Crazy high calcium score of 3,000+
61 male with COPD which doesn't keep me from exercising regularly. No symptoms of anything unusual lately. Diet is not great, but not overweight in the least. Had a Stent put in for carotid artery 18 months ago. Been on atorvastin and ramipril for BP and high cholesterol for a few years now. Cholesterol numbers now look pretty good I think.
Just had a CT ordered for calcium score after "severe coronary calcifications" noted on routine lung CT scan. My score was just over 4000, though with 'accuracy comprised by motion detection or something', though I'm guessing it's at least somewhat roughly accurate. I was stunned by this number when I saw it today in my health app (I was prepared to freak if I saw 400!), and haven't heard back from my doctor yet. Found this group in the meantime, which made me slow my catastrophic thoughts somewhat as I imagined myself undergoing emgergency heart surgery this evening....
As I await further word, perhaps you folks can tell me what these numbers mean in the report, and what I can expect going forward?
LM: 0 LAD: 658 LCx: 329 RCA: 3062
Thank you,
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The reference to statins increasing the calcification by hardening the soft plaque (and I guess adding to the interior artery walls?) and thus the increasing CAC score is interesting. I'd never read/heard that before. My first CAC CT was in late January this year and freaked me out as I had no idea - it's was 1,006. So the cardioligist immediately doubled my statins (Avorvastin) from 20-40 mg and added Zetia plus low-dose aspirin (was already on diltiazem for hypertension though not very bad) . Then I did my part. From February until now, eating only fish and chicken and occasionally pork, lots of veg. Lost 18-20 pounds (around 8kg) in four months. Walk 3 miles every morning with my wife, and BMI normal since June. The stress test in January was also fine (asymptomatic still). Here's the punchline: I had a CTA for something else last month and asked them to also check my heart arteries (since I was already taking the contrast dye). I was shocked to learn my CAC score had risen by more than 25% despite all that above! So is it the doubling of the statins that did that? Or is that normal? Dr changed me over to Rosuvastatin for some reason.
..by the way, because it was so depressing to learn of an ultra-high CAC score, and what that means mortality-wise, I'm glad I did the CTA - for my own mental health. As it turned out, the two worst-affected arteries for me (LAD and RCA) were 40 and 50% stenosis in two small parts and 10-20% in two small other areas. So could be worse, though there obviously could be worse stenosis in other areas not seen. I'm doing TCD doppler scans now to check blood flow in my head and neck. If that's bad, I'll do another CTA for head and neck. I know the doctors don't recommend these due to the affect contrast dye can have on kindeys, but mine seem stronger than usual for my age. So it's a roll of the dice. To each his own I guess.
@aldo2 You have been doing all the right things. Kudos!
The soft plaque is the unstable plaque to be super concerned about. My understanding is that it is a good thing that some of this has actually been converted to calcified stable plaque.
It may help to asks your doctor what they think of the fact that your calcium score has gone up by 25%. Also, they may have thoughts as to how useful it is to ever recheck it. There are times that it just doesn’t provide helpful information.
Has your weight loss and lifestyle changes made a difference in your day-to-day at all?
Hi @sdbonniea123. I am glad to see you have joined Mayo Clinic Connect! You are working through a process that seems very confusing and contradictory. I’m right there with ya!
One cardiologist told me about a study where a group of cardiologists were given testing from a group of patients that had heart attacks within 6 months of being tested. They were asked to identify where the heart attacks happened and they couldn’t. The initial thought is that problems happened where the largest “blockages” of calcified plaque are. However, the problems actually occurred, I believe in the areas of the 25-40% blockage areas. The problem is actually the soft plaque running through the arteries sorta gets off course since it isn’t cleanly going through pathways that have a nice consistent pathway to flow through. With this, the goals are to turn that plaque into the safest form possible free from things like high LDL, and to reduce inflammation from the sides of the arteries that can make it difficult for the walls that are accumulating hard plaque to stay smooth and consistent.
You mention wanting to improve your quality of life. Do you mind sharing, maybe the top thing that is impacted right now? When is your next appointment?
@jlharsh hello and thank you! I'm. A little confused so maybe you can help clarify. So you're saying the group of doctors didn't know where the heart attacks started but think they start where the blockages of hard calcium are the biggest? And then you mentioned an initial thought and what you believe to be the biggest "danger zone, " which seem to be where the smaller blockages are. May I ask what that based on? I hear what you're saying about wanting to solidify the mushy plaque and reduce inflammation. That makes sense to me. I'm taking a statin and changed my diet drastically since the calcium score, and moving around/walking more. I think that's all I can do right now. My angio was denied by the insurance company so the doctors are working on resubmitting and hoping it gets through this time. I think I think my words were I feel like I didn't have any life force - not that I wanted to improve my quality of life - although, I think they go hand in hand. What I meant by that is I don't have a lot of energy (sometimes can barely function) and now that I know I have a very high calcium score it feels as though a blockage might be the culprit in not getting the life force that I need through my body - ie blood flow. Thanks again for reaching out. I'm basically just scared and like many of the others here feel like a walking time bomb. It's surreal and hard not to think about.
I am so, so sorry you are scared, @sdbonniea123.
The exercise these cardiologists went through had the goal of figuring out if they could guess where heart attacks would happen. The hypothesis they started with was that problems start at the place where the blockages are the greatest, where the most calcification, or hard plaque is located. So, following this upfront guess, you would think an 80% blockage would cause more problems than say, a 35% blockage. This is NOT what they found.
