@jp1234 I am so sorry you are dealing with this. I had a high CAC score (538) and my Lp(a) is 256 (and I'm currently 48 years old). I often feel scared and anxious about it all, too. See my other posts for more information on the tests I've had and my diagnosis. But for me the toughest piece is the emotional one. I am very stressed and worry frequently about dropping dead of a heart attack. I also have a young child, which makes me even more anxious and worried about leaving her without me.

In terms of the more practical stuff: My cardiologist has been treating me as a high-risk patient in terms of getting my LDL-C below 55, which seems the best thing you can do to lower your risk despite the high Lp(a) number. This is the same LDL-C goal they have for people who have already had a heart attack or other major event. Right now, there is nothing you can do about your Lp(a). But the good news is that medications that lower Lp(a) are coming soon - in the next few years - and one might even become available in 2026. Rapatha lowers it some, but I think it doesn't lower it enough to make a meaningful difference for most people and it's very expensive - so it is only prescribed if you need it to lower your LDL-C (because statins and ezetimibe don't get it low enough, or because you can't tolerate statins). In terms of treatment, I take aspirin (which is only for those under 60), Crestor, Zetia, metoprolol (I have anxiety - so this is a small dose for my racing heart beat and not to treat high BP), and Wegovy.

You should perhaps try to find a different cardiologist who better addresses your questions. I don't love that my doctor often doesn't bring things up until I ask, but at least if I stay informed and then ask questions, he always gives clear and thoughtful answers.

Personally, my main source of comfort these days is thinking about the drugs that will hopefully be available soon - I am just hoping everything is ok until I can start on something that lowers my Lp(a) directly. I think I will be much more relaxed about my diagnosis when I know that I have lowered that number, since it really seems that Lp(a) is the worst form of cholesterol there is and it sucks to not be able to do anything about it. I also try to take solace in the fact that, even though my grandfather died in his early 50s of a heart attack and many of us who are descended from him have been diagnosed with CVD, everyone is still alive and none of them have had a heart attack - and some of them are in their 80s. So it isn't a death sentence. But it can be hard to remember that in the middle of the night!

I hope you can find some peace around the anxiety. For me, I do my best to try to accept CVD for what it is - I see it as a call to make sure I am doing all I can to stay healthy, a reminder to enjoy my life and tell my family every day that I love them, and otherwise it is a set of risk factors that I must live with and accept as a part of my life. I don't like it, but there is only so much I can do about it. All our lives are fragile and we live with risk all the time. This is just one more to add to the pile -- and then to try to ignore the way we do so many others!