Have you had your blood test measuring your LPA that is the genetic marker for family history. Also LPO B is a better marker for heart disease in the blood test along with the calcium score

Your HDL is accurate? 27?

I pretty much agree with the others. I don’t think your triglycerides are good. You can get them down to 55 and your HDL you can get up to 90. If you haven’t had the LPa then you should that tells you if you’re if you have familiar heart disease. I inherited that. But I have had a lifetime of good eating and relatively good exercise and I have one partially obstructed artery and the other three are clear. I am proactive. The rest of my family my father and my cousins had a heart attack stroke and died early that made me observe it. Your body will continue to lay down plaque - if you have the inherited CAD coronary artery disease, even if you do good things. So what you need are all the other tests that visualize the arteries going to your heart you didn’t mention any of that that’ll stop you from your hypochondriac imagination. Ask the doctors to send you to a cardiologist. They will probably only do that if you show up with familial Indications of heart disease. My dad lowered his cholesterol lipids and was on statins for years. None of that stopped his arteries from laying down plaque. Back then there wasn’t as many tests as there are today. I suggest if you are really sincerely interested you read Peter ATTIA’s book outlives. It will cover all of this. It was recommended by my pain management doctor and I also can’t recommend it enough, especially since you’re 20 years younger than I am and that’s the time when you need to read it. I can’t take statins, but I am on LEVQIO twice a year(injections.) my LP.a is heading up along with my triglycerides so I’m cutting out refined and processed foods and back on VESCEPA to lower my triglycerides. There’s a lot of information out there about heart disease and you should try to immerse yourself in all of that for a while instead of panicking. And you need to make sure that you advocate for yourself because your numbers aren’t that great asked for a cardiologist or some simple test. I did some DNA a while back and I always take the results to my doctor because it shows that I inherited things like lactose intolerance, gluten intolerance, and heart disease.

Thanks, @abf826!

I found the CCTA to be the most reassuring test. Although it was also the most unpleasant test to get of the 3. I have anxiety and a fast heartbeat in general in stressful situations -- and they want your heartbeat at or below 60 for that test. I took a LOT of metoprolol and mine only got down to 80! They were able to use a different machine for me, but I thought I wasn't going to be able to get the test (which made my heart beat even faster). The test itself is also unpleasant - uncomfortable position, the dye feels really strange, the nitroglycerin gave me a headache... But the results were worth it, as it really gave a much more detailed report about what is going on in each artery and how much plaque is really there. I would recommend pursuing it. My CAC number just felt so huge and stress-inducing. The CCTA broke that down into real information, which definitely helps.

I think my doctor did the echo and the nuclear stress test really just to get a baseline sense of my heart and make sure there wasn't anything else going on that we needed to be aware of. ie, to check that I don't have any areas of damage, any areas reduced blood flow, all the valves are good, etc. I was glad to get the reassurance that my heart itself if healthy even if my arteries are not. But these were less important to me in terms of relieving anxiety than the CCTA since I really didn't expect to have any heart problems to begin with. I'd never had any symptoms of anything - I was only there because of my CAC. So while it was good to know all was well, I didn't feel like I learned anything new with those.

But a heads up if you get a nuclear stress test since, like me, you are probably 2 decades younger than every other patient in the waiting room at your cardiologist's office and none of those folks live with small children - I asked about being around a young child after the nuclear test, as you are injected with radioactive material. They said the exposure is minimal for family members, but of course you want to spare growing children exposure if you can. So they said time and distance are the key factors - so the more time that passes, the more time you can spend close to your kid. This meant I was glad I had my test scheduled first thing in the morning, as the half life of the dye is 6 hours and it takes a couple of hours to do the test. So I knew that I was at least halfway diminished by the time my kid got out of school, and I just generally kept a bit of distance (but still did hugs, etc) that evening. So, if you do get a test and that concerns you, I would also recommend trying for an early morning appointment.

As for Wegovy, you are eligible for it if your BMI is over 27 and you have a risk factor for heart disease (which all of us with high CACs do). My cardiologists office was eager to prescribe it to me when I asked about it. Apparently in clinical trials it was very effective at reducing cardiac events, even for those already on statins. But you do have to be overweight to be prescribed it, and it does put you onto an expensive drug for the long term. So it might not be right for you. I was convinced to try it given its effectiveness and have so far found the side effects to be manageable. Here is an interesting NYT article about how many ednocrinologists and cardiologists seem to be taking it themselves! https://www.nytimes.com/2025/02/10/health/doctors-ozempic-weight-loss.html?unlocked_article_code=1._k4.J35H.g2LlVvnhBPJ5&smid=url-share

Hope this helps!