Similarly, a CAC score 75th percentile for a patient s age and sex or an ab- solute score 100 Agatston units would support the decision to use statin therapy and intensify lifestyle modifications. Recommendation-Specific Supportive Text 1. Inflammation promotes atherosclerosis and is a key feature of many chronic rheumatologic inflam- matory joint disorders, such systemic lupus ery- thematosus, RA, and psoriasis.S4.5.5-1 Inflammation mediates the progression of atherosclerosis, as well as instability, erosion, and rupture of vulnera- ble atherosclerotic plaques.S4.5.5-2 Among individu- als with RA, the risk of an MI has been estimated to be similar to that of an adult with diabetes mel- litus or one who is about 10 years older without A large meta-analysis found that persons with RA had an approximately 50% increased risk of CVD death.S4.5.5-4 Individuals with systemic lupus erythematosus and advanced psoriasis have a similarly increased risk of CVD.S4.5.5-5 S4.5.5-7 HIV infection is associated with an increased risk of an ASCVD event even if viremia has been con- trolled by antiretroviral therapy.S4.5.5-8 There is an increased risk of MI in association with long-term use of antiretroviral therapy, and MI rates are increased in individuals with HIV.S4.5.5-9 Traditional ASCVD risk factors, long-term use of antiret- roviral therapy, prolonged immune activation, and inflammation are mediators of atheroscle- rosis progression and development.S4.5.5-9,S4.5.5-10 Coinfection with hepatitis C virus is frequently present in HIV-infected individuals and further increases ASCVD risk.S4.5.5-11,S4.5.5-12 2. The accuracy of the ASCVD risk estimator has not been well validated for adults with chronic inflam- matory disorders or HIV infection. Assessment of traditionalriskfactorsoftenhasresultedinunderesti- mationofactualriskandthepotentialforundertreat- ment with pharmacological therapy.S4.5.5-13,S4.5.5-14 Traditional risk factors should be assessed early in the disease process and then modified. 