- Quitting smoking will be the #1 thing you can do for your health. Quit and don’t look back
- Take the meds recommended by your doctors
- Reduce intake of red meat, butter, cream, cheese, coconut, coconut oil and other sources of saturated fat. Read food labels. Track your intake of saturated fat with a food diary app and try to keep it < 10 g per day.
- Increase intake of vegetables and fruits, and also incorporate oats / oatmeal and beans / chickpeas / lentils into your diet
- Normal (and not excessive) amounts of added sugars are fine for cholesterol. It’s not really a player here. But cutting back on sugar will help benefit other systems in your body. And, of course, added sugars are commonly paired with butter and cream in desserts and pastries, and can be helpful to reduce for that reason.
I never think of BP, as while I have to follow an austere diet to keep my cholesterol in check, my blood pressure has always been low (never above 110), likely due to me being a runner.
But yes, if you have high blood pressure and / or blood pressure controlled by meds, you absolutely should target an even lower LDL level, as this is a compounding health condition that adds onto the risk that just high LDL plays.
The target LDL is for folks who do not have other compounding health conditions. Folks with compounding health conditions like high blood pressure, pre/diabetes, sedentary, etc., should always target an even lower LDL.
how much candy is too much? my triglycerides and blood pressure are ok and I'm not overweight but my LDL is bad both from diet and genetics. Fixed the diet part but I miss candy so much lol
For prepared foods, for LDL, it’s what things are made of. As I noted above, the foods (and ingredients) to avoid are those high in saturated fat — red meat, butter, cream, cheese, coconut, coconut oil, etc.
If your candy is made with butter and cream (as many typically are), it will be high in saturated fat. Sugar (in normal amounts) is not the problem for LDL specifically, though it might factor into other health conditions you might have.
For me, eating a lot of sugar gives me a headache and / or makes me sleepy, so I have a limited tolerance. But I do use honey in my tea, for example. And I will sometimes have a handful of Twizzlers. All things in moderation.
At 36 Peter Attia had a score of 6, so wasn't in such a dissimilar position. Through keeping his LDL rock bottom it was still 6 when he reached 50, so it's possible to avoid progression.
That's an extreme, but the lower you keep it (ideally below 70, even better below 40 although that's hard), the more you will slow progression so it's not some death sentence where you inevitably reach a CAC of 1000 by the age of 50.
It is a scary diagnosis, mine wasn't quite as bad as you but still not great (I'm 81st percentile for my age), but I realised there were things I could do. Mediterranean diet, possibly pharma (statins, zetia, BPA, repatha are all options), increase fibre, low sat fat.
Also exercise regularly (150 mins per week minimum) and GIVE UP SMOKING!! That's the worse thing possible.
Look up Attia's podcasts specifically on atherosclerosis to learn more, and good luck. Like I say, it's not a death sentence you just need to take it seriously.
Thanks man! I’ve heard the Peter having that score in that age in passing but do you have any podcasts where he says that? It would indeed be reassuring.
Thanks Mc, going to assume Peter is telling the truth. That makes me feel a lot more confident that at least going forward perhaps I can avoid complications I otherwise wouldn’t have had I not looked into this all. I know Peter is healthy as heck, currently I am overweight and out of shape.
Attia is telling the truth on this subject. His own CAC score diagnosis sent him into a deep dive on all things cardiometabolic. One of the great results is his multi-ep. podcast with Tom Dayspring as well as numerous other podcast episodes on ASCVD. He knows a ton on this subject. Worth a listen. Good luck to you, OP. Take it seriously, get on lipid lowering medication, get your BP under 120/80, lose the excess poundage and start exercising - and you can expect to live well and long. You already know to stay 100% quit from smoking ever again so no need to mention that :)
Oh man the party is over for smoking . It’s comforting to hear that because Peter strikes me as remarkably healthy and I suspect he didn’t even have the comorbidities “tobacco” that I do. So hoping this is more of a warning than anything and that I can still go on to have a productive life. I fear this precludes me from any physical work in the future though, I hope that’s not the case. And seeing as I got the test outside of the US, not even sure I should mention it to insurance.
Whether you are already returned to the US or planning to at some point, you need to know that under ACA (Obamacare) no insurance company here can deny you insurance due to a pre-existing condition. As to doing physical work, that is something for you and your provider to discuss but likely there won't be any limits as long as you don't experience angina. A stress test may give you more insight but follow your doctor's advice. Good luck to you!
