In patients with 7.5-<20% 10-year ASCVD risk and LDL 120 mg/dL, which assessment can help refine risk stratification?

• A. CAC scoring to further risk stratify
• B. Routine aspirin therapy
• C. Immediate high-intensity statin without discussion
• D. None of the above

Answer: (A)

Coronary artery calcium scoring directly assesses subclinical atherosclerosis and is especially useful when ASCVD risk sits in the intermediate range. For someone with a 7.5–<20% 10-year risk and a higher LDL, the CAC score adds objective imaging data about plaque burden that risk calculators alone can’t provide. If the CAC score is zero, that suggests lower short-term risk and may support deferring statin therapy in select patients; if calcium is detected, it indicates higher atherosclerotic burden and strengthens the case for initiating or intensifying statin therapy to reduce future events. This imaging-based refinement helps tailor management more precisely than relying on risk estimates alone. Routine aspirin for primary prevention is not routinely recommended in this risk category, and jumping to high‑intensity statin without individual discussion isn’t as well supported as using CAC to guide decisions.