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. For individuals with intermediate predicted risk ( 7.5% to <20%) by the PCE or for select adults with borderline (5% to <7.5%) predicted risk, coronary artery calcium measurement can be a useful tool in refining risk assessment for preven- tive interventions (eg, statin therapy).S2.2-4 In these groups, coronary artery calcium measurement can reclassify risk upward (particularly if coronary artery calcium score is 100 Agatston units (AU) or 75th age/sex/race percentile) or downward (if coronary artery calcium is zero) in a signifi- cant proportion of individuals.S2.2-15 The extent of reclassification is sufficient to provide confidence that borderline- or intermediate-risk patients with elevated coronary artery calcium will have event rates that clearly exceed benefit thresholds (ie, 7.5% in 10 years) and those with coronary artery calcium scores of zero will have event rates <7.5%, which can help guide shared decision- making about statinsS2.2-15,S2.2-16,S2.2-21 or potentially In observational data, the pres- ence and severity of coronary artery calcium have Table 3. 