I have an ascending aortic aneurysm and a (very) high CAC score. I see different people for the two conditions. The aorta is monitored by a cardiovascular surgeon. The CAC is treated (or not treated) by a cardiologist. The cardiologist seems entirely unengaged. I see him once a year. He listens to my heart and asks about my symptoms. My PCP manages the lipids. Given how high my CAC score is and the fact that I have high (but not stratospheric - 90th percentile?) lp(a), I thought he might measure hsCRP or prescribe a PCSK9 inhibitor. He answers questions tersely. When I asked about training for a half marathon after I was first diagnosed, he asked me why I would want to do that and suggested I keep my heart rate below 135 as the "safe" way to train.

I've come to learn he is entirely symptom driven. So until I have symptoms, he's not going to do anything. I think that's a reasonable philosophy, but it doesn't align with mine. I live in a rural area so he's the only cardiologist within a two hour drive. I'm working on if/how to find someone with a more preventive mindset. BTW, cardiovascular surgeon is great. He meets with me even after screenings show no growth, explains what was found, and answers all my questions thoroughly.