This is my 10 point conversations, I tend to have with any patient who might have had a predetermined mindset based on social media, CHATGPT or influencers. 1. Based on your age/gender and risk, you are already a candidate for statins, if you choose CAC, there is a 40-50% chance that you may have #PowerOfZero and likely risk below threshold of why suggested statins, allowing you flexible decisions. jacc.org/doi/10.1016/j.jacc.… 2. There is no other good tests that will give you the same information about derisking to guide you optimal information to derisk ahajournals.org/doi/full/10.… 3. If decide to make decisions based on CAC vs current risk scores, likely will result in better adherence as seen in the yet to be published CorCal, CAUGHT CAD RCT’s as well accumulation of retrospective literature sciencedirect.com/science/ar… jamanetwork.com/journals/jam… 4. Likely better LDL and risk factors control (EISNER and Caught CAD) jacc.org/doi/10.1016/j.jacc.… jamanetwork.com/journals/jam… 5. In a shorter term, CAC guided decisions will likely reduce the risk of plaque progression based on CAUGHT CAD jamanetwork.com/journals/jam… 6. Thankfully if we can keep the price $150 or less or impact your disutility of taking pills it is even cost effective from a societal perspective jacc.org/doi/10.1016/j.jcmg.… 7. In a clinical trial those randomized to decision based on CAC vs not CAC, we haven’t seen increased risk of extra stress tests, caths or stenting/bypass (EISNER) jacc.org/doi/10.1016/j.jacc.… 8. While to date there is no data showing CAC guided decision will reduce the risk of CVD clinical events in a short term period, the studies have shown a) there is no increased risk (harm) of MACE (CorCal), b) prior non randomized studies have suggested no better outcomes with statin use, suggesting no harm if you decide to have flexible goals jacc.org/doi/10.1016/j.jcmg.… 9. CAC is not one time test, if zero and don't go on treatment repeat in 3-7 yrs based on baseline risk estimate to guide if need to change the decision course jacc.org/doi/10.1016/j.jcmg.… 10. Now based on studies, CAC beyond guiding you whether you need statin or not, can help as a dosing strategy (higher risk, higher intensity) now acknowledged also by cholesterol management guidelines pmc.ncbi.nlm.nih.gov/article… Once we have provided all the information, let patient make the decisions (see our approach below below) bmj.com/content/373/bmj.n776… @rblument1 @MichaelJBlaha @DrMichaelShapir @DrMarthaGulati @AlexRazavi @Sadeer_AlKindi @miguelcainzos23 @HMHCardioFellow @CiccaroneCenter @ASPCardio @JamalRanaMD