Cardiovascular disease affects a significant proportion of the population with global prevalence of 6081 per 100,000 (Virani et al., 2020). Most core risk factors are well characterized and can be controlled with interventions, also meaning it is possible to identify most people at increased risk of acute events, defined as a 10 year risk of events of >20% . However, the real world occurrence of events in this at risk population is relatively low suggesting there is still much to be learnt or identified in spotting the vulnerable patient harbouring vulnerable atherosclerotic plaque at the earliest possible time.