First time on CHOLESTEROL medication

I wouldn't be worried, based on your cited numbers. You must have a genetic predisposition to depositing plaque, or it is every bit as likely that you have some underlying systemic inflammation. Inflammation makes deposition of plaque easier on the endothelial layers of the arteries. Did your physician suggest a CRP or other test to determine if you need to have a therapy to control it? Might be worth an ask.

So far, your risk for stroke is low, insofar as what I see and understand (I'm not a health expert). It would be your call to stop the aspirin unilaterally, or to challenge your prescription with the person who issued it. Ask him/her what your risk is based on the all-cause mortality associated in the literature with your numbers.

Good idea to have a cardiac CRP
and consider a carotid ultrasound
that sometimes shows intimal vessel wall thickening or any changes in flow. These would indicate atherosclerosis and stroke risk.
Statins do more for us than prevent cardiac events. All the things good for your heart protect the brain.

Very true, and you've just reminded me that I forgot something I had intended to include in my response above: statins do have a modest anti-inflammatory effect. But, if inflammation is the problem with this person, it's obviously insufficient.

Thanks for chiming in!

Like @gloaming said, I think you may have a genetic disposition that is giving you the high calcium score. I know it can feel scary and upsetting to be told you should be on medication for the first time. It sounds like you have done the right things taking care of yourself, so please don’t feel you have done anything wrong or your body is giving out…you may have a lot of years of good health in front of you.

In my personal opinion, I think you should take the medications as a preventative measure. Your HDL looks great. I work my tail off and only get near 50. Your doctor, probably PCP can order blood tests to see how your numbers are doing.

Also know that many studies have shown that once on a statin, your calcium score will rise. It's because the statin converts soft plaque to harder, less likely to break off and cause a stroke plaque, so if you retake the test in a year or so, you should expect it.

Also, with your LDL numbers, I would not be surprised if your cardiologist has you working (and perhaps more/different drugs) to get the LDL under 70. With my family history, my goal was under 50 (it's currently 17, but takes 3 drugs to get there)

Those on this site have been through this. My thoughts (not a med pro).

- Your total cholesterol should be adjusted to be closer to 100
- Your LDL should be closer to 50
- Your triglycerides closer to 50
- You should get an advanced lipids test
- You should be on a statin
- You could be on 81mg aspirin (arguable), but your doc knows far more about this than you (I have been for 20 years)
- You could get a nuclear stress test (was your stress test a "stress with echo?"
- CAC scoring is kinda of automatic - the machine counts - so little chance for error
- Good time to assess whether you have any sort of symptoms
- Good time for Peripheral Artery Disease (PAD) test

Don't be lulled into a sense of "I'm OK because I had an OK stress test."

Know your numbers, discuss your numbers!

Are you seeing a top notch cardiologist - close to a center of excellence for heart issues? If not, you should be, with the goal of determining where your calcium is, a long term treatment plan, etc. This is a wake up call - your obvious pride in not taking meds is admirable, but to me those days are over. As noted, statins will cause plaque to calcify, but this is a very good thing. Please let us know how your efforts go?

I never heard of a CRP test and it was not recommended by the PCP or cardiologist
This may be in my full blood work i had done, but I only checked the red numbers in the web portal report of some 25 or more blood results..
I was not told by either the PCP or Cardiologist that there may be underlying systemic inflammation that may cause making deposition of plaque easier on the endothelial layers of the arteries.

The stress test was a nuclear stress test. As stated, they said I reached 9 minutes and went to 10 METS, supposedly above avg. but I don't know what the number means. Cardiologist said the images and report shows good blood flow.

Cardiologist reported --- of your test is that you have good exercise capacity and the heart gets a blood flow at high exercise level.

As for top rated cardiologist, i did not have time to check into it. PCP said i need to get to a cardiologist ASAP due to the calcium score
I looked up cardiologist rated high in my area, but it was a 4-6 weeks or longer to get an appt.
I selected a cardiologist that had an opening in a 2 week period.

If I would not have had a Calcium Score test done and only the nuclear stress test, and based on the results, I don't know what the treatment plan would have been. I asked the cardiologist this and it was not answers directly and said "You have a good point that underscores the idea of cardiac testing..."