@leeosteo I don't imagine you will be in my position ever, and certainly not anytime soon. I am already younger than you and my score is approaching 600. It takes decades for atherosclerosis to develop. According to the MESA calculator here: https://mesa-nhlbi.org/researchers/tools/mesa-score-risk-calculator, I have the veins of an 87 year old. So you might get there by the time you are 87. Even then, the predicted age is probably an "average" and I'd have to guess you're "better" than average wrt atherosclerosis development. I threw some numbers in that calculator: 0 CAC, 68 years old, and even at very high Total Cholesterol numbers, you're "CAC age" was much lower than your chronological age. All just speculation and averages, but you seem to be in pretty good shape.

The point I was trying to make was that having the high score weighs on my mind. Atherosclerosis really only goes in one direction. There's no fixing it. So now I have this constant hum in the background of the thing that can't be fixed and threatens my life. So if someone could avoid it, trying/taking the statins seems like a trade that might be worth making. I'd guess it depends somewhat on your personality, too. According to my doctors, the statins should keep it from progressing. Then in your case, you'd have pretty good confidence it would never be a problem.

Good luck. By my take you're in as good a shape as one could reasonably expect at this point.

March 24 is lp(a) awareness day. Here's a video by the Family Heart Foundation that explains the effect of high lp(a) over a woman's lifetime. FWIW. (https://www.youtube.com/watch)