Medication vs. Stent treatment for coronary artery disease

I always had high cholesterol and ate poorly. I started a plant based diet with very low fat (per Dr. Dean Ornish or Dr. Caldwell Esselstyn's protocol which showed you can halt or reverse heart disease eating this way) cholesterol went from 275 to 145 in 4 months. LDL 176 to 80. I had a calcium score of 312. Didn't want to do statins (I bad side effects in the past). Had cleerly test (which will be the gold standard soon) which showed 80 percent blockage in LAD and 70 percent on right side. I went on Repatha. Dr. wants to just watch. I just watched a webinar from cleerly which dr. recommended stenting. I don't want stents. My eating is very good.

You don't mention your age, family risk or other conditions you might have, these can all be factors in deciding between stents and medications.

I went through exactly this scenario over the past 2 years - failed several statins, cholesterol continued to rise, but no one ever suggested further exploration. Then in September I got Covid, went to Urgent Care, and instead of Paxlovid I got a trip to the ER for a weird ECG. No heart attack or stroke, but they put me on track to see a cardiologist. I had the equivalent of the cleerly test - a CCTA with contrast that found blockages.

My family (nurses and EMT) were sure they would do stents, which I did not want. But the doctor really listened to me, put me on 3 meds, including Repatha (and no statin) and said we would watch for a year.

First test result last week - Cholesterol down 110 HDL down 40 LDL down 80 from a year ago. All solidly in acceptable range. Color me happy. The cardiologist is too! And the angina pain that I thought was shortness of breath from my asthma is gone.

Maybe you can give the medication a 6 month trial?

I’m 66. I’ve been overweight my whole life. My mother died of a stroke at 47 father died of colon cancer at 60. I don’t have any symptoms but a lot of people who have a first heart attack die I don’t wanna have a heart attack, but my numbers are really low. It’s normal when you are on a Whole Foods plant-based diet for your HDL to go down so I’m not worried about that. My number is about 30. I still have about another 40 pounds to lose over the last two years. I’ve lost about 55 pounds but I’ve been at a plateau the past year and I exercise every day. I try to do 30 minutes on the treadmill.

Congratulations on getting healthy! I haven't had to diet much in my life (good genes and a good diet) but when I was working full-time, raising kids, traveling in my job, and eating 3 meals a day in restaurants, I had to work really hard to maintain a healthy weight. I also have had to retrain my body after several major surgeries, injuries and illnesses.
In both cases, when I hit plateaus in my progress, I learned from my PT to "change it up". That can be changing how you walk - maybe high intensity intervals one day, high elevation another day, longer and maybe a little slower sometimes (like a full 1 hour show.) And sometimes, vary the speed of the treadmill like interval training a short burst as hard as you can go, then twice as long at a basic aerobic (for you) pace, and gradually increase the length of the intense intervals. A trainer once taught me to use hand weights weights while walking about 2.5 mph on a slight incline - I bet there are YouTube videos. (I do each of these on my outdoor walks.) The added weight is also good for bone strength. And maybe once or twice a week, work out to an exercise video instead of walking?
Now I am off to do PT on my healing shoulder.
I tend to alternate walking with 30 minutes of yoga (I used to do circuits at a health club until Covid & age... If I was trying to lose weight, I would throw in a quick "coffee break walk" of 10 minutes or so too. Do you ever get bored with your routine? Maybe your metabolism is bored too?

This is good information to have:

The different types of heart plaques
Coronary plaques are classified into three different categories: calcified, non-calcified, and low-density non-calcified plaques.
Low-density non-calcified plaques, also referred to as high-risk or soft plaques, are made up of fat and connective (fibrous) tissue and are often the most dangerous.
Non-calcified plaques contain fibrous tissues and have some risk to the patient, but not as much as low-density non-calcified plaques.2
Calcified plaques are composed mostly of calcium and are the least likely to cause a plaque rupture or heart attack.
Low-density non-calcified plaques are the most dangerous plaques due to their higher likelihood to rupture. When a plaque ruptures, it can cause a blood clot. This blood clot blocks blood flow to the heart muscle and causes chest pain, a heart attack, or death in some cases.
Non-calcified plaques are not as prone to rupture as low-density plaques but can still cause a rupture or blockage in the arteries if left untreated. Calcified plaques are the least likely to cause a rupture or blockage as they are more stable than non-calcified and low-density non-calcified plaques.