Inclusion Criteria- Informed written consent from the subject prior to testing.
- Age ≥40 years old with at least 1 of the following risk factors for coronary artery disease.
- cigarette smoking
- diabetes mellitus
- hypertension (systolic blood pressure ≥140 mm Hg or taking antihypertensive medication)
- hyperlipidemia (low-density lipoprotein cholesterol ≥130 mg/dl or high-density lipoprotein cholesterol less than 40 mg/dl)
- family history of CV disease in a male first-degree relative <55 or a female first-degree relative <65 years old
Exclusion Criteria- Age >70 years
- Use of cholesterol-lowering medications in the past year
- Known active liver disease (AST or ALT >2x upper limit of normal in home lab)
- Known active thyroid disease (TSH outside normal limits in home lab)
- Uncontrolled hypertension (blood pressure >180/100 mmHg)
- Chronic kidney disease (on dialysis or known creatinine >2.5 mg/dL)
- History of coronary artery disease (previous myocardial infarction, coronary revascularization procedure, angina pectoris with documented ischemia)
- History of cerebrovascular disease (previous stroke, transient ischemic attack, or carotid revascularization procedure)
- History of peripheral arterial disease (claudication with abnormal ankle-brachial indices or previous revascularization procedure)