Patients with familial hypercholesterolemia are at signifi- cant risk of having an early ASCVD event, and the use of risk calculators is not applicable to these patients. In contrast, other studies have found overestimation of risk with the PCE, particularly among those with higher socioeconomic posi- tion and those with continual access to care and preventive services, which could lead to overtreat- ment of individuals less likely to receive net benefit from preventive pharmacotherapies over the next The PCE may be subopti- mally calibrated in more modern populations as compared with the older cohorts from which they Therefore, among adults at bor- derline (5% to <7.5%) and intermediate ( 7.5% to <20%) risk, one may consider additional individual risk-enhancing clinical factors (Table 3) that can be used to revise the 10-year ASCVD risk estimate.S2.2-4 These factors may include having a family history of premature ASCVD,S2.2-5 chronic inflammatory disease [rheumatoid arthritis,S2.2-6 or HIV ], South Asian ancestry,S2.2-13 a history or preterm delivery,S2.2-9 early chronic kidney disease (CKD), metabolic syndrome, per- sistently elevated inflammatory markers,S2.2-14 or elevated lipid biomarkers.S2.2-4 After these clini- cally available risk-enhancing factors have been considered, if there is still uncertainty about the reliability of the risk estimate for individu- als in the borderline- or intermediate-risk cat- egories, further testing to document subclinical coronary atherosclerosis is reasonable to more accurately reclassify the risk estimate upward or 4. 