High Lipoprotein(a) but CAC Score 0

I developed AF, atrial fibrillation, near the end of a 10 km maintenance run at age 65. Long story short, it was sleep apnea, revealed by the very last diagnostic requested by my cardiologist. All other tests, MIBI on a treadmill with contrast, chest x-rays, angiogram, MRI, Doppler ultrasound on my carotid arteries...all showed minimal stenosis and deposition. So, it was the OSA (obstructive sleep apnea).

Because I was new to him, and because I had a new and formal diagnosis of paroxysmal AF, he wanted me on metoprolol and on atorvastatin right away. Three years later, when my AF began to increase in frequency and in duration, he again felt that ischemia might be the culprit, and that means blocked coronary arteries. So, he doubled my dose. I have have two ablations and am now free of AF. I still have no concerning atherosclerosis, and no apparent ischemia, but my GP keeps saying to take it because it will all but assure a healthy and long existence.

Your score is climbing. It will continue, and it means increased stenosis here and there, including in the 'bad' places (carotid and in the left anterior descending artery on the heart). Statins have the effect of 'cementing' friable plaque into place by calcification. This means using free Ca where it can be gotten. So, if you have a diet that is balanced and that includes Ca, you should be okay....or, take a supplement with D3 and some zinc. This is not advice, just what is widely prescribed as people share here and there....see your doctor about this, please. Do not take my word for it.

Statins also have the added benefit of reducing systemic inflammation. As we get older, and we lose ground that way, our endothelial linings here and there become more irritated, and in the lumen of major vessels, arterial or venous, it means increased rates of deposition....in the lumen.

I think there is an injection called Repatha..? I'm not familiar with it, but people talk of it. Maybe inquire of that?

It depends on if your LDL is elevated if not, there isn't much you can do to lower LP(a)

I'm not in the enviable position of having a CAC score of zero. I have exactly the opposite, a score in the 98th percentile (as of a few years ago). My understanding is that a zero CAC score is predictive of very low risk over the next 10 years. Yet it's not a complete pass, because a CAC scan cannot detect soft plaque.

The one thing I would interject is that I had normal LDL and good HDL for decades and it was not protective for me. My CAC scan was a shock. I still didn't want to go on statins, but ultimately I decided to take them. You could try them and see if they affect you. Is there any data that it decreases your lifespan? I don't know. I would say I'd happily turn time back and go on statins if I would not have this plaque threatening to rupture unexpectedly. The zero CAC score is gold!

@gloaming, wow, thank you for sharing your story.

I've been tracking my cholesterol since 2005. It wasn't until 2009, when I went through menopause, did my overall cholesterol go above 200. Since then my LDL fluctuated between 112 and 147, average 119. My HDL fluctuated between 82-102, average around 98. All these years my doctors have said not to worry because I was protected by my HDL. Even after my CAC=0, my doctors continued to say the same. My mothers side has CVD so I thought maybe I should check Lpa to see what I've inherited. Result was 172 (very high) and now a statin recommendation.

I'm so new to CVD specifics and have so many questions.

First, what does this really mean? I read that this number represents an inherited gene that shows I'm likely to have CVD in my future. Is this number (172) something I've had from birth or something I've developed over 68 years and what I actually have now? I've recently read that there's no way, to date, to bring this number down and that statins don't effect this number also. Sounds like all I can do is reduce my LDL either by diet or statin which theoretically should reduce plaque build up.

If my CAC = 0 does this mean I'm still protected by my HDL? My diet has been balanced almost my entire life. I never smoked. I stopped alcohol primarily due to my osteoporosis. Even when I did consume alcohol, prior to osteoporosis diagnosis, it was no more than 2 on an occasional weekend. I've further refined my diet for osteoporosis. 1000-1200 calcium/day from food, D3 supplement (dr directed 4000 iu/day), protein 60g/day, magnesium 3-400/day, multivitamin. I weight train 3x/wk. I'm currently increasing my cardio exercise slowly.

Have you or others used hormone replacement therapy (HRT) now or in the past? It may not advisable with CVD, not sure. However, all of my physical changes seem to related to reduced estrogen at menopause (osteoporosis, cholesterol creeping up and add in sleep disturbances). Since I have osteoporosis I concerned with taking a statin. I've read statins inhibit calcium absorption which is not good for bones. I've just spent two years on a bone building med to increase my bone density.

I know I sound like I'm in denial (smile). I guess my net question is am I still protected by my HDL? Is my HDL too high and possibly contributing to this? Once you start a statin can you ever go off it? I'm not afraid of statins if needed.

Are there other CVD tests I should be looking into? I don't have a cardiologist. My experience with PCPs (primary care doctors) is that they're quick to prescribe meds before understanding the individual. I would want a female cardiologist who understands a woman's body and medical challenges.

@bitsygirl , thank you for sharing your experience.

I guess I could be in the same position as your in the near future. What tests did your doctor recommend that got you to a statin? Is there any test your aware of that detects soft plaque?

It is my understanding that Lipoprotein a is genetic and the cause of the calcification build up. In my case it is built up on my heart valves. They are currently awaiting on an FDA approval for a shot twice a year that will help. As of right now, they try to control that with statin. So I would think just go with what your doctor suggests, or ask your doctor. I had TAVR just a few weeks ago and the culprit is Lipoprotein a. Good luck.

https://www.health.harvard.edu/heart-health/lipoproteina-an-update-on-testing-and-treatment
As we advance as a civilization, and as the absolute numbers of people doing research continues to climb, we are learning more, including, regrettably, that we've been wrong all along. It happened with fat. Fat was to be avoided, and now we understand that we absolutely do need, and must ingest, several kinds of fat that we cannot produce in the quantities we need. Just as an example, fats are needed to get some vitamins and nutrients across lipid membranes surrounding cells and their resident mitochondria. Who knew!?

The science behind lipoproteins and what the numbers mean for individuals is still very much fraught. If you'd like me to suggest a place to begin, not to end,,,,,to begin....to learn up-to-date science, and what the listener-you should take away from each video he makes, look to Dr. Nick Norwitz on YouTube. He has genetic problems and is a hyper-lipid body owner, genetically. He's Harvard and Oxford trained, MD and PhD respectively. He's young, energetic, great personality, humble (with just the right amount of cockiness a young MD ought to present with), and he is very active in reading and digesting what others say in similar channels on YouTube or what bonafide researchers publish in the journals. Also, a hearty shout-out for Dr. Gil Carvalho on his channel 'Nutrion made simple', on YouTube. he's not afraid to review other influencers and then call them out, nicely, but knowledgeably, and he always invites a dialog or a meeting with them to allow them to rebut.

@leeosteo please inform us of your LPa score. Depending on that, ask for a visit to the cardiologist. You may be fine. eat FISH a few times a week to lower your cholesterol. We need to know your age, and what you eat. More info.

@gloaming , thank you for the article and two places to start.

Do you have an article on fat intake? I've avoided fat in meats most of my life. My primary focus has been on good fat e.g., olive and avocado oils.

@loriesco , Im 68, LPa is 172. I eat lean proteins, fruits and vegetables. I have reintroduced fat free milk (16oz/day, kefir, yoghurt, feta cheese) recently because of my osteoporosis. Prior to that I drank little milk. Hard cheeses and nuts have always been my vices (vs chocolate for some people).