BACKGROUND: This study aims to examine which marker or testing protocols have been suggested for cardiovascular disease (CVD) risk assessment in asymptomatic populations, at which CVD risk level, and how this can be implemented for CVD risk assessment in pilot populations.METHODS: A systematic search was performed using Systematic Reviews Subset on PubMed; the OvidSP interface, including all EBM reviews and EMBASE databases; and the G-I-N International Guideline Library. From each recommendation, we extracted data on consideration of the use of a marker or test for cardiovascular risk assessment in asymptomatic populations.RESULTS: Included were 45 guidelines, systematic reviews, or meta-analyses relevant to cardiovascular risk assessment in asymptomatic populations. The majority (9/12) of the citations recommend coronary artery calcium score (CACS) for CVD risk assessment in intermediate-risk (10-yr CVD risk score of 10–20%) asymptomatic adults. Other cardiac and vascular tests that may also be considered include the measurements of carotid-intima media thickness, supplemented by carotid plaque, and the ankle brachial index for prevention of peripheral artery disease and stroke. Stress myocardial perfusion scan is the potential cardiac functional test to be used with pilots with 5-yr risk of ≥15%. Among laboratory markers, only hs-CRP has a potency to be used in CVD risk assessment in intermediate-risk asymptomatic adults; however, the strength of the recommendation is not adequate.DISCUSSION: Among the cardiac and vascular testing available, CACS is the most frequently suggested test. The implications of findings for CVD risk assessment in airline pilots are highlighted in this paper.Wirawan IMA, Griffiths RF, Larsen PD. Cardiovascular tests for risk assessment in asymptomatic adults and implications for pilots. Aerosp Med Hum Perform. 2018; 89(7):648–656.