A healthy 45-year-old man presented to an emergency department after 3 days of fever, cough, and dyspnea. Computed tomography (CT) of the chest suggested a viral pneumonia and incidentally revealed mild coronary artery calcification (CAC) by qualitative assessment. After the (hypothetical) patient’s discharge, his primary care physician ordered a formal CAC score, which was 50 Agatston units (91st percentile for age, sex, and ethnicity). His blood pressure was 128/77 mm Hg. Laboratory values were as follows: total serum cholesterol, 189 mg/dL; low-density lipoprotein cholesterol (LDL-C), 122 mg/dL; high-density lipoprotein cholesterol (HDL-C), 45 mg/dL (to convert to millimoles per liter, multiply by 0.0259); and triglycerides, 109 mg/dL (to convert to millimoles per liter, multiply by 0.0113). He had a hemoglobin A1c level of 5.4 (to convert to a proportion of total hemoglobin, multiply by 0.01). He was a lifelong nonsmoker with no family history of premature coronary artery disease or myocardial infarction. The pooled cohort equations estimated a 10-year atherosclerotic cardiovascular disease (ASCVD) event risk of 1.2%. The primary care physician wondered whether to recommend lifestyle modification alone (given the low 10-year ASCVD risk) or also to initiate preventive statin therapy (given the presence of subclinical atherosclerosis).
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