High CAC Score/AFIB - Under 40 and all other metrics good

I can't help much since I am not well educated with this topic, but there is likely to be a familial component to high CAC. There are, I believe, known genetic markers for high CAC, and maybe it would help to pinpoint which, if any, you have. From there, a diet might help, or some other intervention that is unknown to me, possibly statin. If anyone has determined your CHADs-VASC score due to the transient AF, you might be better off in the long run with a DOAC (Direct Oral Anti-Coagulant) such as apixaban, perhaps only with a baby aspirin each day...but do get that squared away in your inteview.

I was really scared with a 3600 score at 76. Read through all of these and it just is not as important as the tests you have had. The record high I have read is around 10,000. This is the hardened stuff that cannot split off to cause a heart attack by my reading...not a doctor. Just get maximum medical treatment with statins, ezetimibe, and great eating and exercise, and you will be way less than 3600 when you are healthy at 76. My other tests were pretty good.

When I was 75 I had my first CAC score and it was 378. PCP was not very concerned. However, 4 years later, after passing stress tests with zero concern, I had another one done and it was 798. I went on a plant based diet for the past year and the recent CAC score was 801. My regular LIPIDs are under control with statins. My approach has been to Cut out all beef and pork, sugar, most dairy, most of the plant oils except olive and avocado and fried foods. This diet seems to have helped the CAC score getting worse. I do stay active and exercise as time and weather permits. One clinical study I found implies if you can keep the CAC score increase below 15% per year, your risks may be very low. However, I recently had my APO B and Lipoprotein a [Lp a] checked and it was very high at 358. This is a very sticky cholesterol and not a part of the regular LIPID done on most annual physicals. Some clinical trials to address Lp a are underway but still not FDA approved. Diet and exercise seem to reduce the risks but will likely not reduce the level you have. It is genetic and until new FA drugs are approved, there is little else one can do to reduce the risk. This is from my personal experience and research but much of what you find online is controversial and very complex. I would enjoy hearing from others and their experience as well.

You might consider an advanced lipids panel.

If AFIB had occurred while you were wearing the test equipment, would the doc (I assume we are talking cardiologist and not GP?) have called for an angiogram, or catheterization?

You said it was a stress test ... was it with echo (immediately before and immediately after)?

Thanks for the responses! In terms of the AFIB, it has not reoccurred outside of the single incident. Cardiologist referred for the stress test, and additional tests would have been warranted had irregularities appeared in the stress test (but did not). There was no echo associated with the stress test, but both the echo and stress test were performed on the same day (echo was prior to stress test).

My current situation just strikes me as very odd, as I don't meet any risk factors for either AFIB or expected CAC score (BMI< 25, age under 40, good (maybe close to ideal) bloodwork). I would prefer lifestyle changes to taking supplemental medicines, but I'm honestly not sure what lifestyle changes I would make (already eat primarily healthy and exercise). Just a bit baffled at this point.

Hi: when I added a PCSK9 inhibitor (Repatha, in my case) it reduced both Lp(a) and aLipo B by around 56%. Especially the Lp(a), this is above what’s claimed and there are other drugs in trials which do far better, but a start

Great input and truly appreciated. I read about them but was not sure if I wanted to go down that path given I have no other symptoms and cardiologist thinks I as OK at this point. Who knows for sure? I will do more research and study. Thanks again for sharing this option.

Just an FYI: my own AF began years before that near-end-of-a-maintenance-10 km daily run in June of 2017. While cycling up a steep goat path in the Laurentian Mountains just north of Ottawa in 2001, I paused because I got out of breath. My HR ran high for at least five minutes before it began to back off. I don't think, looking back, that it was simple tachycardia because I was very fit and have not had a single such event since...only AF. And flutter. Being very fit, and a competitive runner for years, my HR would normally have recovered inside of one or two minutes while paused on the path. I believe it wasn't a racing heart, but a fibrillating heart.

The point is that once the heart is disordered enough electrically to have even a short initial run of AF, it will be disordered forever. It has established that errant path, or 're-entrant', almost always in or near the pulmonary vein ostia at the rear wall of the left atrium. It may not resort to that path for years, but the path has been trod, if you will, is extant, and will be used again in the future.

