COR LOE Recommendations I B-NR For adults 40 to 75 years of age, clinicians should routinely assess traditional cardiovascular risk factors and calculate 10-year risk of ASCVD by using the pooled cohort equations (PCE).S2.2-1,S2.2-2 IIa B-NR For adults 20 to 39 years of age, it is reasonable to assess traditional ASCVD risk factors at least every 4 to 6 years.S2.2-1 S2.2-3 IIa B-NR In adults at borderline risk (5% to <7.5% 10-year ASCVD risk) or intermediate risk ( 7.5% to <20% 10-year ASCVD risk), it is reasonable to use additional risk-enhancing factors to guide decisions about preventive interventions (eg, statin therapy).S2.2-4 S2.2-14 IIa B-NR In adults at intermediate risk ( 7.5% to <20% 10-year ASCVD risk) or selected adults at borderline risk (5% to <7.5% 10- year ASCVD risk), if risk-based decisions for preventive interventions (eg, statin therapy) remain uncertain, it is reasonable to measure a coronary artery calcium score to guide clinician patient risk discussion.S2.2-15 S2.2-31 Table 2. Example Considerations for Addressing Social Determinants of Health to Help Prevent ASCVD Events Topic/Domain Example Considerations Cardiovascular risk Adults should be routinely assessed for psychosocial stressors and provided with appropriate counseling.S2.1-31 Health literacy should be assessed every 4 to 6 y to maximize recommendation effectiveness.S2.1-36 Diet In addition to the prescription of diet modifications, body size perception, as well as social and cultural influences, should be Potential barriers to adhering to a heart-healthy diet should be assessed, including food access and economic factors; these factors may be particularly relevant to persons from vulnerable populations, such as individuals residing in either inner-city or rural environments, those at socioeconomic disadvantage, and those of advanced age*.S2.1-39 Exercise and physical activity In addition to the prescription of exercise, neighborhood environment and access to facilities for physical activity should be Obesity and weight loss Lifestyle counseling for weight loss should include assessment of and interventional recommendations for psychosocial stressors, sleep hygiene, and other individualized barriers.S2.1-42 S2.1-44 Weight maintenance should be promoted in patients with overweight/obesity who are unable to achieve recommended weight loss. 