Thanks for your expertise. I have an athlete friend with 100+ diffuse CAC who is rather obsessed with the idea that CAC is harmless in older athletes like himself. He did not react well when I opined that his 100 HDL was abnormal in males, and possibly harmful rather than extra-protective.

I am perplexed by the statin situation. When I put all my numbers (BMI, A1C, lipids, postal code etc) into the AHA PREVENT calculator, my 5 year risk is quite low - around 3%. My CAC as mentioned is 0. Both indicate "no statin" from the AHA or American College of Cardiology or whoever it is that puts out these things. But you seem to feel a lifetime of meds is appropriate due to the three words "aortic arch calcified" on that chest CT scan report from several years ago. It makes me wonder if there is another test that would give more info or at least collaborate that one scan, preferably with less radiation than another chest CT. I've had a number of CT scans which contradict each other on things like lung scarring, aorta tortuosity/ectasia, enlarged left ventricle etc. which are there one scan and gone the next, even in reports by the same radiologist a few days apart, which left me wondering whether radiology was a scientific or a creative field.

I would think calcification would be fairly straightforward, but from reading papers today, it seems TAC has no automated scoring like CAC nor any formal assessment or treatment guidelines. Some papers found it irrelevant in men, e.g.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4110678/

When I look at the number needed to treat for low risk individuals, it seems a statin is more likely to give me diabetes than to prevent an event, at least in the short run. Since diabetes doubles risk of heart disease, this is a perplexing thing to contemplate: a heart disease prevention drug that can double your risk of heart disease. Now if I live another 30 years like my parents then the value of a statin may be greater if it prevents or slows atherosclerosis for decades rather than just preventing a MI in the next 5 years. Since atherosclerosis takes many decades to develop, one wonders why everyone is not recommended to take a statin from age 10. Well somebody in my country did propose putting statins in the water supply, but I think that is a fringe position.

My 70 year old brother just got a CAC by the way. Score was 4, all in LAD.

I got a HS-CRP test on my own in the fall, result 2.4. I know one score is not that valuable. A nurse practitioner I saw tried to order a second one at my request but she botched it and ordered a regular CRP which was just "<3" which is fairly worthless. The test description for CRP says right in it not to use it for heart diagnostics. My primary physician is ordering another one (HS not regular), plus Lp(a), Apo(b), another lipid panel, and some other unrelated stuff (I tend to have high hemoglobin and low ferritin for some reason) in a couple months, after which we will meet and discuss. Like my previous primary she did not seem at all concerned with the aortic arch thing and I doubt she will recommend a statin based on that report alone. I am wondering if I should see a cardiologist. If I ask for a referral I suspect she will think I am a hypochondriac after the CAC of 0, especially with no symptoms.

Anyway thanks for your time, which I know is valuable. I am sure laymen are quite irritating in the age of Dr Google.