High CAC Score with Optimal Cholesterol Levels

Hello @tinyelvis
You are in the right place! I want to encourage you to keep asking questions. It gets complicated.

My first thought is that there is more than cholesterol that can cause this problem, and statins do more than control cholesterol. I have been told by a cardiologist that they help with inflammation. I am not a medically trained person but to me, this sounds like your PCP is on the right path.

What prompted you to get these calcium tests? Do you have any other challenges with your health?
Janell

Definitely time for a statin. There are more factors in atherogenesis than
the lipid profile. Suggest that you consider the Mediterranean diet and
exercising after consulting with a cardiologist concerning your risk factors.
A stress test and carotid ultrasound could offer some reassurance.
High sensitivity cardiac CRP lab can determine if inflammation is a factor.

"What prompted you to get these calcium tests?"

I had some odd pain/pressure in my chest which I now believe is related to a small hiatal-hernia. Anyhow, there was a heart-health promotion in our area. I thought it would be a good idea to confirm how healthy I thought I was. I did the follow-up (now 5 years later) to see if there had been any increase, which I did not expect.

Diet and exercise has never been an issue for me. While I do not necessarily follow the Mediterranean diet right now, my diet is definitely not the typical "western" diet that many are critical of. Given my consistently low LDL and other optimal scores in my lipid profile, I always assumed I was doing the "right" thing.

I am going to see a cardiologist in a couple of months. Regardless, it sounds like the statin prescription I was given is the recommended course of action. I just don't understand how this came to be..

Yes, many of us have this experience because many of us have inherited part disease and have heart disease as we age as a function of not eating or exercising enough or properly. First off your LPa is indicative of inherited heart disease. So you are blessed to not have inherited heart disease! As for the rest of everybody’s comments, they lie that numbers in and of themselves are not an accurate picture of what’s going on with one’s body and they may conflict. What does not conflict is a picture and I mean a physical picture of your arteries. It would be best to ask for imaging of your arteries so you can see ”the truth.” Once your cardiologist sees the imaging then they can use the number to guide you in the proper direction. My dad was on statin’s for years and years. It did not stop his arteries from getting clogged with plaque and having manyheart bypass angioplasty and stents over 30 years. He lived a full life by managing diet, exercise, statins, other medications,and seeing a cardiologist every year for those 30 years. My dad had inherited heart disease which he passed on to me. It’s a kaleidoscope and there’s no way around having to take responsibility for our health. The numbers on the lipid test and all the tests that go into informing us about our heart health can be in conflict. A singular test can also be an aberration. Don’t stress about singular tests. There are many lipid and heart tests and numbers in and of themselves on single test. Don’t really give an accurate picture. However, a physical picture of your heart does — then the cardiologist can help with your understanding of this very complex situation. What I don’t like these days is that some of the cardiologist and cardiologist consultants rely on statistical numbers to make up one’s condition. We aren’t statistics. We aren’t numbers. They are lazy about taking the physical pictures. Demand a picture so you can see the condition of your arteries and then you will know exactly what you have to do going forward.

Hi.

"First off your LPa is indicative of inherited heart disease. So you are blessed to not have inherited heart disease!"

This seems contradictory. Did you mean *not* indicative?

"It would be best to ask for imaging of your arteries so you can see the truth. "

What kind of imaging is that?

I was in the same boat as you. In my 40s my Cholesterol always was in favorable range on both scores and PCP would say “You’re not a candidate for High Cholesterol.” Same numbers in my 50s and then at 55, my PCP said “I’m putting you on a Statin just in case you have any plaque developing we want it to stay where it’s at.” Fast forward, heart rhythm issue detected in leg vein procedure while under anesthesia led me to a Cardiologist. Along with Nuclear Stress test they performed my first CAC test and my score was whopping 2000. Cardiologist said it was a good thing PCP put me on those statins 16 years ago. But no explanation for how and why so much Calcium in my arteries. They told me 2000 is a high number but most of their patients with higher numbers, many over 5000 are doing fine.

Was there anything wrong with your heart based on the results on the stress test?

A score under "33" is considered normal from my research however, the internet says 50 "In summary, a high Lp(a) level, particularly above 50 mg/dL, is a strong indicator of inherited risk for cardiovascular disease, and genetic factors play a significant role in determining an individual's Lp(a) level." but you can inherit CAD without the score being something in particular as well as have a higher score but not inherit the disease. This is where everything else comes into play and there IS a ton more to look at! I have some lipid tests which are amazing and others that are troublesome. But the best thing was getting the physical images of the condition of my arteries (3 clear and 1, which is 1/3 blocked).
As far as the imaging (I don't think mine was with contrast dye): A coronary calcium scan (also called a heart CT scan) is a type of CT scan that specifically images the heart arteries to look for calcium buildup, which can indicate coronary artery disease. This is a visual imaging technique that uses X-rays to create detailed pictures of the heart and blood vessels. Another option is a coronary angiogram, which uses X-rays and a contrast dye to visualize the heart's blood vessels, particularly to detect blockages.

This is also helpful. Its all dependent on a "whole lot" of other things! https://pubmed.ncbi.nlm.nih.gov/38593219/#:~:text=A%20dichotomized%20GRS%20(%3E54),not%20provide%20additional%20prognostic%20information.