I had a surprisingly high CAC score (600-ish - 98% for gender and age) after decades of exercising regularly, normal weight, reasonably good diet and not alarming lipids (though not optimal). I was able to get a coronary CT angiogram. It measures roughly the percent blockage, though not as well as a traditional CT angiogram. For me it showed no blockages greater than 25-50%. It doesn't mean I am home free, heart attacks occur from non-obstructive plaques, but it has been real peace of mind regardless. It also showed that the plaques did not contain some features that they can detect that are associated with a higher likelihood of rupture. Some doctors seem to be willing to prescribe this and some don't. I am not sure why. The cardiologist I was working with at the time also had a family history so he may have had more empathy. There was some plaque in the LAD too, so that may have been a factor.

I am curious, do you have a family history? I have learned that many doctors look at slightly off lipid numbers in otherwise healthy people and dismiss them despite the family history. It seems like a mistake.

FWIW, I also seem to have some side effects from Rosuvastatin. It caused muscle soreness and had a negative impact on my ability to work out. I am trying Atorvastatin currently. Only been a few weeks.

I thought of one other thing. You may have high lipoprotein(a). This is genetic and not all doctors know seem to know about it. Statins don't help with this I believe. PCSK 9 inhibitors lower it some. There are drugs in testing now for people with very high lp(a). Given your high CAC score despite reasonable lipid numbers, you might want to at least get tested. (Though again, not much they can do about it right now, so maybe it would just be another worry.) Mine was high, but not crazy high -- maybe 85-ish percentile?