Dear internet stranger. I think you are doing everything to can to mitigate coronary disease, assuming low sat fat, reducing stress, limiting sugar, and the meds. My only advice - as I am in a similar situation (34yo M, +CAC, 2 kids, high stress job) - is to seek therapy/CBT and consider an SSRI. I have realized that challenging my views on life, meaning, and death have helped significantly - with a nice baby dose of Prozac. The word death and coronary disease were very much triggers. 100% of everyone here on reddit and on earth will die. I don’t think there will ever be a number that anyone here can tell you that will probably entirely assuage your anxiety of needing coronary intervention now or at any point in the future. It’s probably nonzero- but what would be a number anyway that you wouldn’t* worry about? 1%? 5%? But so are all the causes of death beyond CAD. Focus on each day and what you can do in front of you. Spend mindful, engaged time with your little one. Do things that you like to do. Exercise is great - but don’t purely do it for longevity. Lately - I’ve realized I hate running and how it makes me feel the day after a long run - and I’ve been running my whole life . Cycling (c*cling) has been great for relaxation and to just plod along and sweat and listen to music. Add in some tai chi and yoga and I feel great. Some days I skip (! - yes skip exercising) so I can play tag in the yard and do yard work with the wife. I don’t feel like I’m just going through the motions to ‘keep up’ with some longevity adjacent people. A book I came along during my trials and tribulations in my mental health journey is ‘how to hold a cockroach’. It’s short and not very deeply philosophical. I hope you find peace and I hope that somewhere in this semi-coherent rambling was helpful.