re: Just had my annual physical and got my blood panel back

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Total Cholesterol- 188
HDL- 57
LDL- 118
Tryg- 59
Non-HDL- 131

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Your numbers are borderline in/out of range. I'm sure some doctors would prescribe a statin based on them alone. Probably more of a patient call/risk tolerance view at your levels, family history, any hypertension, etc...Again, based on numbers alone. For reference, I'm around 40% higher than you in total, non-HDL, and LDL and am still working through the process. Statins are not a slam dunk for me despite having numbers that would indicate so.

In your case, the CAC score of 1400 is way, way more concerning. Anything greater than a 400 (at any age) is considered a severe risk. I know you had a heart cath, but still...

I would get the advanced panel linked previously and again below ($150, no doctor order needed). From there, I'd work with a cardiologist for sure. If you're current one is not up to date on modern testing, maybe get a second opinion after you get your labs. I would not mess around taking advice from people on the internet with a CAC of 1400 - myself included. Heart disease is still the #1 cause of all mortality, and I would take the long view on it - i.e. how will decisions you make today affect your health/longevity 20 years from now.

And one last point on CAC score. See the conclusion below from a study on CAC scores in adults under 50:

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The presence of CAC among individuals aged between 32 and 46 years was associated with increased risk of fatal and nonfatal CHD during 12.5 years of follow-up. A CAC score of 100 or more was associated with early death. Adults younger than 50 years with any CAC, even with very low scores, identified on a computed tomographic scan are at elevated risk of clinical CHD, CVD, and death.

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Labs:
LINK

Study:
LINK /