Early Detection of Coronary Artery Disease by Polygenic and Metabolic Risk Scoring

Inclusion Criteria: 1. Asymptomatic subjects age 40-70y 2. Statin naïve 3. TC ≤ 6.5 mmol/L and LDLC \<5 mmol/L, and 4. 5 year Australian risk ≥2%. Exclusion Criteria: 1. Symptomatic coronary, cerebrovascular, or peripheral vascular disease 2. Intolerance of statins or currently on statins for any length of time 3. Pre-existing muscle disease (eg polymyositis, fibromyalgia) - this may be confused with myalgia from statins 4. Patients on drugs that increase the risk of myopathy/rhabdomyolysis such as cyclosporine and strong CYP3A4 inhibitors (e.g., clarithromycin, itraconazole, and HIV/hepatitis C protease inhibitors) 5. Atrial fibrillation (interferes with CTCA) 6. Chronic kidney disease on haemodialysis (because of vascular calcification) or GFR \<50ml/min per 1.73m2 using the Modification of Diet in Renal Disease (MDRD) formula 7. Inability to provide informed consent 8. Major systemic illness eg. malignancy; rheumatoid arthritis 9. Women of child bearing potential (due to performance of CT) 10. Poorly controlled hypertension: SBP\> 200 and or DBP \> 100 11. Severe psychiatric disorder (eg bipolar depression; psychosis) 12. Patients eligible for treatment based on current Australian guidelines (5 year risk \>15%) 13. Patients eligible for treatment based on current PBS thresholds TC \>7.5 mmol/l and other criteria (see below).