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The patient's coronary artery calcium (CAC) score is 160 Agatston units. Using the MESA CAC score reference values tool, you calculate his probability of a non-zero calcium score to be 45%, and you determine that his CAC score of 160 Agatston units is above the 75th percentile for his age, gender, and race. He is now classified as high risk.

What would you recommend as the next step in his treatment?

  1. Get a stress test to make sure he does not have obstructive coronary artery disease
  2. Discuss starting statin therapy
  3. Re-check his CAC score in six months after he implements intensive lifestyle modifications
  4. Get an echo for further risk stratification

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