1. Secondary testing should be considered for further risk assessment in intermediate-risk patients (10-19% FRS after adjustment for family history) who are not candidates for lipid treatment based on conventional risk factors or for whom treatment decisions are uncertain (Recommendation Strong, Quality Moderate)
2. Secondary testing should be considered for a subset of low- to intermediate-risk patients (5-9% FRS after adjustment for family history for whom further risk assessment is indicated [e.g. strong family history of premature CAD, abdominal obesity, South Asian ancestry or impaired glucose tolerance]) (Recommendation Weak, Quality Low).

Values and Preferences

• Use of these tests is optional; they are only to be used where decision-making will be directly affected (i.e. not in high- or lower-risk patients [FRS <5%])
• Choice of test depends on clinical situation and local expertise
• In appropriate situations, A1C, urine ACR and hsCRP can be helpful, safe and inexpensive, and should be considered
• For noninvasive testing:
  • Clinical suspicion of peripheral vascular disease should prompt ABI
  • Individuals who have been inactive and wish to exercise could be given an exercise stress test
  • Recent evidence suggests CAC testing with computed tomography is superior to carotid ultrasound - however, given its expense and radiation exposure it cannot be widely advocated until further data are available