A big part of me thinks is just silly to need a CT scan to determine if I should recommend a statin that costs $4 per month. I don't ever recall a time that my mind was changed by a calcium score.

I think that clinical impression based on labs, family history, risk factors, overall health and ASCVD risk calculation is probably just as accurate if not more accurate for future cardiac risk as a coronary calcium score.

And on top of that - in a 50 year old with risk factors, how reassured are you really with a normal score? Could have a ton of plaque that just isn't calcified yet.