My cholesterol isn’t as high as yours but will over the “limit” for doctors to recommend statins (~260) but my old country doctor is up-to-date and circles my excellent ratios (HDL is very good) and writes smiley faces on it with “Great!” on my cholesterol numbers.
We just got letters in the mail that he is retiring and a nurse practitioner is taking over his practice. We have been expecting this but sorry to see it actually happen.
If what they said was that Lp(a) is bad, I’m a black swan. My Lp(a) is insanely, ridiculously high, yet I got a zero score on CAC (one test) and have no aortic stenosis, verified by multiple transthoracic echocardiograms over the last 8 years.
How dare he?! Well, this may be your chance to educate a younger one. I wonder if newer docs have any better training in this area.
I know, right? The nerve!
I am expecting to get a lecture next year even though my CAC is zero. I don’t care - will just smile and nod and ignore it.
I actually tried another PCP in 2019 because I knew this coming. I was told I needed to lose weight (even though I am only about 20 lbs overweight and one of the few patients in the waiting room who walked in w/o a cane, walker or wheelchair!)
She then proceeded to tell me to eat a low fat, low salt diet (even though my blood pressure is low-to-normal w/o medication). My husband glanced at me to see my reaction and I was nodding and smiling. I thought he was going to choke on the laugh he was stifling! 
@PaulL I remember some time ago we discussed a study comparing CAC scores with cholesterol numbers to see if there was a correlation.
Do you know if that study was completed and what the results were?
Cheers
Alec
Good question, and the answer is that I have no idea. I’ll try to find time to check.
I haven’t looked into Lp(a) for awhile. I think Dr. Malcolm Kendrick had some really good stuff on it in his writings (blog).
The Lp(a) stuff is described in the discussion between Saladino and Goodrich, and they clearly say that Lp(a) levels are a clear proxy biomarker for oxidised linoleic acid in LDL. But they triangulate the oxidised LDL with other inflammatory markers such as hsCRP. It’s that oxidised linoleic acid in the LDL that could be at the heart of inflammatory problems.
I know it’s Saladino, but he is not so toxic in small doses. Go to the 36.00minute mark to hear the relevant section.
Lp(a):
Our n=2 says no, unless inverse correlation or talking ratios not total cholesterol.
My husband’s cholesterol is under 200 and had a CAC in one artery slightly over 100. My cholesterol is ~260 and had a score of 0. Our ratio’s are similar, although my ratios are slightly better than his due to my high HDL.
eta: neither of us has ever taken a statin
Well, tell him to get his cholesterol up, then! 
The most informative number, even more than LDL numbers, is supposed to be the ratio of triglycerides to HDL. Under 2.0 in American units, under 0.9 elsewhere.
Yeah, we are both good on Trig/HDL ratios - mine was 0.6 and his was 0.8 this year.
Lp(a) is primarily genetic, so I’m not sure where they get this. See here for instance:
While one may be able to modify the amount via diet (some evidence suggests saturated fat is better at lowering Lp(a)), you can only modify it so much. For instance, here are some of my values:
I got a 221 in December of 2020.
So, my lowest value is about 3 times the suggested “good” value of 75.
I theorize the 221 was while on a high saturated fat diet. The highest values were all during/near fasting a lot (Lp(a) follows Dave Feldman’s energy theory for me).
So, while PUFAs might affect this value, if I have such extremely high values with a CAC scan score of zero and no aortic stenosis*, then what does that mean? I mean if you have a value of 75 and PUFAs cause it to rise to 100, you’re half to a third my values.
I agree, things are complex. The thing I don’t understand is why they are mentioning LP(a) as a bio-marker or proxy for oxLDL oxidised LDL?
A lot of what Saladino parrots is summarised in this paper by DiNicolantonio:
Korean study proves that low total cholesterol is risky
NHANES Survey - Low LDL associated with death
I don’t think you need to worry about cholesterol.
