concorder,

This is the aha moment that many of us have as we age ... we find out our genetic predispositions become clear ... even if we have been careful in our life habits.

What tests?
- stress test with echo is appropriate
- advanced lipids test is appropriate
- nuclear stress test might be appropriate
- catheterization if you are symptomatic
- heart ct was appropriate due to chest pain
- do you ejection fraction data?

The concerning part of your post is that you have had some chest pain - on this site many have high and very high CAC - but, are asymptomatic. Some are asymptomatic and end up finding high blockages. Some are symptomatic, but don't have significant blockages.

Ex: On a whim my wife and I got CAC tests around age 65, her - zero, mine 1350. I had started statins due to age and elevated (treated) blood pressure about a year earlier. Asymptomatic. All the non-invasive tests no issues. Stress test very good. CT but calcium tended to reflect so much had to tell, but clearly lots of it. Next CAC 2500. Still no symptoms. Stress test with echo pretty darn good with good pumping, etc. Several vacations with LOTS of hill walking far tougher than the stress tests, Colorado high altitude hiking. Still no symptoms. HDL low 50s (have always been low 50s, even when young while working out in military), LDL 50ish, triglycerides 50ish. Advanced lipids all good. No other health issues. I take a bp med (115/75), atorvastatin 40 mg, 81 mg aspirin (have for 30 years), Vascepa 2 grams per day.

Will have nuclear stress test in October. Cardiologist and others mention positive remodeling likely, so heart over time may have increased size of arteries to account for blockages.