My score was 164, results went to my doctor who wants to put me on a statin. I'm otherwise very healthy, exercise daily - either weigh training, cycling, hiking, tennis.
I really don't want to be taking statins if I don't need to. My Total Cholesterol is 208 as of last June, which is a little on the high side, but not bad. Can I control this through diet and not take the statin?
You absolutely want to take a statin (or other lipid lowering medication if you are intolerant). There are several reasons for this. I calcium score of 164 is not good. A high calcium score is a sign of atherosclerosis. Heart disease needs to be treated.
1. If you have calcified plaque you almost certainly have soft plaque. Soft plaque is what causes heart attacks when it ruptures. Over a long period of time (years) soft plaques calcifies. You can't do anything about the calcified plaque you have. If LDL is low enough you can stop the development of new plaque and may be able to regress some (not all) soft plaque.
For many people with a positive calcium score the desired LDL is under 70. Most people can't get to that level without medication. If you want to have a chance of plaque regression you want LDL below 55. Hardly anyone can reach that level without medication.
I personally have a high calcium score (600s) and take a statin with a goal of under 50. Currently LDL is 39. As someone with heart disease I want to lessen my risk of a heart attack and medication is the way to do that. I also take a low dose aspirin each day. Having a high calcium score is a recommended reason for aspirin because you are no longer taking a statin for primary prevention of heart disease. You are taking it as secondary prevention.
2. When you have calcified plaque people almost always have soft plaque that hasn't calcified. Soft plaque is far more dangerous than calcified plaque. The rupture of soft plaque costs most heart attacks. One good thing that statins do is speed up the process of plaque stabilization thereby calcifying that dangerous soft plaque. This is good since calcified plaque is less dangerous.
Talk to a cardiologist about all this. I am not sure your doctor has properly explained to you how you are at such higher risk now that you know you have a lot of calcified plaque.
Your HDL to LDL ratio and TG to HDL ratio are very good.
They used to think that ratios were important. But, nowadays, not so much. It is of course good to have an optimum level of HDL and it is good to have low triglycerides. Absolutely none of that changes the danger that LDL poses to someone. In this case the OP has actually developed heart disease! It is not a good idea not to treat heart disease.
People have lowered their CAC score with a very low carb diet plus taking Vitamin K. It truly is not set in stone only to go up.
The whole targeting cholesterol is probably very outdated these days. But it’s so embedded in the medical and drug culture that changing will be extremely slow.
FWIW people above 60 with higher cholesterol levels have higher longevity.
People do not lower their CAC score. Calcified plaque does not go away. People can regress some soft plaque if their LDL is low enough (typically under 55).
So here is the thing about longevity and cholesterol levels. Take someone without heart disease and their LDL is 100 without medication. Now, take me. My LDL is 39! Yet, I am far more likely to die from a heart attack than the person without heart disease. Why? I have heart disease. I have 4 blockages in my arteries including a 60% to 70% blockage of my LAD. (I didn't need stents as my blood flow is fine). I am taking high intensity statin and low dose aspirin. So my risk of a heart attack now is much lower than it was. Great. But, I still have heart disease and I am sure that I still have some soft plaque that was there before I started medication. All of this is a long way of saying that many people with low LDL who have heart attacks or strokes were already at greater risk because they have established design. Medication can reduce the risk but not eliminate it.
And, yes, they absolutely do target lowering of LDL (or ApoB) as that one major thing that can be done to lower risk.