https://www.ncbi.nlm.nih.gov/pubmed/30874755 - ACC/AHA and ESC are still not evidence based http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.939.1670&rep=rep1&type=pdf -- only need to check every ten years-- it is the other risk factors that matter! https://www.ncbi.nlm.nih.gov/pubmed/26680162 Signal to noise is around 1 in 10 yrs