In adults at intermediate-risk (predicted 10-year risk of 7.5% to <20%), substantial data indicate how CAC measurement can be effective in mean- ingfully reclassifying risk in a large proportion of In such inter- mediate-risk adults, those with a CAC score 100 Agatston units or CAC 75th percentile appear to have ASCVD event rates suggesting that statin therapy would be beneficial.S4.4.2-17,S4.4.2-23 Those with a CAC of zero appear to have 10-year event rates in a lower range that suggests statin therapy may be of limited value for these patients, with few exceptions including patients with diabetes mellitus, persistent smoking, and family history or premature ASCVD. Cigarette smoking remains a strong risk factor even in the presence of CAC score of zero.S4.4.2-50,S4.4.2-51 In asymptomatic dia- betes mellitus, a CAC score of zero is associated with a favorable 5-year prognosis; but after 5 years, the risk of mortality increases significantly for diabetic individuals even in the presence of a baseline CAC score of zero.S4.4.2-52 In patients with a family history of ASCVD, CAC score of zero may impart less short-term benefit from statin therapy, but considering a high lifetime risk, long-term Table 8. 