The rise of the coronary computed tomography angiography (CCTA) has led to the identification of a growing number of coronary atherosclerotic plaques in asymptomatic patients.

This finding should first lead to questioning the real absence of functional signs in the patient and, depending on the reported symptomatology and the characteristics of the plaque, to consider carrying out an ischemia test.

The management of these lesions (although central in cardiovascular prevention) as well as the treatment of silent ischemic lesions, remains very heterogeneous according to practitioners.

It should be dictated by a comprehensive approach integrating the patient's possible symptoms, plaque characteristics, cardiovascular risk assessment – particularly using SCORE2 – and the search for other manifestations of systemic atherosclerosis. Erectile dysfunction of arterial origin, occurring very early in the atherosclerotic disease, is expected to occupy a prominent place in this assessment.

Taken together, these elements help guide therapeutic strategy and define the appropriate intensity of risk factor control.

Thus, asymptomatic coronary plaque most often does not represent an isolated entity but rather the expression of diffuse atherosclerotic disease, requiring an integrated and personalized management approach.