When I was 75 I had my first CAC score and it was 378. PCP was not very concerned. However, 4 years later, after passing stress tests with zero concern, I had another one done and it was 798. I went on a plant based diet for the past year and the recent CAC score was 801. My regular LIPIDs are under control with statins. My approach has been to Cut out all beef and pork, sugar, most dairy, most of the plant oils except olive and avocado and fried foods. This diet seems to have helped the CAC score getting worse. I do stay active and exercise as time and weather permits. One clinical study I found implies if you can keep the CAC score increase below 15% per year, your risks may be very low. However, I recently had my APO B and Lipoprotein a [Lp a] checked and it was very high at 358. This is a very sticky cholesterol and not a part of the regular LIPID done on most annual physicals. Some clinical trials to address Lp a are underway but still not FDA approved. Diet and exercise seem to reduce the risks but will likely not reduce the level you have. It is genetic and until new FA drugs are approved, there is little else one can do to reduce the risk. This is from my personal experience and research but much of what you find online is controversial and very complex. I would enjoy hearing from others and their experience as well.