66
Management
4.2.7. Management of Adults With Subclinical Coronary
Atherosclerosis (Men ≥40 or Women ≥45 Years)
COR LOE
Recommendations
1 B-NR
1. In adults with a CAC score of ≥1000 AU, treatment with
LDL-C–lowering therapies with consideration of statin
therapy as first line is recommended to achieve a ≥50%
reduction in LDL-C and a goal of LDL-C <55 mg/dL
(1.4 mmol/L) and non–HDL-C <85 mg/dL (2.2 mmol/L).
1 B-R
2. In adults with a CAC score of ≥300 to 999 AU, treatment
with LDL-C–lowering therapies, with consideration of statin
therapy as first line, is recommended to achieve a ≥50%
lowering in LDL-C and a goal LDL-C <70 mg/dL
(1.8 mmol/L) and non–HDL-C <100 mg/dL (2.6 mmol/L).
1 B-R
3. In adults with a CAC score of ≥100 to 299 AU or
≥75th standardized percentile, treatment with LLT, with
consideration of statin therapy as first-line therapy, is
recommended to achieve a ≥50% reduction in LDL-C and
a goal LDL-C <70 mg/dL (1.8 mmol/L) and non–HDL-C
<100 mg/dL (2.6 mmol/L).
2a B-R
4. In adults with a CAC score of 1 to 99 AU and <75th
standardized percentile, or with an incidental finding of mild
CAC on noncardiac CT scan, treatment with moderate-
intensity statin therapy is reasonable to achieve a ≥30% to
49% reduction in LDL-C and a goal of LDL-C <100 mg/dL
(2.6 mmol/L) and non–HDL-C <130 mg/dL (3.4 mmol/L).
2a B-NR
5. In adults with a CAC score of ≥300 to 999 AU, it is
reasonable to intensify therapy by increasing the intensity of
statin therapy or, if needed, adding ezetimibe, a PCSK9 mAb,
or bempedoic acid to achieve a goal of LDL-C <55 mg/dL
(1.4 mmol/L) and non–HDL-C <85 mg/dL (2.2 mmol/L).
2a B-NR
6. Among adults with no prior ASCVD who have moderate-
to-severe incidental coronary atherosclerosis identified on
noncardiac CT scans (eg, by visual estimation or a validated
artificial intelligence-based algorithm), it is reasonable to
initiate high-intensity statin therapy to achieve at least a
≥50% reduction in LDL-C and a goal of LDL-C <70 mg/dL
(1.8 mmol/L) and non–HDL-C <100 mg/dL (2.6 mmol/L);
if mild incidental CAC, moderate-intensity statin therapy is
reasonable to achieve a ≥30% to 49% reduction in LDL-C
and a goal of LDL-C <100 mg/dL (2.6 mmol/L) and non–
HDL-C goal <130 mg/dL.
