That study was released in 2019 I believe so it's fairly recent and most likely still the standard. The most important thing it states is "referral for stress testing and cardiology consultation should be delayed until evidence of unstable angina exists. No immediate or long-term benefit to such individuals from either stress testing or coronary angiography has been documented in the literature." I see a lot of folks here running to do these things after getting a CAC score and it's really not needed, according to that study anyways. Since you are over 400 however they do suggest getting your LDL below 70 along with the dietary and lifestyle changes for everyone else under 400.