48M w/High Calcium Score, Great Stress Test, and Family History

I’m in! 😀

I'm so sorry you are in this situation. I'm in a similar situation - 47F with a CAC of 538 and parent of a kid under 10. It is very stressful. I have, like you, started exercising almost daily. I also saw a cardiologist and had a lot of testing done, which did ease my mind. I updated it all here if you would like to know more. https://connect.mayoclinic.org/discussion/any-people-in-their-40s-with-very-high-cac-scores/

I will say that you do get used to it. I am starting to ease into new patterns and just trying to accept that these are the cards I've been dealt, but I'm doing everything I can to reduce my risks from here on out.

But in terms of what it has upended for me: I sort of felt like I went from a healthy person to a sick person overnight once I had this test, which is hard. I have also debated whether to take on more challenging work opportunities or not - do I want to risk the stress and potentially less time with my family? And yet these are challenges I had hoped to pursue for my own fulfillment and my family's finances. I don't know what the right answer is yet.

It kind of sucks. But at this point I'm also glad I know, since there is a lot they can do to monitor and minimize risk once they know you have CAD. But if they don't know you have it, and especially if you are young and seem perfectly healthy otherwise, then they put you in a low-risk category and you don't get the treatment you need.

Something my mother told me that helped: Heart attacks are actually somewhat rare these days. And even more rare among those who are seeing cardiologists and actively paying attention to their heart health. She is 80, has a CAC of over 4000 with no history of heart attacks or stents, and her father died of a heart attack in his 50s. So I try to take some comfort in that!

I am sorry you are going through this.

have a blood test for LPa.

Suggest have inflammatory indexes run. High sensitivity cardiac CRP, A1c
ESR, lipoprotein A. Have a carotid ultrasound.Mediterranean diet is the best. You are doing everything you need to do assuming you are consulting a preventive cardiologist.
Enjoy your children they grow up fast.

I am 66. I've been a runner for a long time. I have narrowing in one artery and a blockage in another. What has helped me are "collateral arteries." These are normally minor arteries that expand and carry blood to parts of the heart that would otherwise not get enough. It's like a natural bypass. My doctor told me that my years of running helped to develop them. I would not be surprised if you have them as well.

I am on a statin, and I do watch my diet, but I still run with my cardiologist's blessing (running expands the arteries.)

Not a med pro, but triglycerides and LDL seem too high ... both should be nearer to 50ish.

Get advanced lipids panel - one lab calls them Cardio IQ. Look for specific genetic.

If a runner, why is your HDL so low? I would expect well above 50? If you haven't made typo, I would investigate.

Oh my gosh! I am so grateful for this forum. Thanks to all for the comments and suggestions! I have a follow-up next week with my cardio and will raise all of these issues.

In the meantime, @star123 thanks for sharing your post and the words of encouragement. I actually found your first post and started to comment before converting it to my own unique post. I am curious about your follow-up tests though. I'm a bit concerned about any nuclear testing and so am inclined to go with the CCTA but I'm also well aware of the potential reassurance a nuclear stress might give me. As for Wegovy, I don't know anything about that vs Repatha, the latter of which my cardiologist suggested and what we'll be discussing next week. Otherwise, I do intend to ask for my Lp(A) and will also ask for the other labs mentioned by @seniormed (thank you!).

As for the running, @njx58 I have heard about collateral arteries before and have to believe that's having an impact. I've been a runner for the better part of the last 23 years and have no intention of stopping, even if at the moment my weekly mileage is low. I figure if I can build up to a 5k 3-4x/week, with longer runs and strength training in between, I've got to be keeping my heart strong.

@mayoconnectuser1 my lipids have always been elevated. While blood pressure was my first prescription around 25 years ago or so, triglycerides came next and then cholesterol and my doctors have always relied on genetics being the primary driver due to my otherwise relatively healthy lifestyle but appreciate the suggestion and will pursue it with my doc.

Have you had your blood test measuring your LPA that is the genetic marker for family history. Also LPO B is a better marker for heart disease in the blood test along with the calcium score

Your HDL is accurate? 27?

I pretty much agree with the others. I don’t think your triglycerides are good. You can get them down to 55 and your HDL you can get up to 90. If you haven’t had the LPa then you should that tells you if you’re if you have familiar heart disease. I inherited that. But I have had a lifetime of good eating and relatively good exercise and I have one partially obstructed artery and the other three are clear. I am proactive. The rest of my family my father and my cousins had a heart attack stroke and died early that made me observe it. Your body will continue to lay down plaque - if you have the inherited CAD coronary artery disease, even if you do good things. So what you need are all the other tests that visualize the arteries going to your heart you didn’t mention any of that that’ll stop you from your hypochondriac imagination. Ask the doctors to send you to a cardiologist. They will probably only do that if you show up with familial Indications of heart disease. My dad lowered his cholesterol lipids and was on statins for years. None of that stopped his arteries from laying down plaque. Back then there wasn’t as many tests as there are today. I suggest if you are really sincerely interested you read Peter ATTIA’s book outlives. It will cover all of this. It was recommended by my pain management doctor and I also can’t recommend it enough, especially since you’re 20 years younger than I am and that’s the time when you need to read it. I can’t take statins, but I am on LEVQIO twice a year(injections.) my LP.a is heading up along with my triglycerides so I’m cutting out refined and processed foods and back on VESCEPA to lower my triglycerides. There’s a lot of information out there about heart disease and you should try to immerse yourself in all of that for a while instead of panicking. And you need to make sure that you advocate for yourself because your numbers aren’t that great asked for a cardiologist or some simple test. I did some DNA a while back and I always take the results to my doctor because it shows that I inherited things like lactose intolerance, gluten intolerance, and heart disease.