What is your approach to statin and/or PCSK9i initiation and counseling in a patient who has an HDL above 100, LDL within normal range, but markedly elevated calcium score exceeding 1000?   

First, I'd like to know how high is the HDL. They could have a SCARB1 mutation that confers increased atherogenic risk alongside very high HDL levels, likely because of decreased hepatic clearance. I would also like to know their Lipoprotein (a) level and their ApoB level. The LDL can be low while e...