CAC score in 46 year old

Medical Q&A [Moderated]
1

Hi guys!
I would love your take on some recent findings. I’ll try to keep this brief:

I’m 46 years old, 6" 210lbs, waist at 37". This is down from my heaviest at 235 and 40+ waist. I train consistently 3-4 days a week weight training and at least 2-3 days of cardio/gpp. I average about 8k steps per day. Never smoked. Stopped alcohol 5.5 years ago. Blood pressure is consistently good. I’m continuing to slowly improve my body comp and reduce my waist/bw. I attribute so much of my progress to BBM and all your awesome information and resources.

Recently, my Mom just had a doubly bypass heart procedure. Given this recent event my GP recommended I get a coronary calcium score. This came back at a score of 48. Although this falls into the “low risk” category I wonder if it’s low for my age or something to be overly concerned with.

My lipids the last few test have been:
04.23.25
Chol 197
HDL 42
Trig 89
LDL 137.20 (not sure why this particular year came back high)
Chol/HDL ratio 4.69

04.15.24
Chol 179
HDL 47.5
Trig 68
LDL 117.9
Chol/HDL ratio 3.77

04/26/23
Chol 158
HDL 40
Trig 39
LDL 110.2
Chol/HDL ratio 4

Diet wise I try to each as minimally processed as possible shooting for 30 grams + of fiber per day and keeping sat fat under 20 grams per day.

Any reassurance and guidance on these #'s would be great as I want to continue attempting to kick ass for the forseeable future.

Thanks for all you do.
Matt

2

Hey there - great job on your journey so far! That drop in waist measurement is excellent work.

You’re asking some good questions here; even though a score of 48 seems “low”, ideally for someone as young as you are, we’d be looking at a score of 0.

This doesn’t mean you’re in an immediately dire situation, but rather that you do have some evidence of early coronary calcification, and if your goals are to avoid cardiovascular complications like your mother, we ought to attack the risk factors as aggressively as we can.

Regarding the lipids; these labs overall are pretty good, especially your triglycerides. However, if the goal is mitigating the progression of coronary atherosclerosis as much as possible, I’d prefer your most recent panel (indicating a non-HDL-c level of 197-42 = 155 mg/dL) to be a bit lower. The question is how much of this is within your control at this point, versus how much might be genetically driven.

Your diet sounds to be quite solid, especially your fiber & sat fat consumption. I’d encourage regular consumption of fatty fish ~2x/week and some mixed nuts in addition to your fiber and SF targets. You can also consider adding supplemental fiber (such as psyllium) on top of your dietary fiber sources, soy protein, and/or the use of plant sterols as described in the “Portfolio Diet”. Beyond this, the next step for risk mitigation would be the option of medications, which is a bit beyond the scope of what we can cover via the forum here.

It sounds like your training is great and blood pressure is in a good place and would keep that up.

Finally, you didn’t mention your blood glucose or a hemoglobin A1c, but I suspect those look good. I’d also see whether your GP is willing to check a one-time Lipoprotein(a) level.

If you’re interested in further discussion & advice on this or other health matters, we’d also be happy to meet via an individual consultation, which can be arranged via the website.

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