As the owner of a CAC score >2600 with normal treadmill and perfusion studies (no angio because of horrid reaction to IV contrast), and fwiw, a practicing doc for ~49 years (ie, I'm old, but still in the game), I should remind the group that 1. very high CAC scores are not understood by the cardio community 2. A few patients I know in my age cohort with high scores who have gotten an angio have not showed calcified intima plaque but rather Ca++ at the outer portions of the coronary vessels (ymmv) 3. with normal treadmill and perfusion studies we probably do NOT have a time bomb in our chest any more than age-predicted 4. Consider carotid US as carotid and coronary lesions often parallel one another. In my case with my very high CAC score, my carotids are completely clear of atheroma. Just another piece of the puzzle. The most direct way of addressing our anxieties about coronary Ca++ is to get functional studies - treadmill/perfusion testing. And, this is NOT medical advice as that is not appropriate here, but consider statins (or other LDL lowering approaches) to stabilize whatever plaque you might have, esp if lipids are high.