Q.5- Imagine instead of the existing daily weather forecasts and weekly hurricane alerts we were told the probability of a storm within the next 10 years! As you know this is how we predict CVD events today. We tell our patients that their 10-yr risk of a CVD event is for example 8.5% and expect them to change life style and religiously take their medications. Some believe that such long term predictions do not trigger immediate preventive actions. Asymptomatic people are complacent until symptoms occur or feel a serious threat like a lump, a positive biopsy, or a very high PSA. Imagine if we had a similar situation in CVD and could alert people months, weeks, or even days before a heart attack and trigger immediate preventive actions. SHAPE proposed looking for such predictors in subjects from longitudinal cohorts who shortly after an office exam with a blood draw experienced an event (asymptomatic vulnerable patients). The idea is to search for a characteristic pattern among these individuals using machine learning. Do you think such a vision can be realized? If yes where do you think such a powerful predictor could come from, circulating or systemic markers, imaging modalities of focal pathology, wearable data monitors, or a combination with artificial intelligence? Do you think the NIH would fund such an ambitious project? If such a predictor is developed with an accuracy of a mammogram or a biopsy, would it open doors to a new era of acute preemptive interventions in cardiology? What would such preemptive interventions be like? Bypass and other aggressive PCI procedures analogous to surgical removal of tumors? Hyper-intensive medical therapies analogous to chemotherapy?