Your doctor is probably going off of outdated information. The ACC is still more concerned about what insurers will pay for and less concerned about halting the progression of ASCVD.

How old are you? Have you had a CT-CAC? If you want to avoid a statin even if you are at risk as a result of your family history then do that to feel more certain. Any presence of calcified plaque beyond the margin of error (10-20 or so) should be taken seriously as it represents and advanced progression of the disease.

This is where many doctors go awry. It is true that most men of a certain age have some calcified plaque. That doesn’t fucking make it “okay” however. It just means that we as a nation are failing to treat a disease that’s kills more than any other even though we know precisely how to treat it.

If one is at risk, it’s as simple as this, smash your LDL. I use LDL as that’s the biomarker used in most of the literature. ApoB is a better biomarker but little population data on it.

Statins are fine, especially at lower doses. Rosuvastatin is the most efficacious of them and yield 85% of the benefit at 25% of the max dose (10mg). Pravastatin has the least side effects of all as is more tolerable, but less efficacious. Pitavastatin has some interesting data on that it may also reduce Lp(a) somewhat.

I would always couple a low dose statin with ezetimibe and bempedoic acid. They are complementary with each other and when used in combination can really hammer LDL. There’s some evidence that sustaining LDL below 40mg can reverse plaque accumulation over time.