Abstract
BACKGROUND: Cardiovascular risk stratification is essential and informative for long-term prognostication. However, it is often limited by heterogeneous patient profiles. CASE SUMMARY: An asymptomatic 76-year-old man with a history of multiple myeloma in remission presented for cardiovascular risk assessment. Despite intermediate-risk classification of atherosclerotic cardiovascular disease using risk stratification scores, the coronary artery calcium score (73 Agatston units) was used to guide decision-making regarding initiation of lipid-lowering therapy. However, before therapy initiation, the patient experienced an ST-segment elevation myocardial infarction. DISCUSSION: Cardiovascular risk stratification tools serve an important role in evaluating patient risk and facilitating shared decision-making in clinical management. Nonetheless, these tools present certain limitations in predicting comprehensive risk outcomes, especially when used independently. KEY TAKEAWAYS: This case highlights the intricacies associated with cardiovascular risk stratification tools and reinforces the importance of using a multimodal assessment strategy to inform the initiation of preventive therapies.