I get why you're asking—there's a lot of conflicting info out there, and when it comes to aortic health, you don't want to take chances. I’m an aortic dissection survivor myself (Type A in 2015, emergency open-heart surgery, Dacron graft), so I take these concerns seriously.

Your cardiologist gave you the green light for Pilates, and that’s a good sign. Pilates is generally controlled and low impact, which is a plus for aortic health. The concern with any exercise is avoiding sudden spikes in blood pressure, excessive straining, or anything that puts too much pressure on the aorta. Since you’re already on losartan and keeping your numbers stable, your risk is lower—but not zero.

A couple of things to keep in mind. Watch for breath-holding (Valsalva maneuver)—it can cause blood pressure surges. Focus on steady, controlled breathing. No grunting, heaving, heavy weights, deadlifts, or planking. Be mindful of deep twists or loaded spinal flexion—some movements might put unnecessary stress on your core and indirectly affect aortic pressure. Listen to your body—if anything feels off, lightheaded, or strange, stop immediately.

Your calcium score of 665 means there's some coronary artery disease to factor in, but since your cholesterol is controlled and BP is good, that’s more about long-term monitoring than an immediate exercise restriction.

Bottom line? Pilates is likely fine with modifications. Since you’re in a supervised setting, let your instructor know about your aorta so they can help tailor movements. Keep an open line with your cardiologist and trust your instincts—your body will tell you if something isn't right.

Stay strong. Peace.