High Lipoprotein(a) but CAC Score 0

@leeosteo Sounds great to me! You didn't mention meats. Are you vegan? I ate chicken, LEAN pork, Fish and when I switched out to fish more my cholesterol dropped like an anvil weight. I did it twice so there was no doubt what dropped it. your calcium score is great. Have you had a 3d pix taken of your arteries yet? I presume that is where the calcium score came from which is great. What is your cholesterol? Your LPa does sound high but if your 3D pix looks good then you can relax. I have between 66 -88 and my calcium is always exactly the same. My arteries are clear in 3 and 1 is 1/3 blocked. My cardio doc said that my LPa is okay because it also protects against cancer. He said that if I was going to die of a heart attack/stroke he'd see more evidence by now. There is a ratio of numbers used to determine whether you are at risk. I fell in the average for my age bracket. So they never set me up with a cardio doc. They just used a consultant to run the numbers. So I asked to go to a cardio doc because of the LPa and my dads CAD history/heart attacks, and strokes. It was super informative and I asked a million questions and he answered them all. You didn't say if you are at a cardio doc. and if your cholesterol can be lowered by diet I'd skip the statins. Let. me know the cholesterol, the LDL and the HDL. By the way, you made a good switch with the dairy. The hard cheeses are not a good match for someone with cholesterol issues. But watch the dairy fats anyway. I switched to mostly sheep/goat products because I am lactose intolerant and intolerant of casein. I was raised with Feta and Romano and the fermented hard cheeses so I like them anyway! mostly everything I eat now is fermented (sourdough, cabbage, cheeses, tamari) fermented gets rid of gluten and lactose. Try getting rid of "white" things - white potatoes for red, brown rice pastas and rices, that will help too.

@leeosteo I have been playing with low/carb and keto, although not since about 2021 when my heart began to act up and I eventually needed two catheter ablations. And my girth has grown commensurately. A work in progress...

The science is still growing and arguing. I follow Dr. Rob Cywes on his YouTube channel, but have listened to countless lectures by Dr. Stephen Phinney and Dr. Nadir Ali, all high-priced, highly educated, some with two PhDs, and running businesses and giving lectures to cardiologists. They favour meats, dairy, lots of animal fats, even putting a pat of butter on a steak if it helps to ward off hunger pangs. Their science is impeccable. Then, others point to strong evidence that a Mediterranean diet is the way to go, and it is very strong indeed. I now follow the channels of only two people, both on Youtube: Nutrion Made Simple, Dr. Gil Carvalho, and Dr. Nick Norwitz. They seem to have a strong thumb on the pulse of things edible, and between them I get good information. I have not looked specifically for articles stating that animal fats are good or bad....but I believe that some if it is good. Plant oils must be of impeccable quality...and they must be fresh and used up within a few weeks of opening, refrigerated, or discarded after about three months. I learned this starkly two years ago when my wife had a mastectomy and our middle daughter came to be with us and get us through the rough patch. She baked some 'energy cookie balls' and they had some flaxseed I had in the fridge since Christ was a corporal. We both took one look at each other, hers quite accusatory, when we each bit into one of them. She grabbed the bag and looked at the long-since-murderous best-before date, and then waved it in front of me. I had to hang my head and agree I'd messed up. The entire batch had to be thrown into the bin.

Seed and plant oils are not necessarily bad, but they CAN be. Do your research about the best quality brands, and don't hang onto it more than about three months...even if it's in the fridge.

@leeosteo I don't imagine you will be in my position ever, and certainly not anytime soon. I am already younger than you and my score is approaching 600. It takes decades for atherosclerosis to develop. According to the MESA calculator here: https://mesa-nhlbi.org/researchers/tools/mesa-score-risk-calculator, I have the veins of an 87 year old. So you might get there by the time you are 87. Even then, the predicted age is probably an "average" and I'd have to guess you're "better" than average wrt atherosclerosis development. I threw some numbers in that calculator: 0 CAC, 68 years old, and even at very high Total Cholesterol numbers, you're "CAC age" was much lower than your chronological age. All just speculation and averages, but you seem to be in pretty good shape.

The point I was trying to make was that having the high score weighs on my mind. Atherosclerosis really only goes in one direction. There's no fixing it. So now I have this constant hum in the background of the thing that can't be fixed and threatens my life. So if someone could avoid it, trying/taking the statins seems like a trade that might be worth making. I'd guess it depends somewhat on your personality, too. According to my doctors, the statins should keep it from progressing. Then in your case, you'd have pretty good confidence it would never be a problem.

Good luck. By my take you're in as good a shape as one could reasonably expect at this point.

March 24 is lp(a) awareness day. Here's a video by the Family Heart Foundation that explains the effect of high lp(a) over a woman's lifetime. FWIW. (https://www.youtube.com/watch)

@bitsygirl , thanks for the calculator and youtube video. I'll take a look at them. This is all so new to me and I'm trying to educate myself before agreeing to a statin.

