A 53-year-old male with a...

A 53-year-old male with a history of pre-diabetes (HbA1c 6.4), Class I obesity (BMI 31), a significant family history of premature coronary artery disease (CAD), and a 35-year history of daily tobacco smoking (1/2 pack per day) returns to discuss therapy options after recent bloodwork. His blood pressure remains elevated at 145/60 mm Hg, consistent with previous readings. His cholesterol panel shows a total cholesterol of 189 mg/dL, HDL of 31 mg/dL, LDL of 141 mg/dL, and triglycerides of 87 mg/dL.
How would you assess his overall risk and determine the appropriateness of initiating statin therapy or other preventive measures?