I found this explanation:
“ Unfortunately, as we age, plaque accumulates in our arteries. This starts as soft, cholesterol-laden plaque that eventually calcifies and hardens. Even though the process effectively begins at birth, most people do not have clinically significant blockages in their arteries until they are well into middle age.
Interestingly, and somewhat counterintuitively, calcified plaque is probably the less dangerous of the two. When a heart attack happens it is due to the sudden rupture of a soft, unstable plaque that might be obstructing only 10 or 20 per cent of the artery. Longstanding, calcified 90-per-cent blockages don’t cause heart attacks. They may cause angina — chest pain on exertion — but a stable plaque won’t suddenly rupture and provoke a myocardial infarction.”
I don’t remember you saying you are having angina symptoms, or chest pain. I am guessing that when your cardiologist told you they are more concerned about your cholesterol than your 400 calcium score, they are saying the concern is your softer plaque, and that is something you can do something about. I am not a medical person, just someone on this same path as you.
Why did you have your initial calcium testing done, were you having symptoms? Did your cardiologist do bloodwork?
Thank you so much for your response and kindness!! I understand your explanation so thank you for that.
So I actually got a scan because I was working with a functional doctor doing hormone replacement therapy. I told her of my family history which is not good - my father died of a massive heart attack at 52 and my brother at 54, although my brother had been a lifelong drug addict. She said before she would give me any estrogen she needed to make sure my heart health was okay and I should get one of these scans. I had been contemplating it for a long time anyway because of my history, but was always too scared. After the results the doctor just posted on my portal that I needed to take statins but I felt like it was more serious than that. At any rate a couple days later I did end up in the hospital - I was having pressure in my chest and it was probably psychosomatic but it is what it is. They ended up doing several tests including a stress test and EKG. They kept me overnight for observation and then released me. I then got a referral to a cardiologist from my PCP and she ordered me the angio. At that appointment she did say that all the tests I had done in the hospital looked good. She actually said she had never seen too many people with this healthy of a heart. But that doesn't exactly make me feel better because if my arteries are clogged my arteries are clogged. I've had high cholesterol since my early twenties and I remember doctors always being dumbfounded that a young healthy woman would have high such cholesterol. I didn't pay too much attention to it cuz I always felt okay but you know hindsight is 20/20 and I should have done something about it. I tried statins in my 50s and they made me feel really sick so stopped. I'm 61 now. So that's how it all went down and I really just want to know if I have blockages. The the insurance company has denied my angio. The cardiologist is attempting again to push it through, but not sure what I'm going to do if I can't get that test done. I'm currently now on statins and like I said overhauled my diet and walking more. It's just psychologically a tough thing to wrap my mind around. Although I did try and flip it this morning by telling myself that I'm actually a lot better off knowing this because I can make the changes. Whereas when I didn't know and was in denial I was eating bad food and not moving as much as I should.
My husband’s CAC is 5,185. I’ve yet to see anyone on here with that score. We were shocked. We has no symptoms, walks 3 miles plus daily. It was discovered when getting a CAT scan of his lungs for a cough which then resolved, with Flonase and Zyrtec. Only thing that can be done per cardio is diet which we have drastically changed now, exercise and his atorvastatin was increased from 10mg to 80mg. He has a follow up lipid panel in
3 months post the dose increase. Her goal is to get his LDL to 40-50. It’s scary I know!
I do love the explanation of the stability of the calcium plaque above which is what the cardiologist told us as well ; however, 5,185 is still a bit unnerving! Our cardiologist was checking with a cardio interventionalist, but he had no further suggestions. I asked my PCP about this since I’ve avoided statins for years and she referred me to the very same cardio intervention doctor so I’m actually seeing him in November and taking my husband with me! In the meantime though I have acquiesced and started rosuvastatin 10mg daily. I have no symptoms at all, but neither does my husband so who knows what our CAC is ! I read another comment in this category about checking carotid artery too since that could be blocked. I’ll be asking about that as well. Also the statins increasing the CAC ( altho I know they decrease inflammation as well per the cardiologist). Lots to think about!
Yes, a lot to think about @kswartz! You are doing everything you can by staying active, watching what you eat, and working with a cardiologist who is on top of your unique situations. Your husband’s 5000+ calcium score sounds shocking and I imagine you joining him by addressing your own heart health encourages him tremendously.
I am tagging members that may have helpful information/updates to share. @heycal created this discussion after a routine CT. @robmtk and @njx58 have mentioned an extremely high calcium score and/or treating LDL.
Like your husband, my LDL goal is 50. Getting close to that the last year or so has required a knowledgeable care team and multiple medications that seem to have synergy working together. I also get relief from Flonase and antihistamine eye drops, in addition to a super consistent high level of exercise, strict diet and weight training.
You mention walking daily and improving your diet. What kind of changes have you made?
@kswartz The reasoning behind the stabilizing effect of the calcification is that it is much like making bone, which you would immediately see is a stable and durable structure. Bones use calcium and collagen to make themselves. In the case of arterial plaque, I haven't read anywhere that collagen is included in the mix, but the calcium deposition adds rigidity and integrity to the plaque. The rigidity is not great for vessel elasticity (in fact it's bad), but it does help to 'cement' the plaque in place. Initially, as the plaque forms, it is 'friable', meaning it is easily disrupted. Clumps of it can be dislodged and get rushed forward with blood flow until the clump gets jammed into place, blocking a small capillary, perhaps in the brain. Well, whatever relies on that flow is now precluded from receiving it, and you can guess the rest.