My husband has high lp(a) and is on a statin, which his doc says is current treatment for it. Statins are very good in general, with multiple health benefits. Do not understand anti-medicine and anti-science beliefs of today. He is 83 and healthy.

@loriesco, I'm not a vegan. I eat chicken, lean pork, fish, and tofu. My husband and I used to eat more fish but got out of the habit. I'm leaning back in to fish now. I don't believe my CAC score included a 3D photo. What does 3D give you beyond standard CAC?

All my cholesterol numbers were way below "desirable" range until menopause. In the last 20 years, my overall cholesterol has fluctuated between 208-269 (currently 236), LDL fluctuates 112-147 (currently 121), HDL fluctuates 75-102 (currently 102). What is your Lpa?

This is all new to me as of last week. My PCP wants to put me on a statin (atorvastatin). She didn't discuss this with me at all nor suggest a cardiologist. I'm trying to educate myself before going further so I have good questions to ask a cardiologist. I'm learning type of statin also matters. Did your cardiologist didn't put you on a statin?

I drink Fairlife fat free milk (50% more protein, 50% less sugar, lactose free). I need the amino acids and calcium for my osteoporosis.

@gloaming , more good information, thank you. Funny story about the cookies. I get your point. I'll keep researching. This is all very new to me.

@leeosteo they just gave you the "standard" first tier glossover. They didn't even send you to a cardiologist! Your doc at UCSD gave me all the tests I asked for and sent me to a cardio "consultant." I thought he was my regular cardiologist. But after questioning further I found out they did not assign me to a cardio doc because when the specialist crunched the numbers I am inline with an aging person. But I wasn't happy with that and asked for a cardiology doc. It took me a YEAR to see him! but I am so glad I did. He answered all my questions. I believe I had a CCTA: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/coronary-computed-tomography-angiography-ccta
Because you have a high (but not so high like 700!) you can probably ask for one - both a doc and a tomography test. Especially if you have family members who have had strokes or heart attacks.
My cholesterol was amazing until after menopause too. Other tests besides LPa and Cholesterol measure other lipids in your bloodstream. Some are protective some contribute to plaque build-up. Lowering your cholesterol isn't necessarily the answer if you have a familial CAD.
My cholesterol dropped 70 points after only 3 months of increasing the fish. (Cod, salmon, tuna, tilapia, soul, sardines). I even fried it. You should ask your doctor to put you on the fish oil pills although I don't know that they do much. Medicare pays for my Vescepa! . However, Medicare Part D plans may cover prescription-strength omega-3 fatty acids (such as Lovaza, Vascepa, or Epanova) when used to treat specific, severe conditions like very high triglycerides. If I give up simple carbs I drop my trigycerides too. But I get weak-willed and return to the carbs.
I tried for 15 years to get those carbs down. but nothing worked - just eating fish. If I stop, the cholesterol goes back up.
My doc 20 years ago put me on a statin but I got the muscle weakness side effect after 3 weeks. NO THANK YOU. It helps some people but not others.
My LPa is 66 - 88 and my cholesterol is 240 when I don't eat the fish and 173 when I do!
Crazy, huh? Keep your triglycerides in line.
It does not sound like your diet is the culprit.
but here is some advice: don't worry so much about the numbers. Only the trends. Also, get exercise. Walk everyday or stay active. My dad died with his cholesterol under 200. It didn't matter -- his arteries kept depositing plague. I also had a carotid test. that is a test for your arteries in your neck going to your brain. (where strokes happen). You have to figure out a way to get the plague to not deposit and get hard in your arteries. Learn about that. Get your other lipids tested Apoe and I forget the others. Get some books out of the library or buy them.
Yes, you need good proteins and all the rest for your bones but it doesn't work directly on them. If you have osteoperosis than go on the bone meds. There is a section here you can read all about it. I am on Tymlos and Reclast (alternatively) for 5 years and then I'm done. My bones were thought to be strong but I had cervical spine surgery and C5 fell apart in their hands! Off I went for the bone meds! (I get DEXA scans every year for 30 years!) who knew that would happen! I went back on bioidentical HRT to deal with both issues. Aging isn't for the weak of heart! LOL

What I learned about Lp(a) from my cardiologist:
-High Lp(a) is strictly heriditary.
-Statins are not effective against Lp(a), in fact, they can raise it by ~20%.
-Statins can cause soft plaque to calcify. Some studies say this "stabilizes" the plaque.
-There is no treatment that can significantly reduce Lp(a).

@dianempx , thank you for your comments. I'm reading the same. Do you have high Lp(a)? What did your cardiologist suggest for you? Did he/she talk about studies underway now to treat Lp(a)?

I'm still researching this so I have good questions for a cardiologist. I understand everyone's circumstances are different and should be treated as an individual. Just curious what your cardiologist prescribed for you.