Evidence supports the use of the revised or updated PCE for African American men and women and those with a history of DM.[27] The revised PCE has higher accuracy than the FRS for CV risk estimates because it considers race and history of DM, while the FRS does not. As this is a Reviewed, Amended recommendation, the Work Group systematically reviewed evidence related to this recommendation.[24-28] The Work Group s confidence in the quality of the evidence was low because of inconsistency, imprecision, and the unknown applicability of risk calculators other than FRS and PCE in the VA/DoD setting. The benefits of using a 10-year risk calculator likely outweigh the harms because they identify high risk patients better than provider judgment alone. The Work Group recognized that under- and over-estimation of CV risk is a concern and may lead to improper prescribing of lipid- lowering medications. However, patients may prefer awareness of their CV risk to make informed decisions. Thus, the Work Group decided upon a Weak for recommendation. More research is needed on comparative effectiveness, particularly in terms of the estimation accuracy, of the various CV risk calculators in selected populations. Recommendation 4. We suggest against the routine use of coronary artery calcium testing. (Weak against | Reviewed, Not changed) Discussion Coronary artery calcium (CAC) can supplement a 10-year risk calculator to further refine the risk assessment of CVD and the potential need for treatment. The ideal CV risk assessment would correctly reclassify all intermediate risk individuals into a low or high risk category based on future CVD event rates. 