Cardiovascular disease risk assessment is an evolving field with new research indicating that more recommendations tailored to and personalized for patients are possible. Pooled cohort equations continue to be the foundation of risk assessment in patients 40 to 75 years of age, with the PREVENT (Predicting Risk of Cardiovascular Disease Events) calculator emerging as a successor to the 2013 American College of Cardiology/American Heart Association pooled cohort equation. All major calculators have similar predictive outcomes in longitudinal studies. Lipoprotein(a) is a readily available biomarker that is useful in patients with a strong family history of early major adverse cardiovascular events or treatment-resistant dyslipidemia. Current guidelines discourage the use of routine screening electrocardiography for risk stratification. Coronary artery calcium scoring is useful in intermediate-risk patients to reclassify the risk of coronary artery disease based on the presence and burden of coronary atherosclerosis. However, there are limited data on how it improves patient outcomes. No functional or radiographic studies are recommended for screening purposes; their primary role is in the diagnostic evaluation of patients presenting with nonacute chest pain. Treatment goals for primary prevention continue to emphasize a low-density lipoprotein cholesterol reduction of 50% from baseline in patients determined to be candidates for statins based on risk assessment.

Case 2. TK is a 54-year-old patient with high blood pressure, type 2 diabetes, and dyslipidemia. She tells you that over the weekend, she developed shortness of breath and chest discomfort while walking with her grandson. The symptoms lasted about 5 minutes, then stopped; she has had no symptoms since then. What is the next step in assessing her risk of coronary artery disease?