990 calcium score but all bloodwork, EKG/stress are fine what next?

You could still benefit from trying another statin such as
atorvastatin. Ask the new cardiologist about inflammatory
markers like HsCRP. Carotid ultrasound can assess atherosclerosis progression as well. They may recommend
a catheter study.
Mediterranean diet is important. CoQ10 is anti-inflammatory and good even if you are not on statins.

Age 58, male, no smoke, no alcohol, no history of hypertension. LDL typically 130ish. 716 CAC score, no symptoms, echo and Stress Test negative, taking 40mg Atorvastatin, mild side effects, walking 2-4 miles daily, wait and see. Two cardiologists say the same thing, go to ER is chest pains, come back annually for check up.

"Genetic component" sounds apropo. My father, had a heart attack at around the age of 65. He was an early benefiary of bypass surgery, done at Montefiore Hospital in New York. I, almost a clone of my father, had bypass surgery at age 68 in Cleveland, Ohio. Now, at the age of 85 I'm experiencing calcium blockages that inhibit my activities and endanger my life. I've read about progress in chemically dissolving arterial calcium deposits. That was done in Aberdeen, Scotland in 2023. Since then, I've neard nothing. It can't be a dead issue because the financial reward for success would be "off the charts".

I have similar stats and am on a 40 mg atorvastatin. I am 68, in good shape and all my numbers are very good! My CAC score is 2187, with the highest in LAD (widow maker). I have been to the best cardiologists in my area and all say to keep doing what I'm doing, if any symptoms occur, come in right away. It is more of a mental game now for me, but I am enjoying life, and keeping with the exercise, food routines that have given me a full life to this point. At the suggestion of my cardiologist, I do carry a little pack of 4 chewable aspirins to take if I feel I may be having an incident. Just when I am in the woods or by myself. My synopsis is similar to yours in that all the men on my Mom's side died of heart attacks, some quite young. So you cant change that so focus on what you can change. Best to you and thanks for sharing your story as it is so similar.

For all you guys that struggle with statins, I am taking Zetia instead along with Nexletol. My HDL has increased some (68) and my LDL (historically 150 at worst) is high 60’s now. No statin type issues.

hello @mikeis68 great to hear you are doing well and are successfully & pro-actively navigating your situation and are very aware of the family genetics. Agree there is absolutely a mental aspect to this especially for people like us with higher calcium scores on the LAD which had been freaking me out with all the "widow maker" stories. Sounds like you're tolerating the 40mg atorvastatin well and not having any issues. i just saw last week a 2nd cardiologist who was exceptional and took me off of 20mg of rosuvastatin due to all the muscle cramping I was getting and he has my trying Repatha/140mg SureClick injectable which he uses also and said works very well and has very minimal muscle cramping side affects. Will share an update once i have experienced a few weeks of the Repatha and hopefully no uncomfortable side affects.... keep up the great work my friend and all the best to you too!

I have been hearing more positive feedback on atorvastatin and will ask about that. The new cardiologist last week prescribed a new-ish injectable statin called Repatha 140mg sureclick injectable. I have to pick it up this week and will report back on any side affects but hopefully the muscle cramping side affects are minimal. Been taking the CoQ10 also and am curious to see the impact of that on my bloodwork and will ask about the HsCRP test you mentioned, so thank you for that!

Your lipids are in the healthy range. Habits are healthy. No symptoms like angina, shortness of breath etc. Maintain your healthy habits and get on with normal life. You say you had a CT. If that is CT angiogram, does the report details any coronary artery blockages detected? As for statin, I am not a doctor but I would not take statins when the lipid profile and other parameters seem well within normal range. I am elderly, had angioplasty and stenting, the doc wants me to take 10 mg rosuvastatin daily but I take it just twice a week and my lipids are normal. I am just sharing my opinion, please don't take it as advice. Good wishes. PS: Be mentally strong and positive, help others without expecting anything in return and practice gratitude every day. Good wishes to you.

UPDATE - saw a new cardiologist last week which was a great visit and i was very pleased. this doctor was very though with all his questions, observations and feedback plus was a great listener to all my different questions and concerns. He was pleased with my Echo CT results and that my bloodwork overall was good with no markers or concerns. As a next step he did recommended doing a Angio CT scan to determine what the level of narrowing/possible blockage is in the 2 arteries with high CAC. He didnt feel a invasive angiogram would be needed at this time since the Echo CT and blood work was good, but if I was having any chest pains down the road he said the angiogram would be next. We discussed the muscle cramping and dizziness issues i was intermittently having with the rosuvastatin 20mg dose which he said was not unusual and he experienced the same when he took that statin. He suggested trying a newer injectable product called Repatha 140mg sureclick which you inject 1-2x per month and supposed to have much lower side effect on muscle cramping while helping reduce LDL . I'll report back as i get a few weeks under my belt with the Repatha and will share the results of my Angio CT which is scheduled for early Sept.

Here is the link to repatha if any others here have taken this and I'm curious any feedback as to side affects experienced.... thanks and be well.
https://www.repatha.com/what-is-repatha

great to hear @johnv66 !!!!
keep me posted! Take care!!!
mikeis68