Should statin initiation be considered in young adult patients with autoimmune disease or chronic inflammatory conditions without an elevated ASCVD risk score given risk of underestimation of underlying CVD?

I would if the cholesterol/LDL is elevated or if there is a family history of premature CAD. Otherwise, additional risk stratification with a CT coronary calcium score would be appropriate.

Several thoughts: first of all, any calcium equals CAD. Meaning, a low value should be treated as aggressively as a high value (much less than 70). Secondly, I would not say premature CAD, I would just say CAD, since I am now 70 and have calcium in my coronary arteries and feel it is premature.