That said, if you are relatively stable, not unduly affected, and not frequently in AF, it won't kill you. It may make your alert more than you'd like, even a bit bummed, but it won't kill you. Its eventual progression (it is considered to be a progressive disorder) may bring on mitral valve prolapse or even heart failure (really 'heart insufficiency' is what I prefer to call it, the formal name being rather over-dramatic in my view). The longer one's heart is in AF, the more 'remodeling' the heart undertakes to work under those circumstances. You don't want that. But, for now, if you're doing fine, and it's a one-off, I wouldn't stress out over it. Just do monitor yourself, especially if you feel unusual twinges in the chest wall, or a 'fullness' sensation. Wear a good quality smart watch or WellU ring or the new Samsung ring...anything that can check your heart's rhythm in real-time while you watch. If you get an indication of AF, or 'unknown rhythm' or whatever your device says when it isn't purely AF or NSR, you'll want to pay closer attention and self-monitor more frequently. At that point, you should consult a good local or distant electrophysiologist (EP) and get in line for an ablation.

BTW, you don't have to be fibrillating during an ablation for them to find the foci. Almost always they'll routinely ablate around the pulmonary veins and do a PVI (pulmonary vein isolation). They can also 'challenge' your heart with adenosine, caffeine, and isoproterenol and make it go into an arrhythmia, usually fibrillation if that is part of your substrate.

I had a lipid numbers similar to yours for years. Exercised regularly for more than 20 year - running 4-6 times per week. A handful of half-marathons and one marathon. Normal BMI. Resting heart rate in the low 50s. PCP was never concerned. Mother had a quadruple bypass at 62, which is young for a female, but I thought I was protected because (1) my PCP wasn't concerned and (2) the message that it's all lifestyle is so prominent and mine seemed pretty good. I got a CAC test and my score was in the 98th percentile for my age and gender. The CAC was prescribed because they found plaque in my iliac arteries in an x-ray. I can't say my diet had always been plant-based, but I had not eaten any (absolute zero) red meat in decades. All my meat consumption was lean chicken and turkey (white meat). I ate a reasonable number of servings of vegetables each day.

It's been about a year of trying to figure out what went wrong and I still can't be sure. The frustrating thing about this, is that it's so difficult to measure. I had a CT angiogram and it showed that there was no blockage greater than 50%. So I think I am in reasonable shape for now.

FWIW, here are the three things that I suspect may have been causal/related.

I have high lipoprotein(a). It's genetic. I gather some people now are taking drugs that reduce it, but I haven't discussed it yet with my cardiologist. If you reach a certain level above normal, it becomes a risk factor. In fact, my cardiologist gave me a letter to give my immediate family members stating the fact that it is a risk factor and they should consider getting tested.

I have poor blood glucose control. I read "Beat the Heart Attack Gene" and learned a lot. One thing it mentions is the link between diabetes and ASCVD. I wore a CGM for a while, and the peaks I was getting were WELL above normal. I was shocked. I had a two-hour glucose test and by that test I was pre-diabetic (though not by HBA1C or fasting glucose). I've made some dietary changes to try to bring that down, but it has been very challenging to keep down.

I suspect I was getting too much saturated fat. I always aimed to eat low fat. No fried foods. No red meat. No butter. No high fat foods ... But I never focused specifically on the types of fat and apparently saturated fat is particularly bad for some people. I worked with a heart health dietician and she said I should keep it less than 8gm per day, lower than her "standard" recommended level of saturated fat.

As I said, who knows. I don't think you ever can. Since the diagnosis, I've just tried to manage every variable that's associated with atherosclerosis. I also had my carotids and abdominal aorta checked. I imagine your level of plaque is too low to really be worried about that.

I would suggest reading "Beat the Heart Attack Gene". It was a nice combination of accessible but science-based. It's a good starting point, and then you can get more information on the issues it raises.

My score was clearly bad, so I'm not very familiar with how the lower scores break down. The CAC score is absolute, and I think you are in good shape. I wish I had taken a test at your age. (I am early 60s.) At first, I looked back and got frustrated that I worked so hard to stay healthy and still ended up with a high CAC. Now I just thank my lucky stars, because I believe it is what saved me from my mother's fate. She lived through the bypass, but I think her life still ended too early. The doctors never explained what happened to her, but alluded to the fact that some vessel probably just got clogged and they'd never know where it was. Who knows, but that is what I was told.

Good luck! As others have mentioned, lots of people life long, healthy, normal lives with much higher scores and diagnosed much later in life without the same runway you have to manage it.

I went back and forth about mentioning this but I guess I will. I was just watching a video on lipoprotein(a) (one of the YouTube interview an expert for 2 hours type videos ,so take it with a grain of salt) and the expert mentioned that in a small number of people high lipoprotein(a) is associated with Afib. More importantly, he mentioned that a lot of cardiologists don’t know about lipoprotein(a). I’d think you’d want someone that knows about it.