39
4.2.3.5. Polygenic Risk Scores
4.2.3.6. Selective Imaging of Subclinical Atherosclerosis
(Men ≥40 or Women ≥45 Years)
COR LOE
Recommendations
1 B-R
1. In adults at intermediate risk and select adults at borderline
risk with no prior ASCVD, if the decision regarding LLT
remains uncertain, a CAC score should be used for further
risk stratification and to guide the decision to withhold,
postpone, or initiate therapy.
2a B-NR
2. In adults at intermediate risk or select adults at borderline risk
who undergo CAC testing, if the CAC score is 0 Agatston
units (AU), and there is preference to avoid LLT and focus
on lifestyle management, and no higher risk conditions
(FH or severe hypercholesterolemia >190 mg/dL, diabetes
and age >40 years, current cigarette smoking, strong family
history of premature ASCVD) are present, it is reasonable to
defer therapy and reassess with repeat CAC testing in 3 to 7
years to personalize management.
1 B-NR
3. In adults at intermediate risk and select adults at borderline
risk, if the CAC score is >0 AU, it is recommended to initiate
LLT, particularly if the CAC score is ≥100 AU or ≥75th
standardized percentile to reduce ASCVD risk.
2a B-NR
4. In adults at intermediate or high risk with no prior ASCVD,
if there is uncertainty about the intensity of LLT, a CAC
score can be useful to refine treatment goals and decide
whether to intensify LLT.
1 B-NR
5. In adults with no prior ASCVD, if incidental CAC is
identified on noncardiac computed tomography (CT) scans
(eg, by visual estimation or a validated artificial-intelligence
based algorithm), the presence of coronary atherosclerosis
should be considered during decision-making about initiation
or intensification of LLT to reduce ASCVD risk.
2b B-NR
6. In adults with no prior ASCVD who are likely to have a high
burden of noncalcified plaque (eg, inflammatory disorders,
persons living with HIV, and diabetes), selective use of
coronary CT angiography (CCTA) may be useful to inform
risk assessment and guide decisions regarding treatment
intensity of LLT.
