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

Couple of thoughts:
- HDL can be too high (here's a link mentioning anything over 80 as being too high - https://my.clevelandclinic.org/health/articles/24395-hdl-cholesterol)
- Vascepa is the US brand name for icosapent ethyl (https://www.mayoclinic.org/drugs-supplements/icosapent-ethyl-oral-route/description/drg-20075707)

Thanks, @abf826!

I found the CCTA to be the most reassuring test. Although it was also the most unpleasant test to get of the 3. I have anxiety and a fast heartbeat in general in stressful situations -- and they want your heartbeat at or below 60 for that test. I took a LOT of metoprolol and mine only got down to 80! They were able to use a different machine for me, but I thought I wasn't going to be able to get the test (which made my heart beat even faster). The test itself is also unpleasant - uncomfortable position, the dye feels really strange, the nitroglycerin gave me a headache... But the results were worth it, as it really gave a much more detailed report about what is going on in each artery and how much plaque is really there. I would recommend pursuing it. My CAC number just felt so huge and stress-inducing. The CCTA broke that down into real information, which definitely helps.

I think my doctor did the echo and the nuclear stress test really just to get a baseline sense of my heart and make sure there wasn't anything else going on that we needed to be aware of. ie, to check that I don't have any areas of damage, any areas reduced blood flow, all the valves are good, etc. I was glad to get the reassurance that my heart itself if healthy even if my arteries are not. But these were less important to me in terms of relieving anxiety than the CCTA since I really didn't expect to have any heart problems to begin with. I'd never had any symptoms of anything - I was only there because of my CAC. So while it was good to know all was well, I didn't feel like I learned anything new with those.

But a heads up if you get a nuclear stress test since, like me, you are probably 2 decades younger than every other patient in the waiting room at your cardiologist's office and none of those folks live with small children - I asked about being around a young child after the nuclear test, as you are injected with radioactive material. They said the exposure is minimal for family members, but of course you want to spare growing children exposure if you can. So they said time and distance are the key factors - so the more time that passes, the more time you can spend close to your kid. This meant I was glad I had my test scheduled first thing in the morning, as the half life of the dye is 6 hours and it takes a couple of hours to do the test. So I knew that I was at least halfway diminished by the time my kid got out of school, and I just generally kept a bit of distance (but still did hugs, etc) that evening. So, if you do get a test and that concerns you, I would also recommend trying for an early morning appointment.

As for Wegovy, you are eligible for it if your BMI is over 27 and you have a risk factor for heart disease (which all of us with high CACs do). My cardiologists office was eager to prescribe it to me when I asked about it. Apparently in clinical trials it was very effective at reducing cardiac events, even for those already on statins. But you do have to be overweight to be prescribed it, and it does put you onto an expensive drug for the long term. So it might not be right for you. I was convinced to try it given its effectiveness and have so far found the side effects to be manageable. Here is an interesting NYT article about how many ednocrinologists and cardiologists seem to be taking it themselves! https://www.nytimes.com/2025/02/10/health/doctors-ozempic-weight-loss.html?unlocked_article_code=1._k4.J35H.g2LlVvnhBPJ5&smid=url-share

Hope this helps!

Hi, I’m JoJo. Last year, my CAC score was over 1000! That was such a scary surprise because I have a good cholesterol
Score and I thought they were related. I had another test done , I can’t remember what it’s called, but it shows if you’re in heat failures. The number, whatever it was, was through the roof.

I have a genetic condition called ACTA2, which causes me to have very fragile, tortuous arteries, and early onset CAD. I’m stable but was diagnosed with heart failure 2 years ago. They gave me lasix to get rid of
the fluid restricting my lungs and heart from pumping, which was crashing my oxygen and creating an uncomfortable pressure in my chest. I was discharged, feeling normal. They explained I was in heart failure even though I felt perfect!
Here’s a bit of my back story: I was a really healthy 28 year old who ran 5-7 miles daily, and did aerobics and light weights every other day of the week. I had excellent BP and cholesterol scores. Then one day and I woke up , and my aorta dissected from my carotids, including my ascending, thoracic, descending, to my femoral arteries. My surgeon said it looked like a bomb went off on in my chest.. he saved my life by doing the FETT( frozen elephant trunk technique.). When i dissected a few pieces of my aorta sloughed off and blocked circulation to both legs and my left arm.
First, they repaired my aorta with hemashield graft, and, like I mentioned before, the FETT.

After my aorta was mended they turned to my blockages. Thankfully, they were able to clear two of them. But my left leg wouldn’t clear. At this point it had been 12 hours since it was blocked. The cardiovascular surgeon had told my parents I might lose 3 of my limbs.

To save my leg, they did what is called a femoral/femoral bypass. They used my right femoral artery , creating a bypass around the left femoral’s blockage. This restored circulation but as a result of all the trauma to my left leg, I had compartment syndrome. They were forced to do a 4 compartment fasciotomy on my
Left calf.
It would have been really hard for them to figure out I was having a major medical emergency (aortic dissection)as I had only a twinge of pain in my chest that traveled down the middle of my chest. I would have never gone to the ER for it but when the tissue blocked my femoral artery the pain was comparable (I imagine) to getting your leg tightened in a vice. It was excruciating.

