The short answer
A quick, low-dose CT scan that looks for calcified plaque in your heart arteries. It can tip a borderline decision either way.
A score of 0 means lower near-term risk, and some people can hold off on a statin (not if you smoke, have diabetes or a strong family history). A score of 100 or more favors treatment. Insurance often doesn't cover it, but the cash price is usually modest.
Source: 2018 AHA/ACC cholesterol guideline.