Incidental calcification in the aorta has been commonly ignored. A 42-year-old white man with a family history of CVD (the father suffered an MI in his 50s) demonstrated calcium of the aorta on x-ray of the lumbar spine. While the patient is a smoker, he is not overweight, hypertensive, or diabetic, and he has normal lipid values. Is he at risk? Should further evaluations be done with electron beam tomography? Should the patient be treated empirically with a statin or just counseled on smoking cessation and lifestyle modification?
—Konrad W. Krawczyk, MD, Milwaukee

Obtain ultrasound or CT images of the aorta to rule out a possible aneurysm. As far as risk for cardiovascular events is concerned, lifestyle modification and smoking cessation is the way to go at present.
—Peter F. Cohn, MD

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