers and Framingham Risk Score (FRS) in predicting subclinical atherosclerosis in this population. Methods: From 230 referrals,182 individuals with a family history of premature CAD, Patients between the ages of 35 to 55 were enrolled in the Early Atherosclerosis Clinic at St. Paul's Hospital, Vancouver, Canada for evaluation of risk of CAD. Premature CAD was defined as CAD events in first-degree family members (male< 55, female< 65). Patients underwent clinical and risk factor evaluations as well as Cardiac CT or Calcium Score (CS) to assess presence of subclinical/clinical atherosclerosis if indicated by the treating physician. Results: In this pilot, 67 individuals (55% male, mean age 45.8 ± 6.0 years) completed evaluation, 31(46%) had evidence of subclinical atherosclerosis on CT coronary angiography or CT calcium score with a mean segment involvement score (SIS) of 3.1 and mean CS of 128. Aside from male sex and age, other risk factors and biomarkers including diabetes mellitus, hypertension, smoking history, total cholesterol, LDL-C, HDL-C, Cholesterol/HDL-C ratio and FRS were not significantly different between those with or without subclinical atherosclerosis (Table 1). Conclusions: In young individuals with a family history of premature CAD, risk factors, biomarkers, and FRS failed to identify patients with premature, subclinical atherosclerosis in this pilot study. Detection of subclinical atherosclerosis and early implementation of treatment with the aim of stabilizing plaques and stopping progression might prove vital in reducing events in these individuals. Further studies are warranted. [ABSTRACT FROM AUTHOR]