The strong impression I’m getting is that the data we are both looking for doesn’t exist and that the kind of trial needed to obtain it would probably not be feasible.

I noticed this from Dr. Paul Ridker from Harvard, who is clear that he does see CAC as a strong predictor of future cardiac events but also questions its overall usefulness in terms of treatment:

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Paul Ridker, the PI of the JUPITER trial, notes that “there are no statin trials based on CAC scores nor do statins lower CAC” and writes:
It is imprudent to use a technology we know is associated with radiation exposure, expense, and a considerable “incidentaloma” rate without knowing that it actually identifies individuals who preferentially benefit from any specific therapy.
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That’s the heart of it (no pun intended) for me: Why some people have such high CAC scores and others can have a 0 is not entirely clear, beyond genetics. But it’s clear that plenty of people have super-high cholesterol and/or horrific diets and are overweight and yet have minimal to 0 CAC scores. Others, like me, have pretty good lipid profiles (on all of the traditional non-CAC risk calculators, my 5/10-year risk clocks in at like 1-2% — then at least quadruples when my CAC is added). But it’s the CAC score more than any other measurement — by far — that predicts fatal outcomes. I’d like to say this could be due to not having enough data/the test being relatively new/etc, but unfortunately there are *are* massive-scale studies (MESA) that have conclusively demonstrated the airtight link between CAC and heart incidents.

So I’m taking the statin (and struggling on it), have radically overhauled my diet, but the bottom line is I don’t know if any of this will matter at all, because I know that I have a CAC level that would be high for any age, that it can’t be brought down, and that the simple fact of having it has dramatically raised my prospects of dropping dead any minute now.

I have found this pretty much impossible to come to terms with, because it feels like I may have already lost the battle and it’s just a question of time — days, weeks, months, a few years — until I have the big one. No one is entitled to a long life. I should be happy I got 42 years. But man, it went fast, and I guess I just always figured I’d be here a lot longer.