Connect
High CAC Score/AFIB - Under 40 and all other metrics good
Hi everyone,
I wanted to gauge if anyone on here had a similar experience as I am working through:
Current Health - I'm a reasonably healthy 38 year old male. I've never had any history of problems with cholesterol (most recent labs from last month indicated total Chol of 144, Tri of 43, HDL of 63, LDL of 72 - these have been reasonably steady for 10+ years of being checked/tracked). I grew up in a family that didn't eat well, which followed me through college, but I learned/focused on my health starting around age 22-23, lost significant weight, and have lived a healthy life since with no incidents. While I'm not a vegetarian, I eat a generally plant-based diet, with probably 3-4 servings of meat a week.
I ran a couple of marathons about 10 years ago (pre-kids!) but would say I stay generally fit - mostly cardio 3-5 times a week, 20-30 minutes per session).
Initial issue - I had an AFIB episode (with RVR) earlier this year (lasted for ~3 hours, and resolved spontaneously). As a follow-up to this, I had an echo, stress test, and 30 day monitor - all had no significant findings (30 day monitor flagged a slow heart rate during sleep (down to about 39 bpm).
CAC Test - As a "final" follow-up I spoke to my cardiologist about having a CAC scan, which he suggested based on family history (mother passed away at 69 due to CHF and CAD). I had this scan recently and received a score of 207, including 138 in the LAD.
Context/Question - The score in the CAC was particularly surprising to me given current age/health/history, and I'm a bit at a loss for where to go next. I'm working to schedule a follow-up with the cardiologist, but haven't easily found stories of similar scenarios involving others. I'm working to prepare my "question listing" for the doctor, as I tend to be a strong advocate for my health, but just looking for perspective from others who may have seen similar situations.
Thanks in advance!
Like
Helpful
HugInterested in more discussions like this? Go to the Heart & Blood Health Support Group.
Connect
As a brief update, I met with my cardiologist yesterday. His initial response was to order statins + blood thinner, but as we discussed my background/labs/lifestyle, we determined it may be likely to do some additional testing to determine if those would be helpful. We pulled labs for LP(a) and ApoB, as we were both surprised by the relatively (for under age 40) amount of calcification shown on the CAC (207) given my lipid history. We are also looking to do a CT angiography (assuming insurance will approve). At this time we haven't started any pharmaceutical treatments.
I'd be curious if anyone had thoughts on statins and how it impacts individuals with historically low cholesterol but high CAC scores. One theory I have relates to intense exercise over the years (which also seems correlated with higher CAC scores), but may not indicate as significant a risk of CAD.
My smart phone states I have high abnormal heart rate and I have a headache on the right side
Perhaps you should contact your primary care provider? Together these could be a symptom of something serious.
In a similar situation, I went looking for the best questions to ask. High CAC (from 769 to 1,208 in 2.5 years), managed bp, triglycerides and cholesterol, echo, stress test and CT Angiogram all check out great -lots of calcified plaque but no blockages, healthy diet and lifestyle with no symptoms.
The cardiologist is saying to keep up the good work.
Basically, go home, keep taking statins and wait for more plaqueto calcify inside the artery walls(?)
I am not satisfied with one size fits all treatment plans for diverse groups of people.
I want to get to treat the underlying root cause and know everything my Dr and I can do is being done, then accept that. We are our own quarterbacks.
A book I saw in a similar post here helped me learn what tests to ask for to get to my individual genome type and a customized plan.
It covers Lp(a) in depth and I recommend it to anyone learning to navigate this disease.
Beat The Heart Attack Gene by Bale and Doneen.
You've got a lot of runway ahead of you and you are asking good questions.
-
Like -
Helpful -
Hug
2 ReactionsThanks for all the replies, I checked the setting on my smart watch and it was set for 100, I am 70 and will be 71 in 5 days so I have adjusted to 120. My most recent BP from my last doctors visit less than 2 weeks ago was 117/76 so I feel much better. Thanks again
-
Like -
Helpful -
Hug
1 ReactionWanted to share an update if helpful:
Since the last update, I had a CT Angiogram performed, which indicated the following:
LAD:
Mild stenosis in ostial LAD.
Moderate stenosis in moderately sized first diagonal artery.
Low probability of ischemia with FFRct of .86 in LAD and .95 in the first diagonal.
Low probability of ischemia in RCA with FFRct of .88
RCA:
Minimal stenosis in the proximal RCA.
LV:
Mild left atrial enlargement
This CTA also identified an anomalous RCA: "The RCA is anomalous and arises from the left coronary cusp with an interarterial course between the aorta and pulmonary artery with slit like narrowing concerning for
severe stenosis and malignant course."
From this, I was initially referred to a surgeon, but had a 2nd opinion at Vandy. Vandy ordered a Nuclear Stress Test which determined perfusion was normal. EF was 52% at rest, 65% at stress. Enlarged LV cavity.
During stress test, hit 104% of MPHR. Went for 13:31 reaching HR of 190bpm and 14.8 METS. TID ratio of .7.
Based on stress test, Vandy recommended no additional action. They believe the functional capacity is fine despite the previous CAC score and anomalous RCA. He recommended staying on the 10mg of atorvastatin and performing an annual stress test. He had no concerns with continuing strenuous exercise.
I still find my entire situation to be odd - Again, very strong lipid panel historically. Had Lipo(a) tested at 19.4 and Apo(B) at 52 (both prior to starting statin). Statin has since decreased LDL to 45.
My biggest concern is understanding the basics of how I initially ended up with such a high CAC score for my age. Approaching 40 with young children I want to extend my healthspan and lifespan as much as possible.
-
Like -
Helpful -
Hug
1 ReactionI understand your quandary, or how things don't seem to line up on the basis of your understanding on on the basis of what readings and feedback from experts say is the case. My only offering, as a non-expert in all things health, is that inflammation is often the hidden culprit where the body seems to show signs of advanced pathology or even of aging. Or, it can just be choosing one's parents incautiously. In which case, tsk tsk! 😀
If it hasn't already been ruled out, get a CRP (c-reactive protein) test done to determine if you've been fighting something silently for years. Could be diet, lack of sleep, OSA (obstructive sleep apnea), too much sugar, systemic infection, low grade, etc...