CAC zero just means your soft plaque hasn't calcified yet. anyone with a positive cac has had soft plaque for who knows how long and could of been treating it to either reverse or stop progression.
30% of people that have heart attacks have zero cac.
- if you have plaque
-now now how much, what type and can scan again and monitor
-it doesn't progress linear....meaning for me at 52 I had 44 mm soft plaque (pretty damn low) oh it took 52 years so I am good till 80 right....Nope nothing much changed with me esp lipid levels plaque begats more plaque...
-most of the combo that I have seen is always statin, pcsk9 if LPa, Apbo b over 40 sometimes 30 and glp1 (straight from my cardiologist, with the serial images and cases to demo)
Point is CAC tells you literally nothing Means you don't have safe plaque.....if zero you still have deepening on age but 30-50year have 40 % still have soft plaque.
Lipids are damn near meaningless IMO unless you use as guide to treat based on if you have athero or not. Only way to do that is ccta/ai like clearly.