Dear colleagues,

I am referring Mrs Keller, 47, for a coronary artery calcium score to refine her cardiovascular risk before committing to long-term lipid-lowering therapy.

Findings: arterial hypertension since 2023 (ramipril, increased to 10 mg today; home mean 136/86 mmHg), LDL cholesterol 162 mg/dl, non-HDL 186 mg/dl, HbA1c 5.9 %, BMI 27.4, former smoker (10 pack-years, stopped 2019), mild hepatic steatosis on ultrasound (May 2026), eGFR 92 ml/min. Family history: father with myocardial infarction at 58. Lipoprotein(a) is ordered with the next blood draw. SCORE2 is about 3 %, low to moderate for her age; the family history and the LDL level are the reasons for the question.

Simvastatin 20 mg was stopped in March 2024 for myalgia with a CK of 210 U/l; atorvastatin 20 mg is started today as a rechallenge. Current medication: ramipril 10 mg, atorvastatin 20 mg, sertraline 50 mg, vitamin D3 1,000 IU.

The 2021 ESC prevention guideline lists coronary artery calcium scoring as a risk modifier that may be considered in people at low-to-moderate risk. I would be grateful for the score and your assessment of whether the result changes the treatment intensity.

With kind regards,

Dr. med. Sarah Weber

Internal medicine and general practice, Hamburg