Wanted to share an update if helpful:

Since the last update, I had a CT Angiogram performed, which indicated the following:

LAD:
Mild stenosis in ostial LAD.
Moderate stenosis in moderately sized first diagonal artery.
Low probability of ischemia with FFRct of .86 in LAD and .95 in the first diagonal.
Low probability of ischemia in RCA with FFRct of .88

RCA:
Minimal stenosis in the proximal RCA.

LV:
Mild left atrial enlargement

This CTA also identified an anomalous RCA: "The RCA is anomalous and arises from the left coronary cusp with an interarterial course between the aorta and pulmonary artery with slit like narrowing concerning for
severe stenosis and malignant course."

From this, I was initially referred to a surgeon, but had a 2nd opinion at Vandy. Vandy ordered a Nuclear Stress Test which determined perfusion was normal. EF was 52% at rest, 65% at stress. Enlarged LV cavity.

During stress test, hit 104% of MPHR. Went for 13:31 reaching HR of 190bpm and 14.8 METS. TID ratio of .7.

Based on stress test, Vandy recommended no additional action. They believe the functional capacity is fine despite the previous CAC score and anomalous RCA. He recommended staying on the 10mg of atorvastatin and performing an annual stress test. He had no concerns with continuing strenuous exercise.

I still find my entire situation to be odd - Again, very strong lipid panel historically. Had Lipo(a) tested at 19.4 and Apo(B) at 52 (both prior to starting statin). Statin has since decreased LDL to 45.

My biggest concern is understanding the basics of how I initially ended up with such a high CAC score for my age. Approaching 40 with young children I want to extend my healthspan and lifespan as much as possible.