Among the non-conventional approaches, measurement of CAC scores has been most promising. CAC is highly specific to the atherosclerosis and is thought to develop late in its pathophysiology, reflecting a chronic plaque burden. CAC has been used in the global CVD risk stratification of asymptomatic patients to identify additional risk among those with a seemingly low-risk; the additional predictive value of CAC for CAD risk was greater than that provided by the conventional risk factors, regardless of racial or ethnic considerations. The higher the CAC score, the greater the prevalence of myocardial perfusion abnormalities associated with obstructive CAD and risk of death or myocardial infarction within 3 to 5 years. Approximately two-thirds of persons with SCI have intermediate risk for CAD; evidence suggests that many have silent CAD. Of note, and somewhat troubling, in reports in symptomatic individuals without CAC, 16-24% have obstructive CAD, an observation corroborated by the finding that approximately 20% of occluded vessels may not have detectable calcification.