I have a very high calcium score. What next?

I don't believe so, I think you will need an angiography for that, the calcium score just tells you the amount of calcification, not the percentage of blockage.

I see. I had a carotid ultrasound last year that showed no plaque and due to that my PC thought there’s no need to get calcium score, but I think I will anyway. I’m just not sure what I’ll do with the information. Since I have type 1 diabetes and family history of heart disease, I live and treat myself as if I do with taking statin, controlling weight and insulin levels, tight, nutritious diet, monitoring blood pressure, getting regular labs, no smoking, limiting alcohol, daily exercise, medical visits every 3 months, etc. What would I do differently if I had a high calcium score? With no symptoms would I get invasive test?

M50 - CAC 801 - 9 total blockages - 5 over 80%

Don't bother with a calcium score, you're already doing everything you need to do and the results won't change that. Just always pay attention to angina symptoms that's all.

After seeing my nearly 800 calcium score and my cruddy family history the radiologist recommended a further angiogram. I got the CT Angiogram with contrast injected, so now I know that I have multiple soft plaques and calcified plaques throughout my vascular system, resulting in 40% -50% narrowing of my coronary and vertebral arteries. For someone who is normal weight, non-diabetic, and who has exercised rigorously and taken statins for 25 years, there appears to be no way to reverse the damage that started as a child. I could still have a liquid-filled plaque burst and stroke me. Stenting is restricted to folks with 75% or more stenosis per common practice. If you have already outlived your statistical expiration they are not very interested in you, unless a sroke puts you in a wheelchair then they might recommend speech and physical therapy.

Wow! I’m trying to figure out how that happens, except I will say I recall my Dad, who had no risk factors, had a heart attack and immediate quadruple bypass at age 63. Eventually 4 stents, statins, cardioversion, and a long, active life despite all of that.

Have your cholesterol labs been good?

Have been testing lipids since about age 40....with initial total around 220....
HDL around 40. Statins reduced LDL to around 100. So no one asked about my cruddy relatives' deaths when I was younger when atherosclerosis was building inside my arteries.

The damage to my arteries started in childhood. My familial history really
sucked for vascular atherosclerosis. But statins were not around when I
was a teenager and no one suggested stress re
duction etc. I joined a gym at 44 and rigorously pursued
fitness....statins at 50, low athletic BP and heart rate etc. But my
chances of making it to 80 are slim without major vascular complications.
I am 75 now and asymptomatic, so I thank the Lord for every day I can
breathe clear. I know so many folks my age who are already slipping in and
out of Congestive heart failure.