Targeting treatment using calculated cardiovascular disease risk: effective? A shot in the dark? Or is it time to change the paradigm?

Background: The current paradigm for cardiovascular risk screening is one of screen and treat; i.e. a risk calculation is used to screen the population to determine who should receive therapy. This is marginally effective with somewhere between 199 and 999 people receiving lipid-lowering therapy and consequently being exposed to the drug-related risk without receiving any benefit.
Hypothesis: New evidence suggests that a diagnostic test could be applied to decide which patients will benefit from treatment.
Conclusion: Changing the paradigm from 'screen and treat' to 'screen, diagnose and treat' could save large amounts of money by avoiding drugs and could prevent many people from being exposed to side effects.