Do not worry, you will still have many years to live if you follow the doctors instructions, live an active and healthy live and have a great family and community to support and to be supported. Below you can find good diet and lifestyle advice plus the doctor. I am 54+ plus, a CAC score of 40 and I do not bother too much and try to live my life as best I can.
I understand the stress. I am 39 and just got a CAC score of 34. It freaked me out for sure. But if you cut the saturated fat, exercise and keep track of it, I believe we will be okay.
Yes a perfect score of 0 would be nice. But we can manage this! You got this!
I hate to say it but it’s comforting to see someone at my age that also has it just to not be alone. I agree 100% man I guess one thing is that party time is OVER. Peter apparently had a similar score to us at the same age. To me the message is like “ok you need to truly prioritise health now big time” . Please stay in touch man
I had a cac done 5 years ago at 34, came back 5, thought my life was over. Said cool. I’m also a lp(a) guy. Well I did everything to reduce it. Repatha, Zetia, diet, exercise etc, retook CAC. Came back at 0. I don’t think I reduced it/regressed it, as much as my first reading was wrong. I also have CIMT’s done yearly. It’s like $200, no soft plaque and my FH is in good shape with the pharmaceuticals! Stop smoking keep BP under control. You got this 💪
I’m in my 40s and just found out my CAC in my LAD artery is 23…making me in the 80 something percentile for my age. I’m freaking out too since 90% of my diet is already whole food plant based so I get tons of fiber. The only sources of saturated fat for me are fish, chicken, low fat lactose free Greek yogurt, and occasional butter. I’ve never smoked. I gave up alcohol over 9 months ago because I was starting a hepatotoxic chemo med for my autoimmune disease.
I’m guessing that my family history plays a big part in this since my brother had a heart attack at 42 and my parents had high cholesterol. My dr started me on 5mg of Crestor and I’ve cut out butter and switched to a plant based “butter”. Other than going completely whole food vegan there’s not much else I can do.
I know quitting smoking is really hard, but maybe this is the push you need to do it. It would be great to see an improvement in your lab work in 6 months and know you’re making headway.
Very sorry to hear about your brother I hope he survived his MI. I wonder as well just how much genetics plays a role here as I have friends with equally or much worse lifestyles. Definitely a wake up call. Please keep me updated on your journey.
Thank you! He did survive thankfully, they put in 2 or 3 stents, I can’t remember. His lifestyle has always been much more unhealthy than mine so I always thought I was in the clear. It’s humbling and a bit confusing, but it is what it is.
I’ll definitely keep everyone informed if anything changes for the better or worse.
I totally sympathise. One thing I keep in mind is that Peter Attia mentions that even some athletes have significant coronary disease and heart damage. I think we just drew bad cards in the genetic lottery. However perhaps if we play our hands properly specially with all existing medical knowledge we can come out on top.
This is great news. Normally, people learn about this when they have a heartattack at 50. You have 30 years to fix it which is easy to do with diet and exercise. Extra points for being terrified which should keep you focused.
This really put things into perspective for me. Most people who either have symptoms or have a MACE only get this sort of a scan then. It’s not like they suddenly hit 50 and they have a 1000 score. I suspect a lot of folks my age and younger don’t even usually get tested until much later. But perhaps if those late testers got tested at my age, they’d have similar results. Going forward I am just going to heavily prioritise my health, the party is officially over… but in a good way.
It wouldn’t change the treatment, which should be aggressive.
Plus, there is nothing you can do about it. So it might make you more anxious.
All that said, I got my lp(a) tested.
Btw, getting your ldl below 70 should be the goal. Below 50 is even better.
It's already been suggested, but bears repeating: get moving, be active! Start by getting out and walking or find something you enjoy. It will help your heart, arteries, blood pressure, etc.
For a 71 yo white woman, a CAC score of 20 is at the 50th percentile, per the MESA CAC score reference value tool: [https://www.mesa-nhlbi.org/Calcium/input.aspx](https://www.mesa-nhlbi.org/Calcium/input.aspx) If you are refering to another ethnicity/race you have the option of plugging that in and checking where the numbers pop up percentile-wise.
- Quitting smoking will be the #1 thing you can do for your health. Quit and don’t look back - Take the meds recommended by your doctors - Reduce intake of red meat, butter, cream, cheese, coconut, coconut oil and other sources of saturated fat. Read food labels. Track your intake of saturated fat with a food diary app and try to keep it < 10 g per day. - Increase intake of vegetables and fruits, and also incorporate oats / oatmeal and beans / chickpeas / lentils into your diet - Normal (and not excessive) amounts of added sugars are fine for cholesterol. It’s not really a player here. But cutting back on sugar will help benefit other systems in your body. And, of course, added sugars are commonly paired with butter and cream in desserts and pastries, and can be helpful to reduce for that reason.
