Angiogram reveals LAD 70% blocked with no flow restriction?

My guess, without more concrete information, is that your LAD is determined to be only moderately clogged, for want of a better term, with approximately 70% normal flow. They wouldn't perform a stent until it exceeds 70% blocked.

It’s 70% blocked and has no flow restriction. Exact terms used by my cardiologist.

Okay, that was not apparent from your first post. You said '...LAD was 70%...', but it isn't clear from that syntax that it was blocked vs. clear/unobstructed.

So, at 70% blocked, and no restriction of flow, you don't need the stent. You'll be monitored yearly from now on, or should be, and when you get sufficiently blocked, whatever the limit is for your consulting physician, he/she'll say it's time.

Perhaps it is 70% blocked based on it's predicted size, but there may have been positive remodeling?

Many studies have shown that a majority of heart attacks and strokes occur in individuals with limited stenoses. Blockage is only one part of the "problem". Inflammation and plaque "eruption" are extremely important in most thrombosis events. Based on your comments you have plaque and therefore need to address that.

So, my suggestion is to consider lifestyle and medication treatment to limit new plaque and stabilize your existing plaque. Hopefully, your cardiologist can help with those interventions.

Can you go further into this scenario, please?
I have a CAC of 1,208, just had an echo showing 55%, and an angiogram showing no blockage. BP and cholesterol are managed with valsartan, Ezetimibe and Rosuvastatin. No symptoms and okay with the meds.

Standard of Care is to improve diet and exercise? That's all?

That does not seem like enough to change and too much like waiting for things to get worse.

I want to attack the underlying cause(s) and stop more plaque from accumulating. Total cholesterol is 100. LDL is very low. So why did my CAC increase from 769 only two years ago and how do I stop that?

Did you start on statins after the initial CAC test? I believe statins are known to calcify the soft plaque which leads to a higher CAC score. That calcification is thought to stabilize the plaque (a mostly good thing).

I have high lipoprotein(a), which I gather can lead to blockages, and medications to reduce it are still experimental (as I understand it). I haven’t been diagnosed long enough to have a second scan. I am not even sure my cardiologist would prescribe it. (If there were more than one in my area, I’d consider changing perhaps.) But it’s the high lipoprotein(a) that scares me the most. The lipoprotein(a) might be something to discuss with your cardiologist.

I started on statins a few years ago. My CAC was already 769 then. Yes, the statins calcify plaque, which is a good thing happening to a bad thing.

I am trying to get to the underlying root cause that contributed to the plaque in the first place, so that I can make a change and stop further accumulation.

First off- Since you have established plaque (CAC>0), my suggestion is to continue Rosuvastatin. Increasing CAC score is a consequence of the dangerous soft plaque being calcified. While it's counterintuitive, CAC score increases (caused by your statin stabilizing your soft plaque) are a good thing, if your body continues to manufacture plaque.

My CAC score in 2000 was 35 and rose substantially over the next 19 years to 1913. That scared me to take action. I lost 66 pounds from 236 to 170 in one year on a low carb diet and a 7 day cardio exercise regimen. My CAC score stabilized over the next year to 1860. Probably no change since there is an error band associated with any measurement.

As I continued my education, the realization came that a higher CAC score is likely not always bad, but indicative of my soft plaque becoming stabilized by a calcium cap.

Fast forward to now. CLEERLY is available to use AI to analyze my 2020 CTA. All the biomarkers that SOC uses are just that, markers. The real question is, is my plaque increasing? Is it the dangerous soft plaque? Is it the stable calcified plaque. The CLEERLY analysis can discern the answers and help you determine if your lifestyle changes and medications are effective to stop the disease (soft plaque) progression.

I will shortly have another CTA that CLEERLY can analyze, to see if my disease has been tamed. My 2020 CLEERLY analysis showed a very high plaque burden, about 724.8 cubic mm of plaque burden and 2.4 cubic mm of the dangerous non-calcified plaque. It is my hope that the lifestyle and medication treatments I used over the last 4 years will show a decrease in the non-calcified plaque. If not, I will need to look into additional medical and/or lifestyle modifications.

Of course the best solution would be to find the CAUSE that my body makes plaque and address that. However, it may be that it is rooted in my genetics. So until there is a path to discovering the CAUSE, I will at least have a CLEER picture of the success of my treatments.

My current coronary medications are Repatha, 5 mg Rosuvastatin and 10 mg Ezetimibe. My exercise routine is 5 days of cardio (30 minutes), 3 days of strength training (65 minutes) and 2 days of HIIT (20 minutes).

You can follow Dr. Ford Brewer of PrevMed on YouTube for a lot more detail. Good luck and please continue to be your own advocate. SOC is for 300 million Americans. Your personal, individualized care is targeted and for you.

@pkoutou
On a positive note, at least they have discovered this and can monitor and make a plan to treatment. Medication, diet, and exercise are in order which they will help. I'm not a physician, but I think @gloaming is right about the stent. For me, I have some minor blockages (and one stent for a big blockage), but unfortunately, surgery is the only option if the other blockages get much worse.

Be sure to have your cardiologist monitor this. Be your own advocate. Just curious, why did they perform an angiogram? Were you showing symptoms like labored breathing?