Guideline #1: Perform a Coronary Artery Calcium (CAC) Scan on all adult individuals above the age of 40 who are not already diagnosed with ASCVD.

Guideline #2: All patients with positive CAC scores (>0) should be treated to lower their LDL-C below 50 mg/dl.

Guideline #3: Ezetimibe 10 mg/day should always be ordered whenever also ordering a statin to lower LDL-C.

Guideline #4: Every asymptomatic diabetic patient should receive a CAC score before initiating statin therapy. Diabetes is not a coronary artery disease equivalent.

Guideline #5: It is not necessary to start medical therapy on anyone with a zero calcium scan unless his/her major risk factors are very significant.

Guideline #6: The lipid goal is to reduce LDL-cholesterol (LDL-C) to 50 mg/dl or less, therefore medically treat all patients with a positive CAC scan if LDL-C is above 50 mg/dl

Guideline #7: Start medical therapy with rosuvastatin 10 mg/d, ezetimibe 10 mg/d, and a low cholesterol diet (less than 200 mg of cholesterol/day).

Guideline #8: In patients who are “intolerant” of statins, start rosuvastatin slowly, 5 mg once per week, ezetimibe 10 mg/day, and a low cholesterol diet.

Guideline #9: If fasting triglycerides are elevated (>150 mg/dl but <500 mg/dl), correct secondary causes first, then initiate fenofibrate and statin therapy.

Guideline #10: Low dose aspirin (82 mg/day) is recommended for individuals with a CAC score > 100. Aspirin is not recommended for individuals > 65 years of age.

Guideline #11: To achieve an LDL-C below 50 mg/dl, a low cholesterol diet (<200 mg/day) is essential.

Guideline #12: Exercise is beneficial in many metabolic ways but it has a minimal effect on lowering LDL-C.

Guideline #13: For risk assessment, measure both fasting Lipoprotein(a) and high sensitivity C-reactive protein (hsCRP), and calculate non-HDL total cholesterol.

Guideline #14: If mild symptoms of stable angina occur (e.g. with exercise), increase aggressive medical therapy to lower all risk factors.

Guideline #15: Normalize the major risk factors for atherosclerosis including smoking, blood pressure, hyperglycemia, and triglycerides.

Guideline #16: A repeat CAC score is unnecessary for patients with known symptomatic atherosclerotic cardiovascular disease. It will almost always be positive.

Guideline #17: When statins are started in a patient with a positive coronary artery calcium scan, monitor the hemoglobin A1C which will tend to increase.

Guideline #18: A repeat CAC score in a patient with a positive score is unnecessary. Calcium in the wall of the artery almost never regresses.

Guideline #19: Patient involvement with CAC testing and treatment goals is necessary to achieve an LDL < 50 mg/dl.

Guideline #20: Expert consultation for difficult ASCVD clinical problems in asymptomatic individuals should be obtained.