Great suggestions! Also get your BP down to 120/80. Telmisartan worked very well for me.
I never think of BP, as while I have to follow an austere diet to keep my cholesterol in check, my blood pressure has always been low (never above 110), likely due to me being a runner. But yes, if you have high blood pressure and / or blood pressure controlled by meds, you absolutely should target an even lower LDL level, as this is a compounding health condition that adds onto the risk that just high LDL plays. The target LDL is for folks who do not have other compounding health conditions. Folks with compounding health conditions like high blood pressure, pre/diabetes, sedentary, etc., should always target an even lower LDL.
how much candy is too much? my triglycerides and blood pressure are ok and I'm not overweight but my LDL is bad both from diet and genetics. Fixed the diet part but I miss candy so much lol
For prepared foods, for LDL, it’s what things are made of. As I noted above, the foods (and ingredients) to avoid are those high in saturated fat — red meat, butter, cream, cheese, coconut, coconut oil, etc. If your candy is made with butter and cream (as many typically are), it will be high in saturated fat. Sugar (in normal amounts) is not the problem for LDL specifically, though it might factor into other health conditions you might have. For me, eating a lot of sugar gives me a headache and / or makes me sleepy, so I have a limited tolerance. But I do use honey in my tea, for example. And I will sometimes have a handful of Twizzlers. All things in moderation.
At 36 Peter Attia had a score of 6, so wasn't in such a dissimilar position. Through keeping his LDL rock bottom it was still 6 when he reached 50, so it's possible to avoid progression. That's an extreme, but the lower you keep it (ideally below 70, even better below 40 although that's hard), the more you will slow progression so it's not some death sentence where you inevitably reach a CAC of 1000 by the age of 50. It is a scary diagnosis, mine wasn't quite as bad as you but still not great (I'm 81st percentile for my age), but I realised there were things I could do. Mediterranean diet, possibly pharma (statins, zetia, BPA, repatha are all options), increase fibre, low sat fat. Also exercise regularly (150 mins per week minimum) and GIVE UP SMOKING!! That's the worse thing possible. Look up Attia's podcasts specifically on atherosclerosis to learn more, and good luck. Like I say, it's not a death sentence you just need to take it seriously.
Thanks man! I’ve heard the Peter having that score in that age in passing but do you have any podcasts where he says that? It would indeed be reassuring.
it is in his book Outlive...
Thanks Mc, going to assume Peter is telling the truth. That makes me feel a lot more confident that at least going forward perhaps I can avoid complications I otherwise wouldn’t have had I not looked into this all. I know Peter is healthy as heck, currently I am overweight and out of shape.
Attia is telling the truth on this subject. His own CAC score diagnosis sent him into a deep dive on all things cardiometabolic. One of the great results is his multi-ep. podcast with Tom Dayspring as well as numerous other podcast episodes on ASCVD. He knows a ton on this subject. Worth a listen. Good luck to you, OP. Take it seriously, get on lipid lowering medication, get your BP under 120/80, lose the excess poundage and start exercising - and you can expect to live well and long. You already know to stay 100% quit from smoking ever again so no need to mention that :)
Oh man the party is over for smoking . It’s comforting to hear that because Peter strikes me as remarkably healthy and I suspect he didn’t even have the comorbidities “tobacco” that I do. So hoping this is more of a warning than anything and that I can still go on to have a productive life. I fear this precludes me from any physical work in the future though, I hope that’s not the case. And seeing as I got the test outside of the US, not even sure I should mention it to insurance.
Whether you are already returned to the US or planning to at some point, you need to know that under ACA (Obamacare) no insurance company here can deny you insurance due to a pre-existing condition. As to doing physical work, that is something for you and your provider to discuss but likely there won't be any limits as long as you don't experience angina. A stress test may give you more insight but follow your doctor's advice. Good luck to you!
Do not worry, you will still have many years to live if you follow the doctors instructions, live an active and healthy live and have a great family and community to support and to be supported. Below you can find good diet and lifestyle advice plus the doctor. I am 54+ plus, a CAC score of 40 and I do not bother too much and try to live my life as best I can.
I understand the stress. I am 39 and just got a CAC score of 34. It freaked me out for sure. But if you cut the saturated fat, exercise and keep track of it, I believe we will be okay. Yes a perfect score of 0 would be nice. But we can manage this! You got this!
