@bluesdoc Your response made me feel a little better. Thank you.

Thanks, bluesdoc. I'm glad I had the CAC scoring done two years ago. I am already a lifelong exerciser, but I did change my diet to follow American Heart Association guidelines (Mediterranean diet) I've come to terms with the high score, and no longer feel that it's a Damocles sword hanging over my head. So unless I become symptomatic, I'll continue to follow the best heart-healthy practices, including taking a statin to keep LDL in the 50-70 range.

My score is 1852. In addition to the CS you should have a NMR to get the technicolor on your lipidology. Your small particle LDL is key. My LDL on standard testing has been under 90 mostly under 80. HDL over 60. Triglycerides under 100. I was going along assuming (by the normal cholesterol testing) my CVD risk was less than 1/2 the general population. I had been on statins for twenty plus years and normal height and weight with no cormobid condition's. My curiosity was raised after a corodid ultrasound showed a 40 percent blockage. I then ordered the above tests as well as a apo(a) that all confirmed my pathogentic small particle cholesterol numbers. The calcium score for the most part shows stable plaque with much lower risk for stroke and cardiac event. The little disclosed fact with statins is they convert cholesterol to calcium abeit mostly a stable form. I asked my cardiologist why they aren't testing for the pathogentic small particle cholesterol is since there is no treatment why test. The treatment for blockage is stenting which is one of the most profitable cardiac procedures this with statins being a blockbuster profitable drug it's no wonder what I discovered is not publized by anyone.
I firmly believe in full disclosure informed consent.

In saying all of this, is there a drug that lowers only pathogentic LDL? Not based on my research. Niacin, Vit-K, fish oil ..etc may help.

To reduce my risks I keep my blood pressure on the low side less than 110/70. Take ASA get at or above your requirement for sleep.

Lipidology is a field still in it's infancy.

Just my take on the subject.

Do you do any follow-up stress/echo testing, say every 2 or 3 years, since you can't get an angiogram?

What are the odds that the score represents calcium on the outside of the artery. I’ve heard this happens and hoping it happens a lot. I’m 58 with a 1150 score from 2 years ago so likely higher now. I feel great, walk 4 miles 5 times a week at fast pace and have no symptoms. All other tests show doing well including stress test. I take statin and BP pills now so all look good. Doc hates vitamins and just wants to wait for symptoms to look into it further.