Improvement in Lifetime Risk Estimate The present guidelines include a lifetime ASCVD risk al- gorithm for those 20 to 59 years of age, but it is based on an insufficient database. Along with a risk algorithm for short-term risk of ASCVD (eg, 10 years), a more robust lifetime risk algorithm would facilitate the clini- cian patient risk discussion for treatment decisions. 8.2.3. Refinement of Clinician Patient Risk Discussion An ongoing study of how a clinician can best interact with a patient to arrive at an informed decision must be done, taking multiple factors into consideration. This is particularly important because cholesterol-lowering therapy is meant to be a lifetime therapy. 8.2.4. Monitoring and Adjustment of Treatment The clinician patient risk discussion will likely prove in- adequate unless an ongoing interaction between the patient and clinician occurs. This involves monitoring the effectiveness of therapy and adherence to therapy. Thus, the clinician patient risk discussion should in- clude more than the initial treatment decision. Ongoing research on how to improve the entire process of initial decision-making and long-term follow-up is necessary. 8.2.5. Prognostic Significance of CAC The present guideline makes use of the available data to predict the risk associated with CAC. These data need to be amplified by new and ongoing studies to guide treatment decisions. Particular uncertainty exists about the predictive value of intermediate CAC scores. In addition, the predictive significance of a CAC score of zero must be further verified in follow-up studies. For patients with a CAC score of zero, it is currently uncer- tain when and if follow-up CAC measurements should be done to reassess risk status. 