u/JLEroll

This. The family history and high Lp(a) are 2 significant Risk Enhancers and should automatically put you at an under 70 (or lower) ldl target. Since you have already tried diet, medication should be your next step. If your cardiologist downplays this, they are not following guidance or what’s in your best interest.

I’m basically you in 15 years but with developed health disease. I wish I had started statins at 30.

Well meaning people responding but this isn’t a cholesterol management question. You are having heart symptoms that are unrelated to cholesterol and that should be answered by a cardiologist.

Having said that, if your cardiologist isn’t concerned/ has cleared you, it’s possibly anxiety or GI rather than heart issues.

Their song McMemories has been getting play on SiriusXMU. Thanks for adding this

There are a few things that are probably going on here, none you should feel bad about.

First, as you mentioned, LDL can increase temporarily during weight loss. Second, LDL can naturally increase as we get older, especially for women.

Third, and most important, is that guidance has changed in the past few years which take a more long term and preventative approach. In your situation, the family history of premature cardiac events is a significant risk enhancer and your doctor should have had you on medication with an ldl target of under 70 for years. Also drilling into that QRISK, it said you had a 7% chance (1 in 14) of a cardiac event in the next 10 years!! In what world is that low risk?! Take advantage of the medical advances and don’t let history repeat itself.

What is your ldl? HDL, total cholesterol, and ratios aren’t typically used for decision making.

Also have you had lp(a) tested?

This and you can also read the wiki at the top of the sub for lots of great info and tips.

But for context, this is not an emergency situation. 135 is elevated/borderline. Without other risk factors, your goal would be to get to under 100 but it’s unlikely you would be prescribed medication with 135. If you do have additional risk factors, your goal would be under 70 and would generally need lower dose medication to get there.

If by “same path” you mean being middle aged, having an unfavorable test result, and taking a treatment to manage it, you are going to be in good company friend.

Do you have history of premature heart disease in your family? If yes, I think it might be worth the pursuit for lower. If not, I would probably stop. You are already treating more aggressively than guidelines and the mild CAC score doesn’t suggest any immediate danger or urgency to go beyond that.

Technically the guidelines seem to support the cardiologist here of first getting the max tolerated statin, see Figure 7 in the 2026 AHA Guidelines.

However, from a practical standpoint it seems like a given to add Zetia or another second medication sooner than later.

https://preview.redd.it/pf72h5rzpwxh1.png?width=615&format=png&auto=webp&s=932cddad9a373e5a0403868d9f4384868fede4fd

This isn't clear cut. There is still Level 1 Strong guidance to generally avoid statins while pregnant but the actual research on it seems inconclusive and there is carve out to consider ASCVD high risk patients. I think most reasonable people would think pausing while expecting makes sense, but some doctors use this as a blanket reason to not treat young women.

https://preview.redd.it/o698fgtspwxh1.png?width=1007&format=png&auto=webp&s=9db6f9c872a2d16abb36ae6d8850219d01d79094

I totally get this. My dad had HA & quadruple bypass at 50 & I'm very high risk myself. Its completely understandable wanting to get more info and to put your worries to rest. I just don't think the CAC gives you the answers you are looking for.

There is no harm in the test itself, but the trepidation comes with people and/or their doctors using a zero score to justify minimizing risks/treatment. It sounds like you are taking it seriously, but I'm seeing mixed messages from the doc on how much they are following guidelines / committed to prevention.

For reference, here is Figure 7 in the 2026 AHA Guidelines which summarize the treatment for > 190 / severe hypercholesterolemia. You should be currently in the middle path since you have the family history additional risk factor. I don't think a high CAC (which would be extremely rare for 25F) would count as clinical ASCVD and move you to the right (someone else can correct me here) so I don't think it would change it. Either way, your cardiologist should be taking the more aggressive approach or you should be looking for a different cardiologist.

https://preview.redd.it/imdzbn8rlwxh1.png?width=1062&format=png&auto=webp&s=8eb29b8b7bbc0f9962bda96f113cccc2c5c574ae

What exactly would the CAC do? It doesn’t zap or treat the plaque. It’s just a diagnostic tool to help diagnose people in borderline situations. You are way over that line and you need to be treated either way.

I would look for a different cardiologist. First off, particle size is not recommended for treatment guidelines. Second, CAC scans aren’t recommended for women until age 45. Third, the 10% diet change is based on averages and vary widely person to person.

The advice that you need a statin seems very sound though. Family member having a premature cardiac event is a significant Risk Enhancer and you should probably target an LDL under 70. Also your LDL is over 190, which indicates severe hypercholesterolemia and comes with a Level 1 Strong recommendation to treat with max dose statin and additional medication, if necessary.

This is bad advice that does not follow prevailing medical literature.

Sounds like the correct priorities. Unless you are a brain surgeon. If you are a brain surgeon, you should probably get back to work on that open skull on the table.

The only things I really needed from home was a long phone plug and a few pairs of boxers. For everything else, what ever the hospital provided was fine. Also you can always have a family member/ friend or even Uber order if there’s something you really want.

You will be in great hands and will come out of this stronger than ever!

Im 4 months out from mine and feeling great. Do you still think about it every day? (I do)

I had a different open heart procedure 4 months ago and I feel great! Pretty much back to normal recovery wise and full of love for life. This might be the best thing that ever happened to him

You can scroll thru the sub or use search to find a bunch of posts with similar questions and people’s personal experiences.
Just one quick tip is that you shouldn’t have to see him with a breathing tube if you don’t want (and most shouldn’t want to see that). Either it will be out by the time they get you or you can just wait. He’s not going anywhere in that 30 minutes

Tell me more about how the world works

It’s called using a citation ya weirdo. The opinion/thoughts/ human element is in the paragraphs I wrote out.

The “flowchart “ is just a snip from the 2026 AHA Guidelines which provides the highest level authority for a citation as it’s a consensus of the smart people scientists you mention.

This sub requires advice to be backed by the prevailing scientific literature. If you are looking for a place that caters to conspiracies and toilet drivel, probably want to look somewhere else.

Excellent work. I was in a similar situation of having a disappointing / less than expected first result so I understand how that feels. Everyone responds to treatment differently and sometimes it takes some trial and error to get there. Glad the diet changes made a big impact and its good to know you also have more options like trying Zetia in your back pocket.

Listen to your doctor and come back here if you have more questions. You got this!

See my comment above. The purpose of this sub is to help people, not cherry pick what we want to see or hear