Noninvasive Tests
GXT
May be indicated for sedentary patient wishing to start exercise program; note that CAD risk is also increased in subjects with low exercise capacity (<6 METS)
ABI
Consider for patient with suspected PAD. ABI <0.90 is an indication for intensive statin therapy
Carotid IMT
Each 0.1 mm increase in CIMT is associated with a 10% increased risk for MI and a 13% increased risk for stroke. Visible arterial wall plaques defined as a CIMT ≥1.5 mm or CIMT values >75% for age and sex are considered as evidence of subclinical atherosclerosis and an indication for statin therapy
Coronary artery calcium
Highest incremental value but radiation exposure and not yet generally available. CAC >100 is generally an indication for statin Rx. CAC >300 places patient in very high risk category (10 y risk of MI/CV death = 28%)