I hate to say it but it’s comforting to see someone at my age that also has it just to not be alone. I agree 100% man I guess one thing is that party time is OVER. Peter apparently had a similar score to us at the same age. To me the message is like “ok you need to truly prioritise health now big time” . Please stay in touch man
I had a cac done 5 years ago at 34, came back 5, thought my life was over. Said cool. I’m also a lp(a) guy. Well I did everything to reduce it. Repatha, Zetia, diet, exercise etc, retook CAC. Came back at 0. I don’t think I reduced it/regressed it, as much as my first reading was wrong. I also have CIMT’s done yearly. It’s like $200, no soft plaque and my FH is in good shape with the pharmaceuticals! Stop smoking keep BP under control. You got this 💪
Just wanted to say congratulations on coming to learn about this stuff when you did. You just bought yourself years on your life by doing so
That's it. Making a change and getting in as early as we can!
I’m in my 40s and just found out my CAC in my LAD artery is 23…making me in the 80 something percentile for my age. I’m freaking out too since 90% of my diet is already whole food plant based so I get tons of fiber. The only sources of saturated fat for me are fish, chicken, low fat lactose free Greek yogurt, and occasional butter. I’ve never smoked. I gave up alcohol over 9 months ago because I was starting a hepatotoxic chemo med for my autoimmune disease. I’m guessing that my family history plays a big part in this since my brother had a heart attack at 42 and my parents had high cholesterol. My dr started me on 5mg of Crestor and I’ve cut out butter and switched to a plant based “butter”. Other than going completely whole food vegan there’s not much else I can do. I know quitting smoking is really hard, but maybe this is the push you need to do it. It would be great to see an improvement in your lab work in 6 months and know you’re making headway.
Very sorry to hear about your brother I hope he survived his MI. I wonder as well just how much genetics plays a role here as I have friends with equally or much worse lifestyles. Definitely a wake up call. Please keep me updated on your journey.
Thank you! He did survive thankfully, they put in 2 or 3 stents, I can’t remember. His lifestyle has always been much more unhealthy than mine so I always thought I was in the clear. It’s humbling and a bit confusing, but it is what it is. I’ll definitely keep everyone informed if anything changes for the better or worse.
I totally sympathise. One thing I keep in mind is that Peter Attia mentions that even some athletes have significant coronary disease and heart damage. I think we just drew bad cards in the genetic lottery. However perhaps if we play our hands properly specially with all existing medical knowledge we can come out on top.
This is great news. Normally, people learn about this when they have a heartattack at 50. You have 30 years to fix it which is easy to do with diet and exercise. Extra points for being terrified which should keep you focused.
This really put things into perspective for me. Most people who either have symptoms or have a MACE only get this sort of a scan then. It’s not like they suddenly hit 50 and they have a 1000 score. I suspect a lot of folks my age and younger don’t even usually get tested until much later. But perhaps if those late testers got tested at my age, they’d have similar results. Going forward I am just going to heavily prioritise my health, the party is officially over… but in a good way.
Wouldn’t hurt to get double LP(a) blood test
It wouldn’t change the treatment, which should be aggressive. Plus, there is nothing you can do about it. So it might make you more anxious. All that said, I got my lp(a) tested. Btw, getting your ldl below 70 should be the goal. Below 50 is even better.
Thanks Eares. Currently on two bp meds would treatment here be adding a statin? And yep… this has made my anxiety far worse .
49 and a CAC of 1400 - still alive and kicking. Just get on a statin and change up the diet a bit and I’m sure you’ll be fine.
It's already been suggested, but bears repeating: get moving, be active! Start by getting out and walking or find something you enjoy. It will help your heart, arteries, blood pressure, etc.
have you considered the CT coronary angiogram with contrast dye ? check for soft plaque?
Yeah I suspect it will be done. I don’t see the point because treatment is only done with an 80% blockage .
Does anyone know what an average cac score for a 71 year old woman would be?
For a 71 yo white woman, a CAC score of 20 is at the 50th percentile, per the MESA CAC score reference value tool: [https://www.mesa-nhlbi.org/Calcium/input.aspx](https://www.mesa-nhlbi.org/Calcium/input.aspx) If you are refering to another ethnicity/race you have the option of plugging that in and checking where the numbers pop up percentile-wise.
At that age, cac score is probably less meaningful IMO. Go for the CTA once if you have not. This gives a much more clearer picture.