I have a very high calcium score. What next?

I just had my Medicare wellness check and my cholesterol levels were great. Total was 117. A1c 5.4. Glucose 81. BP was great. I’m on Lipitor and zeta. I do a 2 mile fast walk every day. I eat healthy due to Barrett’s esophagus. No booze, soda, or smoking or fried fatty foods.I feel great. My pcp asked if I wanted a heart scan for $49 and I said yes due to my father dying of a massive heart attack. I’m 67 and not overweight. So my score came back at 573. My brother has cholesterol levels in the 300’s and his score was 46. I can’t figure this out. My Dr. Called and said get on a baby aspirin for this. I told my brother I have one foot in the grave! LOL! I don’t know what to think about this test.

Here is what to think about this test-
The calcium test shows calcified plaque. This is the most stable plaque you can have. The real issue is what about and how much of the non calcified plaque that is less stable and more prone to rupture do you have? How much and how many and in how many vessels do i have lesions with lipid rich plaque?
The answers can be had thru invasive and/or non invasive tests. Discuss with you cardiologist how to get these answers and what they mean to your risk profile.
Now, regarding your brother whose test came back much lower than yours. A low calcium score means that fewer lesions have "healed" and calcified. There could be a lot(or none) of non-calcified plaque-lurking sight unseen(as of now), the calcium test is not a measure of the truly dangerous plaque, it really only shows at what stage in the overall process your arteries are at.
It seems you do not have a cardiologist, that is the first action necessary.
I would anticipate you will be going to max dosage on your statin which is 80mg. I think if you research or discuss with your cardiologist which statin is the most effective you will be switching to 40mg of Rosuvastatin/Crestor.
Why? Your goal is to increase the rate at which your existing lesions continue to remodel/increase fibrous cap thickness and even reduce lipid content.
You have a family heart history. You must now be more diligent-and aggressive-in your acvsd management.
Good luck. You can ve sure that all of us who received a score like yours or higher all were in shock same as you. How you react now makes all the difference. Do not let any grass grow under your feet.

I asked my doctor if I need to see a cardiologist and he said no. I have a full physical scheduled for July so I’ll ask again about this. I’m going to really watch what I eat, exercise more. I weigh 182 and am 5’11 feet tall so I’m going to lose 7 #. That’s my plan for now. Thanks for the info.

Re: Statins. I've taken statins for a long time and have had no reactions. But then I had a high calcium score of 642. My cardiologist casually said we'll double your statins to 40 mg. First of all, my stomach could not tolerate the higher dose. Secondly, I read that doubling the dose does very little to bring down your LDL. Mine was 80 at the time and we wanted to bring it lower. Reading that made me question my cardiologist so I asked around and got the best one I could find in NYC. This new fellow does NOT take insurance but I went anyway. He gave me a round of tests including a nuclear stress test and sonograms and told me my blood flood was fine despite the high score. He knew, without me telling him, that a double dose of statins would not bring down my LDL. He prescribed Praluent which is an injectable you take twice a month. It is expensive but with my very good insurance, the co-pay is $90 a month. I'll pay it because after being on it one month, my LDL dropped from 80 to 22 and my overall cholesterol dropped from 150 to 77. I still need to lose weight. I'm 5'6" and weigh 166 pounds.

Unfortunately Medicare requirements (in my case) will most likely not cover the two rx based pcsk9 injectables. I see the rnp in charge of the lipid lab on wednesday and hope to convince her to see if we can get Inclisiran approval from my Humana advantage coverage.
I love your cardiologist's response, the pcks9 route is superior to dramatically lower ldl-c as shown in your case.
Thanks for posting

Have you tried a whole food plant based diet? Cardiologist Dean Ornish or Dr. Caldwell Esselstyn have seen remarkable results with their programs.

Curious if you had lipoprotein (a) test. My calcium high and also LPa. It’s genetic and was high as well. Which can cause high CAC

No, I haven't. I avoid red meat but honestly do not like vegetables enough to try that. I also believe it's genetics and that my cholesterol would not go down enough. I ate poorly early in life and am not sure I can recover from that.

I would get all oils and processed out of your diet which injure the endothelial lining.

Check out this dr who had stents and open heart surgery. His biok is Open Heaet. replay of Dr. Taher from https://www.youtube.com/watch?v=260F11NCUS0