REFINE-CAC Protocol: Risk Evaluation With AI-CPA + HCS For Patients IN Whom Calcium is confirmEd to Improve Coronary Artery Disease Care

Inclusion Criteria: 1. Calcium score between 1-299 between 3-6 months prior to Day 0 or incidental CAC findings on a chest CT between 3 to 6 months prior to Day 0 2. Men ≥40 and ≤79, Women ≥45 and ≤79 3. Patients who do not have symptoms suggestive of CAD 4. Visible plaque on CCTA 5. No other clinical CCTA subsequent to CAC findings but prior to screening 6. No prior history of atherosclerotic cardiovascular disease (ASCVD) 7. Acceptable CCTA quality per Heartflow acceptance criteria 8. eGFR \>45 mL/min per most recent measurement within 90 days 9. Willingness to comply with all aspects of the protocol including research CCTAs, lab draws, medication adherence assessments, attending all study visits, and the ability to comply with prescribed medications 10. For participants of childbearing potential (those who have not been surgically sterilized), a pregnancy test must be performed with negative results known within 7 days prior to randomization 11. Ability to provide informed consent Exclusion Criteria: 1. Symptoms suggestive of CAD (e.g. stable angina) 2. On PCSK9 targeted therapy (e.g. evolocumab, alirocumab, inclisiran, or enlicitide) 3. Reduced left ventricular ejection fraction (LVEF) \<35%, if known 4. Prior history of ASCVD 5. Prior coronary artery bypass graft (CABG) 6. Prior percutaneous coronary intervention (PCI) 7. Life expectancy less than 2 years due to non-CV comorbidities 8. Enrolled in an investigational trial that involves a non-approved cardiac drug or device 9. Previously evaluated with and/or in a trial which includes AI-CPA 10. Any condition that might interfere with trial procedures or follow up visits 11. LDL-C \<70 mg/dL at baseline lab draw 12. Active chemotherapy and/or radiation