A new method of analyzing images from routine heart scans can, for the first time, reliably and noninvasively measure blood vessel inflammation -- which may help doctors deploy preventative interventions for the patients most at-risk patients for cardiovascular disease. Every year, roughly 750,000 Americans have a heart attack, and cardiovascular disease accounts for one in every four deaths in the United States, making it the leading cause of mortality for both men and women. What's more, the standard-of-care method to assess heart disease - coronary calcification score (CCS) -- only detects hardened arteries at time-points when the damage has become irreversible, does not change when patients receive treatments, and cannot distinguish which blood vessel plaques are most prone to rupturing. To create a better diagnostic, Alexios Antonopoulos and colleagues devised a method to identify dangerous blood vessel inflammation from measurements of fat tissue around arteries taken with computerized tomography (CT). The researchers developed a metric called CT fat attenuation index (FAI) based on changes in fat cell size that correlated with multiple markers of blood vessel inflammation in samples from 453 patients undergoing cardiac surgery. Increased FAI corresponded with pronounced blood vessel inflammation in a subset of 40 patients who were evaluated by positron emission tomography (a highly costly clinical gold standard). Antonopolous et al. went on to quantify FAI in 273 additional subjects (156 with and 117 without significant coronary plaques), and demonstrated that the marker dynamically changed around culprit lesions in five patients who experienced heart attacks. The authors say that if ongoing follow up studies confirm the prognostic value of FAI, the metric could revolutionize risk stratification and clinical management for heart disease.