Cardiovascular disease is the leading cause of death in the western countries. Conventional risk evaluation of asymptomatic individuals is unfortunately inaccurate. There is a need for better diagnostic tools to identify persons, who will benefit from intensified preventive treatment. Coronary artery calcium score (CACS) measured by multi-slice CT scan contributes significantly to risk stratification especially in persons with intermediate risk assessed by conventional risk analysis. A CACS-guided preventive intervention strategy seems appealing to reduce mortality due to cardiovascular disease.