I plugged in a 20 yo DIABETIC with TC 130, HDL 30, BP sys. 110 into pooled cohort risk estimator and lifetime risk was 50%.
No Coronary Calcium in 50% was found in of Statin-Eligible Patients: MESA link
In 2009 I was already risk stratifying my patients with CAC and LDLp. The Tubby Theory from Topeka
The new guidelines further strengthens this procedure.
It is interesting to me that the important subject of preventing the 30% residual risk with long term low dose preventive statin therapy is not discussed. It's the lifetime risk we need to worry about now not the 10 year risk.
In Oct. 2014 I called this the Multiplier effect of statins when you give them earlier.
If you give the lowest dose of statin with only 1000 mg Niacin, side effects are less likely. If you keep LDLp less than 1,000 it is unlikely atheroma will be laid down in the wall of the artery over 50 years.
It is also important to rule out false negative CAC with a CIMT.
Finally check out the six calculators for risk and the articles explaining why we should get LDLp lower earlier in life.
As for diet and lifestyle. That really does not work in a society of abundance.