Recently a 53 year old patient came in for a routine follow up for Hormone Replacement Therapy and confirmed he has been smoking a pack of cigarettes each day for years. Given the risk factor for this type of patient, a routine calcium score was ordered to assess the risk of coronary artery disease. He was found to have a significant lesion in his left anterior descending artery. Patients smoking a pack a day, or less, are at a high risk of vascular disease including the carotid and coronary arteries. Getting scanned early, reducing the amount of smoking and improving diet and exercise can help to prevent a heart attack.