Recommendation 1
We suggest that CAC screening by CT may be appropriate for asymptomatic, middle-aged adults (FRS 10-20%) where treatment decisions are uncertain (Conditional Recommendation, Moderate Quality Evidence).
Recommendation 2
We suggest that CAC screening by CT not be undertaken for a) high risk individuals b) patients on statin treatment or c) most asymptomatic, low-risk adults (Strong Recommendation, Moderate Quality Evidence).
Recommendation 3
We suggest that CAC screening might be considered for a subset of low-risk middle aged individuals with a family history of premature CHD (male <55 years; female <65 years) (Conditional Recommendation, Low Quality Evidence).
Recommendation 4
We suggest that in patients warranting risk factor management based on usual criteria, CAC scoring not be undetaken. Moreover, CAC scoring (seeking a result with a value of zero) should not be used as a rationale for withholding otherwise indicated, preventive therapies (Strong recommendation, Low Quality Evidence).
Recommendation:
We suggest that Lp(a) may aid risk assessment in subjects at intermediate Framingham risk or with a family history of premature CAD (Conditional Recommendation, Moderate Quality Evidence).
Values/preferences:
Lp(a) is a marker of CVD risk. Particular attention should be given to individuals with Lp(a) levels above 30 mg/dL for whom CVD risk is increased by approximately 2 fold. Although no randomized clinical trials are available to support basing treatment decisions solely on the basis of an elevated Lp(a), identification of high levels of Lp(a) may be particularly useful for mutual decision-making in the situation indicated above. Moreover, in younger patients who have a very strong family history of premature CVD suspected to be related to atherogenic dyslipidemia but who by virtue of young age, do not meet usual risk criteria for treatment, detection of high Lp(a) may help inform mutual decision making regarding treatment. Lp(a) is not considered a treatment target and repeatmeasures are not indicated.