Is there any intervention to do before my heart is damaged?

I’m sure she has you on statins for a start.
Are you able to do some cardio like walking for
20 minutes 6 days a week.?
The Mediterranean diet is effective. Your sleep habits,
socialization and stress reduction are all risks you can work on. Ask your doctor about supplements such as
fish oil or eat non fried fish frequently.Stevia,.turmeric and melatonin are antioxidant and anti inflammatory.
Have you had the comprehensive lipid test with lipoprotein a? Suggest a carotid Doppler to measure
for signs of atherosclerosis. In addition make sure
you have a comprehensive lipid check and lipoprotein a.
Follow up exams twice a year would be reasonable.

@seniormed Thanks. I have all that going on, but I'm still wondering why the plaque and calcium should be left in place when there are methods to remove them. If I have a heart attack, aren't they going to use surgical methods to clear my arteries? Why wait?

My CAC also is around 600 - in my early 60s. My mother had a triple bypass at the age I was when I was diagnosed with the high CAC. I was almost immediately scheduled for a nuclear stress test. I believe the stress test is pretty routine. It's a long winding story that I won't bother with, but shortly after my diagnosis I also got a CT coronary angiogram. The angiogram can relatively precisely identify the percent blockage in each important artery. Mine showed no blockage greater than 50%. I think 70% is around where they intervene. It reduced my stress (but perhaps irrationally because heart attacks occur at that level of blockage).

I can completely relate to your question. It feels like they tell you to wait until you have a heart attack before they'll do anything. I've asked my cardiologist about any following evaluation ... another stress test, another CT angiogram ... and he said nothing unless I start having symptoms. I specifically asked him about whether that's a good approach ... do people typically start having symptoms before they have a heart attack ... and he said yes. Is it true? It's so complicated, I can only believe that he is doing the best thing for me. In my mind, it would make sense to try to find blockages greater than 70% or an existing impact of the blockages on heart function so they can intervene before I have symptoms or a heart attack. So much of health care is aimed at systemic good and not individual good, especially now that there is increasing burden on the system.

When I was diagnosed, I read "Beat the Heart Attack Gene". It was a good introduction to how to avoid a heart attack. It's a mainstream book of course but I think it was science-based and at the least introduced me to a lot of the considerations in a way I could understand.

Good luck!

For most surgical and catheter procedures the risks would probably
be greater than any benefit at your degree of involvement.
Physicians want to avoid causing harm.
Almost as important- insurance would not likely pay.
You could probably find an aggressive cardiologist who would find a
reason to justify cardiac catheter, but….

@strngr12 As has been stated in a previous reply, they don't intervene until there is a confirmed 70% blockage. Meanwhile, you may take years to get much closer with lifestyle and medicine prescriptions, which generally are much better and less risky that opening arteries and scraping their linings....which are already damaged due to the inflammation that encouraged the plaque in the first place. In case it's news, the plaque doesn't accumulate like fat in your drain pipes. It isn't up against the endothelial lining. Instead, its underneath, in what is called the 'lumen.' So 'scraping', as you can imagine, is not something done easily.

stringr12, hi. I'm in a similar situation to yours my calc is a bit lower and I'm more that a bit older. I have low blood pressure, passed the stress test flying (with said colors said the tech).
I'm happy to read your doctor's comments, but listen to mine.
I wanted genetic testing and lp(a). He said, "You don't need more testing. You need to take medication, now." Well, statins were too muscle damaging. And Repatha caused immediate weight loss (plus digestive distress),
I'm delaying incliseran praying the research can continue for crispr, which is in stage two clinical trial.
I had to see a different doctor for the genetic testing. And he said immediately without preface, "I'm surprised you are still alive." Asking for a more clinical assessment (after laughing), He sited my calc scores.
See why I take heart from your PCP's comments.
(I have the gene NM_000384-3 variant c.10580G>A p.Arg3527Gin heterozygous and pathogenic
Of interest to no one, except that I bet you have a variant in the APOB gene associated with familial hypercholesterolemia (FH))
Diet and exercise cannot save us. We need drugs. Unless, of course, we can get into a clinical trial or live long enough and have enough money to pay for Crispr.
Repatha, Incliseran, and enlicitide (https://www.sciencenews.org/article/cholesterol-lowering-pill-enlicitide)
Are all more powerful than statins.
All of them increase calc scores because they stabilize unstable plaque. https://www.acc.org/Latest-in-Cardiology/Articles/2021/01/19/14/27/The-Agatston-Coronary-Artery-Calcium-Score-in-Statin-Users.
Your higher scores may be safer than my lower numbers if you have been on statins and/or because of your youth. Still, thanks for your post and to your doctor.

@strngr12
I see some good post giving you information.

What I can do since my cardiologist did not think a stent was needed either and my experience. I had several ICD shocks and was hospitalized in 2015. The did a catherization. The catherization did show evidence of clogged arteries (some as high at 50-60%) but my blood was flowing freely. So no stents.

They put me on a statin at that time and have been taking it for over 10 years now. I think as you doctors have discussed with you is your heart and cardiovascular system getting enough blood. For me the answer was yes and the statin should prevent getting worse. At the time I had catherization I was playing tennis 4-5 times a week including singles. No shortness of breath.

Just speaking for my experience on this and what I was told not trying to infer I am a medical professional or giving medical advice. I am 78 now and still exercise 6 days a week for 1-2 hours. No more tennis though (was bother ICD/Pacemaker wires) so do water aerobics, swim, bike, walk with no discomfort or shortness of breath.

@gloaming - How do they confirm the 70%+ blockage? Angiogram? Something else?

OMG @strngr12, you read my mind! I've been asking the same questions. My score is over 300, but most is from just the right coronary artery. (I don't know the % blockage, just the CAC score.) I asked the Cardiac NP and my PCP if there is anything to be done and they shook their heads. I was only told to "lower the risk." That seems passive and inadequate, like waiting for the other shoe to drop.
They know I am statin intolerant and averse (rosuvastatin caused irreversible peripheral neuropathy). The NP prescribed Leqvio and I just had my 2nd injection. Then I'm to keep my annual cardio visit (8 months from first injection), nothing else. But I'm in search of more. I will follow your post with interest.
One brother (so far) and my dad had bypass surgery in their 70's. I'm hoping to avoid the same.

@justlucky Yes, a CT angiogram or a catheter application angiogram where they make a small incision in the wrist and slide the catheter up your arm's radial artery. The CT angiogram is most often non-invasive, so no catheter....that I'm aware of. Both methods require substantial fluoroscopy to get photons through your thorax tissues.