Luckily my mom, tasked with driving me to the ER, blocked a cardiologist, Dr. “K” in the ER pkg lot. He got out and asked what I was there for. I told him my leg, then I went into shock right after telling him I felt a bubble like burst in my chest before the leg pain started, and everything started to go numb and ache. With that “bubble like burst” description he immediately thought dissection so they had them check and indeed I had several dissections and needed to be taken to a trauma surgery hospital. Dr. K, or “The Parking Lot Hero🙂” called his OWN surgeon and asked that he come in fix me up.

Dr. Carey Stowe met me as the helicopter landed , I signed some papers and then I was whisked away to a total of 17 hours of surgery.
I am 54 now, and got this very distressing news about heart failure about 18 months ago. I don’t understand it and am trying to learn. I appreciate all of you that are posting Q&A’s.
I was so confused my unbelievable high numbers as my cholesterol had been normal as long as I can remember. I had never heard anything about the CAC or the other number which shows your stage in failure, the higher it is(I think) - at any other ER or hospital visit when they do bloodwori. I had the stress test, which I passed. It was horrible. I hated doing that. I actually had two stress tests within 6 months of each other. And they also did a noninvasive angiogram cat scan that showed I have 79-90% blockages in nearly all my major coronary arteries. Only one is below 30%. But my heart ejection rate is 56? So confusing.

Thank you for sharing your story and thoughtful post. I related. I am 53, active, good diet (but did love cheese and eggs), and non-smoker. My dad, brother, cousin, and uncle all died from heart disease in their 50s so my doc recommended calcium scoring. I was 283, but all in my LAD with 0 anywhere else. I thought it had to be a mistake. But apparently false positives are rare. That specific artery caused my dad’s death at the age I am now. Humbling!

I had been on a low dose statin and went immediately to high dose and a baby aspirin per my GP two weeks ago. I don’t see cardiology until next week. Similar to you, I have been a runner for decades. I have been afraid to run now honestly but have been walking 6-8 miles a day, eating pescatarian with egg whites and light cheese. A little chicken. No drinks. Very low carbs and sugar. Hoping to at least delay progression!

It is humbling to see yourself as healthy and sometimes invincible, only to find out part of your body is rebelling! But I have found even in the last three weeks that I feel much better than I did. I have pretty bad osteoarthritis that even seems better, which apparently sometimes happens when inflammation is reduced.

My sister is a doctor and was the second person I told after my husband. She told me that a blocked artery is an opportunity, not a threat. I think of that all the time. Had I not known, maybe I would have found out from a heart attack or stroke. Maybe like so many of my family members, I wouldn’t have lived.

So hopefully you can take a little comfort in knowing that new meds since the ‘80s have absolutely improved generational survival, and you are doing all the right things!

Good luck and hang in there!

elody,

Can you share your lipid numbers?

Doesn't sound like you've had stress test with echo, yet?

Advanced lipids panel appropriate?

Sure. 205 total. 60 HDL. 112 LDL. Triglycerides always run very high in our family, so 197, which is actually pretty good for me. This was on 10 mg of statin. I'm up to 40 mg now and would expect change. I rarely ate meat at all and we eat volumes of vegetables/have for years. I have also supplemented with psyllium for years and have now doubled that. I average about 14k steps a day either running or walking. No smoking. I did like wine or drinks, but that is pretty rare (like 2 drinks a month) these days.

Glad for the early warning and chance to increase meds/walk even more/cut out cheese and yolks.

No stress test yet, but I'm sure I'll fly through it. My resting heartbeat is low 50s, and I live in the mountain foothills. So walking with elevation is an everyday thing. But I may be surprised again! The only symptoms I've had is a little lightheadedness on a treadmill during a work trip. That may have also been low blood sugar.

OK. You probably know what to do, but my understanding is that physical fitness does not always translate to cardio issues.

Triglycerides can be lowered with Vascepa, I think. It and LDL could be targeted at around 50, or so.

The stress test should include an echo test ... this provides before and after ultrasound imagery of the heart. A stress test alone doesn't provide this.

With increase in statins, LDL should go down, but calcium may increase as more of the plaque is converted.

Hi @elody, One thing to note about your CAC: my cardiologist explained that sometimes much of the calcium is along the outside of the artery and really isn't causing much problem at all. You really can't know until you have a CCTA. This is why my doc emphasized that the high CAC flagged me as someone needing follow-up testing, rather than a clear diagnosis in itself.

For me, my 538 CAC score was mostly in my right coronary artery (491.2). But on the CCTA, I only had mild (ie, 0-25%) luminal narrowing in the RCA. Most of that calcium was apparently outside. In fact, the only place I had "minimal" narrowing (ie, 25-49%) was in my LAD, which only had a CAC score of 15.1. So, it is really hard to know what is really going on in your arteries until you have some follow-up work done - a high CAC in one artery doesn't mean that artery is blocked. I hope this eases your mind some and will help you get additional testing to fully understand your own situation.

I'll add that of course the fact that the calcium was on the outside didn't change that I needed to make some changes in my medications and lifestyle. The truth remains that I have been diagnosed with coronary artery disease at a relatively young age and I will need to stay on top of that. But it was a relief to know that nothing was blocking blood flow, that I didn't need any imminent intrusive interventions like a stent, etc. The CCTA also notes if you have any markers of unstable or risky plaques (ie, those most likely to break off and cause a heart attack), which I did not. But having that checked also helped ease my mind.

I hope this makes you feel a bit better. I really appreciated your sister's comment!

Very much so! I see my cardiologist for the first time Wednesday, and it's also very helpful to hear your experience!