The aim of the study was to evaluate the incidence of asymptomatic coronary heart disease in patients with cardiovascular risk factors and evaluate the diagnostic value of myocardial stress perfusion magnetic resonance as screening test in these patients. We performed a retrospective analysis of 103 consecutive asymptomatic patients with at least one clinical risk factor for cardiovascular disease, who have undergone myocardial stress perfusion magnetic resonance. For respective evaluation of ischemic myocardium and infracted myocardium, magnetic resonance imaging protocol included the study of both myocardial viability by late enhancement imaging and first-pass perfusion at rest and during maximal stress (adenosine). The reference standard was catheter coronary angiography for 10 patients and clinical follow-up for 93 patients. The incidence of coronary heart disease was 22/103 (21%), including 6/103 (6%) ischemia and 16/103 (15%) infarcts. Respective sensitivity, specificity, negative and positive predictive values for myocardial stress perfusion magnetic resonance in detecting ischemic myocardium were 100, 97, 67 and 100%. Myocardial stress perfusion magnetic resonance can be regarded and further investigated as screening test for the detection of asymptomatic coronary heart disease in high-risk subjects. Prospective studies, larger study groups and cost-effectiveness analysis are needed.