High Lipoprotein(a) but CAC Score 0

@19281928
I think that much of these different reactions may be driven more by individual differences in our bodies rather than different beliefs.
Our bodies just act differently towards fats and different foods and nutrients and even thru different ages of our lives.
Ai says it this way:
People react differently to fats and other nutrients due to a complex interplay of genetics, gut microbiome composition, and metabolic health. This concept, known as personalized nutrition or nutrigenetics, explains why a diet like the Atkins diet (high-fat, low-carb) can yield vastly different results for two people even if they follow it identically.
research with different people and even identical twins and how the react differently:
https://www.fooddive.com/news/study-everyone-responds-differently-to-the-same-nutritional-content-even/556572/

Ok.....what I see is low CAC, high Lp(A), rising HDL and rising LDL....no reported triglycerides which would be helpful.

CAC only looks at hard plaque not soft plaque....CAC is a picture in time that is frequently zero before about 60 years old or thereabouts. A CCTA is usually used to find a more complete picture if the doctor feels that it is needed.

Lp(A) is more of a future indicator of which way your body may age, plus a major risk factor for the aortic valve.
Without hormone therapy and probably even with BHRT or HRT, albeit lessened, your cardio system will continue to age and be driven by your life style and genetics, Lp(A) is one of these.

ApoB, blood test, might help clarify the LDL by showing the number of plaque forming particles.
But...
It looks like your doctor feels that the higher LDL and the high Lp(A) will be driving your cardio system as you age. So the dr wishes to lower the LDL to lower your risk of cardio plaque forming driven by your genetics, Lp(A) in this case. Basically, your doctor is looking at future problems. It is much easier to prevent a problem than to "fix" an existing problem with plaque etc.

I actually have a similar problem. I have had an array of cardio tests which I requested. My very high HDL and low optimal triglycerides have blinded most doctors to any possible cardio problems. I had a borderline Lp(A) and ApoB, very high HDL, slightly elevated LDL and low triglycerides. My CAC was below 11 in one artery with one valve showing mild calcification, both these areas are where plaque occurs with age, due to the way the blood flows. I am in my 70s so this is a good age to see how the body is using my mixed bag of cardio numbers, earlier in my 50s or 60s probably nothing would have been found on the CAC scan. A mixed bag but heavy leaning towards "no problem".
I am having an ultrasound next week to check that valve just to make sure that the mild plaque is not in a place to impede the valve.
But right now no statins etc are being prescribed.

@19281928
I think that much of these different reactions may be driven more by individual differences in our bodies rather than different beliefs.
Our bodies just act differently towards fats and different foods and nutrients and even thru different ages of our lives.
Ai says it this way:
People react differently to fats and other nutrients due to a complex interplay of genetics, gut microbiome composition, and metabolic health. This concept, known as personalized nutrition or nutrigenetics, explains why a diet like the Atkins diet (high-fat, low-carb) can yield vastly different results for two people even if they follow it identically.
research with different people and even identical twins and how the react differently:
https://www.fooddive.com/news/study-everyone-responds-differently-to-the-same-nutritional-content-even/556572/

@kathleen1314 , yes it looks like we're somewhat similar.. exception my very high lpa. I'll be 69 this year and this is the first potential cardio issue in my life. I have no symptoms. My bloodwork standard lipid panel results came back slightly elevated overall, LDL and HDL but my doctor said not to worry. Then the lpa results and she's immediately recommending statin. I was caught off guard thinking I'm ok with CAC=0. The more I research the more I can see your comments are probably right on. My PCP is probably trying to protect me from a future event. However, I'd prefer more tests to understand the full picture before taking a statin. Even though the outcome may be the same, a statin. I also think I should consult with a cardiologist first. Thanks for your input.

@leeosteo I do have high Lp(a) and my cardiologist recommended Repatha but did not mention studies. I declined taking Repatha for now because I don't feel it does enough and I want to wait until more information is available and those studies come up with a more effective treatment.

@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)

@kathleen1314 , yes it looks like we're somewhat similar.. exception my very high lpa. I'll be 69 this year and this is the first potential cardio issue in my life. I have no symptoms. My bloodwork standard lipid panel results came back slightly elevated overall, LDL and HDL but my doctor said not to worry. Then the lpa results and she's immediately recommending statin. I was caught off guard thinking I'm ok with CAC=0. The more I research the more I can see your comments are probably right on. My PCP is probably trying to protect me from a future event. However, I'd prefer more tests to understand the full picture before taking a statin. Even though the outcome may be the same, a statin. I also think I should consult with a cardiologist first. Thanks for your input.

If you are 68 with a cac score of 0 that means your risk of a coronary event is very low despite your high LPa. Statins do nothing to lower LPa and a few studies showed that it might even increase it. Niacin ( vit B3) has been shown to lower it about 15-20% . There are some new drugs nearing approval that can lower it 80% or so.
But really with your cac score I would find something else to worry about although I would do a repeat test in a few years to see if it has increased and take action then if the increase is significant.

@leeosteo
Yes, I agree. I find that I have a "line" that I have to cross to feel "comfortable" with any decision. I have to feel that I have done everything I can and researched all options in order to feel comfortable with any medication or supplement. I have an additional problem though I overreact to most meds and many supplements. I see to have a genetic condition that lends to this reaction.
So for me to take a med like a statin I would have to be desperate, because there is a good chance, based on past experiences, that I will experience the one in a million reaction. My husband is different and is taking statins with good results. He loves them and is irritating me because my home now seems full of foods that we didn't eat before he felt statin would protect him from them...sigh
Something that is really helping me with working thru all my options is AI copilot. I am not as enamored with Ai google and the Google ai mode for personal health questions, but copilot is better at finding all options and placing them into context. Might give it a try and see if it helps you work thru your options.