If a middle-aged person has heart symptoms but no calcium buildup in their arteries, things like diabetes, smoking, and low 'good' cholesterol are linked to future heart problems — but their 'bad' cholesterol level doesn’t seem to matter, which might mean other non-plaque-related issues are causing the heart trouble.

If you're a middle-aged person with signs of heart disease and calcium in your arteries, having very high 'bad' cholesterol makes your risk of heart problems more than double. But if your arteries are clean, even sky-high cholesterol doesn’t seem to increase your risk.

If you're a middle-aged person with symptoms, having higher 'bad' cholesterol (LDL) means you're more likely to have heart problems over the next four years — but only if scans show you already have plaque in your heart arteries.

If a middle-aged person has higher 'bad' cholesterol, they're more likely to have buildup in their heart arteries — every 38.7-point rise means about a 17% higher chance of early heart disease signs, even if they already have symptoms.

Even if you're middle-aged and seem healthy with normal cholesterol and no heart disease risks, almost half of people like you might already have early signs of heart disease you can't feel.

If a middle-aged person has very high 'bad' cholesterol but feels fine, they’re more than 2.6 times as likely to have early signs of heart artery buildup — even if everything else about their health is accounted for.