Q. Is angiogram necessary for a 72-year-old man with high blood pressure and cholesterol?

Hi doctor,

My father is 72 years old and his blood cholesterol levels are high. He is currently under medication (ASA and two other drugs) to control his blood pressure. But he does not have any other symptoms like chest pain. My father's cardiologist advised that he should get a CTA test done. Here is the result. Agatston CAC score: 35. LM: without stenosis. LAD: Calcified and soft plaque at ostium to proximal portion with about moderate stenosis. Calcified plaque at mid-portion, followed by muscle bridge segment with mild narrowing. Calcified plaque at mid of diagonal with mild stenosis. LCx: Without stenosis. RCA: Is dominant vessel, without stenosis. After the test, we visited four cardiologists. Two of them suggested that my father needs a traditional angiogram. Other two doctors suggested that he does not require an angiogram and only needs medication to control his cholesterol levels. We are very confused. From your perspective, what do you think is the best solution? Please help. Thank you.

Thanks for your reply, doctor.

I am answering your questions one by one. Apart from high blood pressure, he has a benign prostatic hyperplasia. His LDL is 165 mg/dL, HDL is 35 mg/dL, triglyceride is 263 mg/dL, and VLDL is 52.6 mg/dL. (Please find the attached reports below). No, he does not have any chest pain or other complaints. No, he is active and has not become weak. Every morning he goes outside for a 30-minute walk. I appreciate your help, doctor. Thank you.