1 Your risk is very lowIf you never smoke, don't have a family history of CVD diseases and if you have a W/H ratio < 1 with a normal BMI it is of poor interest to measure biological markers of atheroma and even LDL-C.
2 Your risk is clinical mainly because you smokeIf you have clinical risks but no history of CVD, after 50 you should test your biology and your superficial arteries id est carotids for IMT, atheromatous plaque or calcifications.
But what biology?
LDL-C, TG, HDL, ApoB (which is a measure of the number of LDL particles per liter, the smaller they are the greater number of particles and the more atherogenic), fasting glucose and HbA1c, CRP us. If you live in poor sunny environments you should add your vitamin D.
And what strategy?
You should begin to normalize the metabolic risk factors as TG, fasting glucose and CRP by an appropriate diet based on low intake of refined CH, fibers, proteins and antiinflammatory phytochemicals. It could be the ancestral med , cretan or jap diets or paleo with a clear understanding of the importance of veggies. If the risk is not only the presence of biological risks factors and if apoB is high you should take statins with a high probability of benefit according on your inflammatory status. This is not a long life advice. Your inflammatory status will evolve with improvements in diet, exercise and vitamin D level.
3 You had a CVD event, either stroke, MI or PAD or other ischemic event.Ok you can test your biology but you should asap take a statin an anti-platelet agent and make huge efforts in the fields of diet and exercise. Monitor your progresses with BMI, W/H ratio, fasting glucose and LDL-P. They will improve drastically if you eat properly, exercise and normalize your vitamin D level with sun exposure and supplements. It will take at least one year but after with a very strict combination of these measures a stabilization or even a regression af the IMT of your carotids will occur in the third year. On the other hand if atheroma progresses you should test other risk factors as Lpa, Lp-PLA2, fasting TG, fasting insulin and ask for a very specialized advice...
It is of critical importance to evaluate the whole picture of your metabolism and the widest spectrum of risk factors, through these measurements and not only the LDL-C.
Journal of Clinical Lipidology (2011) 5, 338–367