I think you are taking a sensible approach. There is no benefit to being more aggressive than medical management. Yes, events may occur, but getting more aggressive such as getting a CTCA or stents have not been shown to benefit outcomes.
If Lp(a) negative - I’d not goal any more aggressively, in general than an APOB anywhere in the 50’s.
There is some literature on Nattokinase in higher doses helping - there may be some excess bleeding risk there, as the literature isn’t as complete as I’d like it on the safety aspect. It is probably safe, but I’d talk with his doctor if thinking about this.
Getting something to non-invasively follow, such as carotid intimal thickness by U.S. might be a sensible approach to monitor yearly.
What shape is Dad in otherwise? This is really important in determining the longer plan - and naturally I can’t give advice specific to him - but in generalities - if someone isn’t likely to be alive 10 years from now due to non-vascular disease causes, the approach might be a little less aggressive than someone you think might otherwise make it to 100.
Irrespective, generally not a reason for panic. Also was the 300 CAC added diffusely through multiple vessels or focused all on a couple of vessels? I tend to be a little less excited if there is a bit in multiple places that add up to this versus almost all of it focused in one focal area. If so, then some might argue for a CTCA.
Anyway, hopefully this helps you contextualize a little on coming up with a plan with Dad’s doctors to most safely navigate through this.
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@DrFraser Dad is in great shape except for the CAC results. He goes to the gym three times a week and is mentally tip top. He is a vegetarian. He did have a fight with prostate cancer that he won about 3 years ago. He had an LDL of 130 and ApoB of 120, but started Bempedoic Acid and Ezetemibe and it lowered to 65. All of his other blood biomarkers are optimal. That’s why we were so surprised by these results. We are hoping he can make it to 100 or beyond.
About 50% of the calcium is in the right coronary artery. So it appears to be concentrated. 
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Beth
#11
DeStrider,
If it gives you hope, I have been well over 400 for at least 15 years. Over 300 for well over 20. I also have elevated Lp(a)
My cardiologists are at UCSF and I can only share that they tell me not to worry about it (easy for them to say, right?!). For ME, they have told me there is nothing I can’t do and I’m perfectly healthy (aside from this one big thing). AKA, go run marathons if I so wish. I do know my plaque is not in the widow maker. As Dr F has said, they also told me they never do stents preventatively, and aside from medicine, diet, and exercise, there is nothing to do.
If there is shortness of breath or another sign, then you go and have the testing done… I did and went for all the testing but I was fine.
And glad he’s a vegetarian…. If he can give up all the sat fat he’s willing to give up, that would is what they would advise. Meaning, give up cheese/butter if he is willing.
I don’t tolerate statins so am on a pcsk9… i started ezetemibe recently … also on colchicine
Oh, and don’t forget baby aspirin… they advise me to take on 3x per week… I probably take a little extra
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I’d expect those results with having an APOB of 120 … likely for many decades. The other usual focuses are making sure Dad is insulin sensitive and his BP is well controlled. Those would be the usual risk mitigation approaches that have reasonable evidence.
Sounds like Dad is lucky to have you looking after him … It’s a problem with the health system that, if the lipids were like this 30 years ago, that it wasn’t addressed and managed for the entire time.
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@DrFraser Should we be worried that 50% of the calcification is in the right coronary artery?
As for BP, he just started Telmisartan 20 mg. He’s in the 120-130 SBP and 60-70 DBP range. He is also taking Empagliflozin and Metformin along with Rapamycin (4 mg + GFJ).
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You could try manganese
I had been taking Nattokinase and K2-Mk7 for over as year previously but no real improvement (probably a dosing issue, too low)
My PWV (pulse wave velocity) improved significantly after I started 5mg x 5 days a week and 10mg x 2 days a week.
My results
The study I based the beginning of this experiment on.
Not a new discovery, manganese is known to have lipid and plaque related benefits.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9529386/
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AnUser
#15
Could you get an appointment with Thomas Dayspring?
I think he would add a PCSK9 inhibitor.
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Jeff_A
#16
Fortunately, this is not particularly significant in an asymptomatic pt > 75. Some would go as far as to say it may often cause more harm than good for most in that age group to perform CAC. He’s at 52% percentile, so he’s just an average 77 yo man. I had a 48 yr old pt last week with a CAC of 930. All 77 yo men have +CAC, only 2% of 77 yo men have a CAC of 0.
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@Jeff_A But it would still be advisable to take a low dose statin like atorvastatin to reduce any further build up, correct?
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Jeff_A
#18
Yes, I would pursue all tx as normal to hit targets. > 400 CAC your targets should be the same as those who have already had an event. By more harm than good, I meant many will be much higher than this at 77. Often into the 1000s, I’ve seen one 7000+ CAC personally. Then they have caths, leading to stents that they may or may not need. Many 77 yr olds esp w/ scores into the 1000s have multiple comorbidities and it is generally best to leave them alone if they have no symptoms. But people will freak out, it will cause mental issues and they’ll often demand everything be done, which can be a particularly slippery slope in this population.
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Wow. A 7000 score! How was he able to survive?!
Thanks for your words of wisdom. My father did panic at first, but knowing he is about average has pacified him a bit.
Thanks again. 
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Wow, these are some wild claims (not by you but by whatever your research has led you to). Can you link to any of this research/ studies?
I updated my original post with some citations : Mainstream medical care does not admit to Artherosclerosis reversal because it is hard to achieve. WWII studies of many victims of starvation found them with no Artherosclerosis, even though it was common in Europe at the time : the presumption is that extreme fasting reverses Artherosclerosis, but no doctor can recommend that as a treatment!
Ask the doctor: Is it possible to reverse coronary artery disease? - Harvard Health
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Is it related to fasting itself or to CR to very low levels of body fat?
AnUser
#23
What’s the source paper for this claim?
What is your CAC after your protocol, and what does your CT angiogram say?
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AnUser
#24
That is not what the cited paper says.
Neither does this other citation say this.
Here is the cite for Artherosclerosis reversal from starvation Ask the doctor: Is it possible to reverse coronary artery disease? - Harvard Health.
I never did the full dosage protocols for Natto + Serrapeptase + Lumbrokinase, because my CAC = 1 (almost no calcified plaque) and CIMT = 0.726mm (basically no plaque in Carotid artery). Will retest yearly and next year will include an MRA (MRI angiogram is just slightly more expensive than CT angiogram, around $600 without insurance in San Diego, and comes without the added cancer risk of radiation).
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Those are exact quotes from the same citation : recheck the link you followed.
AnUser
#27
Those quotes in the paper you linked does not say atherosclerosis is reversed in the papers they cite.
That isn’t the primary source paper.
That LDL seems rather low. Man cannot live without cholesterol. It is the LDL particle numbers and size that are important. Both the brain and the liver produce cholesterol. That plaque results when something happens to an artery and calcium and cholesterol rush in to patch it up. Often caused by some trauma…like maybe big insulin spikes. Metabolic health may be a far better indicator of overall health. Most of us are insulin resistant and that is a big problem. Do some research.
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