The GLP and weight loss are terrific. They’ll do a lot for you, but it’s not nearly enough given the damage done before now, not the least of which by LDL 250 and the inflammation factory all that visceral fat was. 125 LDL is continuing the work of narrowing your arteries, just at a slower pace.
If you want to live a long life, and a decent shot of avoiding a heart attack or stroke that leaves you out of breath after 3 steps, drooling and in diapers, or in a coffin, you’d be wise to get a CAC (calcium) score. You’ll have to pay for it yourself, but it can be done for around $150. Mostly as a tool, a wake up call, to motivate you to do what’s necessary by confirming the cardiovascular disease you already have.
After it comes back positive showing just how fucked up your cardiac arteries undoubtedly are, you can use that result to get Repatha, which should be combined with a statin (insist on Pitavastatin as it has the lowest risk of all statins), and ezetimibe. That’ll get your ApoB and LDL down low enough to stop any further plaque buildup (you’ve already got a ton), remove (a little, but it’ll help) some of the fresher plaque, and start stabilizing the rest. Then your risk will slowly back away from the cliff, going down each year as you maintain the weight loss and good lipids.
If you’re lucky all this will start before you develop angina, and none of your vessels are on the threshold of the 90% blockage where noticeable symptoms begin and you’ll have to pencil in some time to get a stent (or 3).