A healthy 45-year-old man presented to an emergency department after 3 days of fever, cough, and dyspnea. Computed tomography (CT) of the chest suggested a viral pneumonia and incidentally revealed mild coronary artery calcification (CAC) by qualitative assessment. After the (hypothetical) patient’s discharge, his primary care physician ordered a formal CAC score, which was 50 Agatston units (91st percentile for age, sex, and ethnicity). His blood pressure was 128/77 mm Hg. Laboratory values were as follows: total serum cholesterol, 189 mg/dL; low-density lipoprotein cholesterol (LDL-C), 122 mg/dL; high-density lipoprotein cholesterol (HDL-C), 45 mg/dL (to convert to millimoles per liter, multiply by 0.0259); and triglycerides, 109 mg/dL (to convert to millimoles per liter, multiply by 0.0113). He had a hemoglobin A_1c level of 5.4 (to convert to a proportion of total hemoglobin, multiply by 0.01). He was a lifelong nonsmoker with no family history of premature coronary artery disease or myocardial infarction. The pooled cohort equations estimated a 10-year atherosclerotic cardiovascular disease (ASCVD) event risk of 1.2%. The primary care physician wondered whether to recommend lifestyle modification alone (given the low 10-year ASCVD risk) or also to initiate preventive statin therapy (given the presence of subclinical atherosclerosis).

一名健康的 45 岁男性在发烧、咳嗽和呼吸困难 3 天后到急诊科就诊。胸部计算机断层扫描 (CT) 提示病毒性肺炎，并通过定性评估偶然发现轻度冠状动脉钙化 (CAC)。在（假设的）患者出院后，他的初级保健医生订购了正式的 CAC 评分，即 50 Agatston 单位（年龄、性别和种族的第 91 个百分位）。他的血压为 128/77 毫米汞柱。实验室值如下：总血清胆固醇，189 mg/dL；低密度脂蛋白胆固醇 (LDL-C), 122 mg/dL; 高密度脂蛋白胆固醇 (HDL-C)，45 mg/dL（转换为毫摩尔每升，乘以 0.0259）；和甘油三酯，109 mg/dL（转换为毫摩尔每升，乘以 0.0113）。他有血红蛋白 A _1c5.4 的水平（转换为总血红蛋白的比例，乘以 0.01）。他终生不吸烟，没有早发冠状动脉疾病或心肌梗塞的家族史。汇总队列方程估计 10 年动脉粥样硬化性心血管疾病 (ASCVD) 事件风险为 1.2%。初级保健医生想知道是否建议单独改变生活方式（考虑到 10 年 ASCVD 风险低）或也开始预防性他汀类药物治疗（考虑到亚临床动脉粥样硬化的存在）。