I would never counsel a person who asks the question to forego a second opinion...............................................but....................................................is he wrong about the weight and pre-diabetic? If you know he isn't wrong, I would have to say, matter-of-factly, that you have your answer. And your marching orders. Lose the weight, get off the diabetes/metabolic syndrome wagon, and start walking!

It sounds to me as if you have an endocrine problem, or you're not getting out and exercising, even walking 30 minutes each day, or you're eating the wrong stuff. One of those, or a combination, maybe all three, has your LPa and calcium score higher than someone on 40 mg of atorvastatin or equivalent for the past 20 years should have.

I don't know if you'll like my response, but sure, get a second opinion. Just be working subconsciously on a cold, hard solution that buys you another 15 good years meantime. That second opinion might be as unpalatable as the first.