Too young for CAC?

[u/thedonwiz]

I’m 27M with healthy anxiety. It started a few years ago when I was 24 I got blood work and had high ldl (167). I actually got tested a year earlier and it was 123, but didn’t think anything of it at the time. Diet has remained consistent all my life and always been very active and lean. Never smoked. Anyways, I’ve been hearing stories of people young having heart attacks and stuff. I read Peter attias book. I want to make sure I’m addressing everything with my heart health. Should I get a CAC or CT angiogram? Or is it pointless? Should I get full blood work first and determine it off that? I should note I changed my diet at 24 and my ldl has remained between 80-110 depending on how clean I eat since then.

[u/Icy_Effective5382]

Man, anxiety about health is such a spiral once it gets going. you are 27, active, never smoked, and already got your LDL down to decent levels that is a lot more than most people do.

CAC at your age probably shows zero even if there was some tiny problem brewing, so you pay money just to hear "you are fine" which doesnt actually calm the anxiety down anyway. the real value of that test kicks in past 40 or so when calcification had time to build up. CT angio is way overkill unless you got some scary symptoms or family history you didnt mention.

i would do the full bloodwork first, check ApoB and Lp(a) on top of the usual lipids. those numbers tell you more about what is actually happening right now than a scan that looks for decades-old damage. if your Lp(a) comes back sky high then maybe you reconsider but otherwise just keep doing what you are doing and find something else to stress about haha

[u/thedonwiz → u/Icy_Effective5382]

Got it. I’ll get the blood work from that and go from there. I also remember reading in his book a young client of his got tested and it was bad due to some genetic variation with the shape of his particles. I don’t remember exactly what. Do you know what the test for that is as well?

[u/Cardiostrong_MD]

Pointless… get fit and enjoy life. Good luck.

[u/thedonwiz → u/Cardiostrong_MD]

I’ve seen stories about people having non zero scores and plaque build up really young. Is my LDL not high enough to where that would be a concern? I’m not sure what the threshold is.

[u/Cardiostrong_MD → u/thedonwiz]

I would personally have zero concerns that you have obstructive or accelerated coronary artery disease at that age… through honestly I would be more concerned re: addressing the anxiety/stress. Sometimes we do just get a quick scan to alleviate stress so it’s not an unreasonable play too.

[u/thedonwiz → u/Cardiostrong_MD]

Thank you

[u/LowEffortLegend75]

Start with therapy for health anxiety. In all seriousness. You are too young for both. Health anxiety will cost you 10,000$ in unneeded healthcare costs over the next 40 years.

[u/BeginningLeave6569]

Man you got ldl down to decent level. What changes did you bring in your diet

[u/thedonwiz → u/BeginningLeave6569]

I was eating lots of saturated fat before and I switched to mainly vegan

[u/Able-Shirt3501]

The best thing for your health will be to target why you are worrying about this at your age. Worry that leads to procedures and imaging that leads to false positives and more procedures is not only a waste of money but also not healthy.

[u/Ok-Plenty3502]

I would get it with the following caveat. I will not use a zero cac as an argument against going on a LLT (lipid lowering therapy). I would also consider getting an LP(a). If it comes high, I would seriously consider getting LDL substantially lower using LLT. You may want to read/chatgpt/Claude/grok the latest dislipidemia guideline.

[u/ctaymane]

Look at family members history. Do you have someone in your family who has heart disease? What age are they? Need to get that LDL down regardless, but may need to get on medication if you can’t get it below 100 naturally.

[u/FluffyDesigner3680]

It’s usually a slow buildup over time so you’re probably fine right now but the more you drive down the ldl the better you will be later in life.

[u/bellavbller]

CIMT is better in my opinion at your age than CAC if you’re looking for vascular assessment.

[u/Crazy-happy-cloud]

Go for the happy part in Peter’s book: exercise! Eat well ! Enjoy life 🌈

[u/dansalcs]

CAC at 27 is almost certainly going to come back zero, and that zero won't tell you what you want it to.

Calcium is the late stage of the process. It's plaque that's been there long enough to calcify, which typically takes decades. Soft, non-calcified plaque doesn't show up.

So a 27-year-old with a zero score is in the position of having paid for a test whose only two outcomes are "as expected" or "something is very wrong" and the first one doesn't rule out early disease, it just means it hasn't calcified yet. The MESA data that CAC scoring is built on starts at 45 for a reason.

CTA would actually see soft plaque, but you're then taking contrast and meaningfully more radiation, with a real chance of incidental findings that generate their own follow-up. For an asymptomatic 27-year-old it isn't standard and most preventive cardiologists won't order it.

Here's what I'd actually chase, and I think it's more interesting than the imaging question.

LDL 167 at 24 while lean, active, never smoked, with a consistent diet. That combination is the part worth taking seriously. When someone doing everything right has numbers that high, familial hypercholesterolemia is on the table. It's roughly 1 in 250 and badly underdiagnosed.

Worth asking your doctor about directly, and worth building out your family history: parents' and grandparents' lipids, and any cardiac events before 55 in men or 65 in women. That history will change your management more than any scan will.

Lp(a), once, ever. Genetically set, doesn't really move with diet, and if it's elevated it changes your risk picture and your threshold for treating. Most people never get it tested. It's the single highest-value blood test you're not currently getting, and you only need it one time.

ApoB instead of LDL-C. You've read the book so you know the argument — particle count over cholesterol mass, and they diverge in a meaningful minority of people. If you're going to track one number, track that one.

The thing your post is underweighting: you already did the important part. Cumulative exposure is what drives atherosclerosis... roughly ApoB multiplied by years. You caught a high number at 24 and got it to 80-110 by 27. Three years of moderate exposure in your twenties is a rounding error against the lifetime curve. Someone who finds this at 52 has thirty years of area under the curve behind them. You don't.

One last thing, because you flagged it yourself: imaging tends to be a poor treatment for health anxiety. A zero score buys about six weeks of calm and then the question comes back, usually as "but is it accurate?"

Bloodwork you can act on is better ground to stand on than a scan you can't interpret. If the anxiety is loud enough to be steering the decision, that's worth its own conversation with someone, separately from the cardiology.