Hi, @susane1121. I'd say I have a somewhat similar history: high CAC and elevated Lp(a) despite regular exercise, a decent diet, and only non-obstructive disease. My numbers are substantially lower than yours, though (CAC around 600 and Lp(a) around 170).

From my admittedly non-expert perspective, it sounds like you and your doctors are doing the right things to slow the progression of atherosclerosis. I also suspect that your healthy lifestyle may have helped keep things from becoming much worse.

I mainly wanted to mention that there are now medications available that can lower Lp(a) to some degree, and there are newer therapies in clinical trials that appear capable of lowering it much more dramatically. Ongoing studies are looking at whether these reductions result in fewer cardiovascular events. If those trials are successful, these treatments may become more widely available.

One other thought: if you aren't already seeing a preventive cardiologist, it may be worth learning how their approach differs from that of an interventional cardiologist and considering whether adding a preventive cardiologist to your care team would be helpful. They often focus on reducing long-term cardiovascular risk and may pay attention to factors such as HbA1c, inflammatory markers, ApoB, and other risk indicators in addition to LDL.

Good luck. From my perspective, you're handling a very difficult situation exceptionally well.