I am reporting back in on my 1444 CAC score from December of 2022, and my recent visit to the Cleveland Clinic for clarification of what this means to my health. I am a male, 63-years old, with no current symptoms of cardiovascular disease, but moderately high cholesterol levels as a chaser.

I was unable to get in at Mayo Scottsdale due to patient load, so that is why I went with Cleveland.
I will not mention the name of the doctor I met with, but he is one of the top interventional cardiologists at the Clinic. He had great knowledge, but I did not find him to be very engaging as a human.
The first bit of good news is that he said any score above 400 puts you into the "special" category that has proven out to result in 14% cardiovascular events over the next 10 years. Think about this carefully, as it also means that 86% of us will not have such an event over the next 10 years.
Under 400, but not zero puts you in at about 7%.
He did not recommend any further testing for me at this time since I seem to be exercising well and have no overt symptoms.
He said that even if there was a blockage, a stent would not prevent a heart attack, and he is the guy that goes in and cleans heart arteries out for a living. So there is no need to do preventative stent work, and it in fact might make things higher risk by having a man-made material present in the artery.
I asked him about the 2022 JAMA meta study on statins, and he said that they are still the frontline tool for cardiologists in preventing heart disease. But I ran the math, and it would reduce my absolute 14% risk down to about 9%. For me with Celiac Disease, the risk of using statins does not warrant the slight reduction.
I felt my trip was interesting. First, that the CAC score was a suggestion of poor cardiac health, but when you look at it on an absolute basis, perhaps not that much risk. So as many of you have questioned by your own experience, is the CT Heartscan worth even doing? I am not sure that it is.
Second, there seem to be few good tools for cardiologists to really help with heart health. The argument for statins is getting thinner each year, especially given the side effects felt by many users.
Third, is using a $1K a month injectable going to reduce the risk enough to warrant the cost or is it more important to reduce risk by weight lost, diet and exercise? Nexletol is likely the state of the art anti inflammatory and cholesterol reducing drug at over $700 a month.
For me, Celiac Disease and Sjogrens Syndrome are my primary diseases. My Celiac Disease is well managed through diet, but my gut health will never be normal, and it makes tolerating something like statins virtually impossible. But it is the Sjogrens and its inflammatory nature that likely puts my heart at highest risk. I already gave up red meat completely seven years ago, and it made a considerable difference.
I would have to go with weight reduction and A1C management as my biggest priority for heart health at this point. I think it outweighs the benefits of cholesterol reduction by drugs.
It is still a work in progress, and that is just my general reaction after going to Cleveland. I feel relieved by the news, but not out of the woods on taking action. My overall risk is about 7x higher than the general population of having a cardiovascular event, and I would like to lower that risk. But living in fear does not seem to be warranted at 14% over the next 10-years. We are all going to die from something. I just want to put that off as long as possible and have a quality life in the meantime. Just worrying about a CAC score seems to be more harm than good.
Pete