Would you recommend a statin for someone with these test results and MESA score? She has a BMI of 22, LDL-C of 143 mg/dL,Lp(a) of 79 nmol/L (<75 is normal) exceeds physical activity guidelines, has a pretty good diet and is otherwise healthy. Such a low score on the MESA risk calculator is encouraging, although the lipid panel and Lp(a) are somewhat high.
I would probably not recommend lipid lowering therapy based on the information you have provided, but this always involves an individual conversation with the patient to discuss their preferences, potential benefits vs. potential risks, etc.
I suppose the risks of statins are very low, while some suggest that LDL-C (or non-HDL C or ApoB) should be very low as a preventative measure, given the cumulative nature of lifetime exposure.
As an off-topic aside, I had earlier asked what might cause substantial increases in Lp(a) levels. A Test in Context: Lipoprotein(a): Diagnosis, Prognosis, Controversies, and Emerging Therapies - ScienceDirect suggests statins may cause increases of up to 50% in some studies
While this is correct, this individual is already almost 70 years old, has no other significant risk factors, and has a CAC of 0 (a particularly remarkable finding, since most people would not even check in an individual of this age, as it is assumed that the vast majority will have some calcification present by this age).
If her personal preference is to maximally reduce risk above all else, then yes, lipid lowering therapy could be started; but I think the likelihood of clinical benefit (meaning, averting a cardiovascular event or premature death) is very low.
As with any other intervention, there’s a wide range of individual responses here, although the direction of effect generally points towards an increase, yes.