A 58-year-old woman presents to a cardiologist’s office to discuss her cardiovascular disease (CVD) risk. She is asymptomatic and has never smoked. She has a history of hypothyroidism and swims 4 times a week for 30 minutes. Her brother experienced a myocardial infarction (MI) at age 59. Prior to his MI, her brother was a vegetarian and an avid runner without hypertension or dyslipidemia. His 10-year atherosclerotic cardiovascular disease (ASCVD) risk was 7% (calculated based on traditional risk factors). Her father was a smoker and had an MI at age 66. The patient’s blood pressure is less than 120/80 mm Hg without medication. Her body mass index is 21.3. Her estimated 10-year ASCVD risk is 2% based on traditional risk factors. However, her low-density lipoprotein cholesterol (LDL-C) level has increased. Her most recent lipid panel showed a total cholesterol level of 286 mg/dL, triglycerides of 75 mg/dL, HDL-C level of 106 mg/dL, and LDL-C of 165 mg/dL. Because of her family history and increasing LDL-C, she underwent a cardiac computed tomography (CT) scan to measure her coronary artery calcium (CAC) score. Her CAC score is 88 (normal value = 0 Agatston units) (Table).
Polonsky TS, Blumenthal RS, Greenland P. Coronary Artery Calcium Score. JAMA. 2014;312(8):837-838. doi:10.1001/jama.2014.1948