> Heart attack at age 29 survivor here.

There is no scoring system that is designed for people in this age range - and based on another of your comments, it sounds like you had a significant family history, which is, itself, a very strong predictor that would obviate the kind of screening tools that the article and my comments have focused on.

That said, we are beginning to split very fine hairs. The coronary artery calcium score is only recommended for people whose 10-year ASCVD scores are on the 5-20% range who are uncertain about initiating a statin. These people are not thought to be at risk of an imminent plaque rupture (if so, their ASCVD risk would have been improperly assessed. This is a possibility, but this possibility is not the basis of public health decision making). If your coronary CTA is to be helpful as a screening tool it would essentially only be indicated for people in the 5-20% ASCVD risk pool who have 0 CAC where there is a sustained clinical suspicion of coronary disease. In such a patient, I would just advise starting statins instead of doing a contrast study.

Actually, yes guidelines are actually that any prior statin prescription removes the need for CAC measurements. That includes those who are discovered to have statin intolerance, and thus requires out-of-pocket payment for any CAC.

I think the challenge here is that other than a CCTA there's no good way to estimate individual (as opposed to hereditary) ASCVD risk. Sure LDL, ApoB, Lp(a), and BP, are statistical proxies, but tell you little about the individual risk. CAC isn't much better, but if you've been taking EPA and VitK2 you have a much higher chance of more stable plaques, which are also more visible on CAC without much larger X-ray exposure and iodine contrast effects.