For Those Who Test Negative For Sub-clinical Atherosclerosis 

The 1^st National SHAPE Guideline defines a negative test as a person with a coronary calcium score (CCS) of zero or carotid intima-media thickness (CIMT) lower than the 50^th percentile. If the subject does not have established risk factors, the Guideline categorizes them as Lower Risk and recommends retesting in five years. But if any of the traditional risk factors exist, the Guideline categorizes them as Moderate Risk and recommends treating the risk factors according to existing guidelines and also retesting in five years. 

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For Those Who Test Positive For Sub-clinical Atherosclerosis 

Those with a CCS greater than zero or a CIMT higher than the 50^th percentile are classified as testing positive for sub-clinical atherosclerosis. The 1^st National SHAPE Guideline breaks this population into three sub-groups: Moderately High Risk, High Risk, and Very High Risk.

Moderately High Risk: Those who have a CCS greater than zero but less than 100 and less than the 75^th percentile, or a CIMT between the 50^th and 75^th percentile and no discernable plaque buildup.

High Risk   is defined by having a CCS greater than the 75^th percentile or greater than 100. These patients are considered as appropriate for aggressive lifestyle modifications to a lower target low-density lipoprotein (LDL) cholesterol. If the CCS is greater than 400 or greater than the 90^th percentile, additional testing for myocardial ischemia is recommended. High Risk patients with no evidence of poor blood flow in the heart muscle (ischemia) are still treated to an even lower LDL goal than the patients with less extensive atherosclerosis (LDL less than 70). Those who test for ischemia fall into the very high-risk group.

Very High Risk is defined by having an abnormal test for ischemia. The National SHAPE Guideline recommends that these patients undergo coronary angiography.    This group also requires the most aggressive therapy.