Need advice after receiving results of my CAC score

Most do what you do if they are motivated to live well and longer. I think you're doing what you can, even if it's a tad late. The score, by itself isn't a disaster, if worrying. It might be a reflection of all those years of married bliss, during which you gained bit of butter here and there. IOW, it took a while, and is probably not an indicator of what has gone wrong in the past five years. This is just a guess; I know nothing of your history, any infections, other drugs and treatment, other habits besides the iffy eating habits. It's good you don't smoke or drink or that number might be twice that by now.

As I understand things, this is just a snapshot of what is extant in one or more measured places. Like the problem with quantum physics, you cannot know an object's direction and speed and its appearance at the same time. You get one type of information, speed and direction, or what it looks like...take yer pick. It's sort of the same with the CAC. You can get a good estimate of what is in place, but you don't really know if it's stable or going in the wrong direction....climbing. Assuming it is climbing, your physician has prescribed a low initial dose of a statin, hoping it will stop any further accumulation. I was initially on that dose, but when my heart began fibrillating more and more, he felt ischemia might be the issue and ordered another 20 mg, so I'm up to 40 now. In case that sounds worrying, I know of a woman who takes 100 mg.

You should expect nothing more. Annual monitoring, blood test, maybe another CAC in two/three years for that directionality thing, and more encouragement to manage things on your own to the extent you can without having to take more drugs. When any one important vessel gets 70% occluded, that is when they will begin to talk about a bypass or stent...but a lot depends on your symptoms. If you seem fine, they're fine.

See a cardiologist. Most likely you will need a cardiac stress test either ech stress test or nuclear stress test. Further evauation plus minus after the stress rest. My best guess. Good luck.

You are making the right lifestyle choices. Your family doctor is starting a good statin.You will likely have a stress echo. He should check your cardiac
CRP and sed rate as well. A carotid Doppler is important as part of your
risk profiling. Best diet is Mediterranean with limited alcohol.

Hello Bob
I’m 73. Married 49 yrs. I live in MA. I am athletic: kodokan judo (30 yrs), sea kayaking around North America (31 yrs), have summited Denali (age 32), Mt Whitney (2011), Mt Rainier (1981) but on my own initiative I went for a CT calcium scan and got a score of 1146. Yikes. Puts me in the 90th percentile for stroke or heart attack.

I’m 5’10” and weigh 180. Can’t lose weight. I’m recently dx’d Type 2 Diabetes and wonder if I can ever be more than 3 hrs away from a hospital in case I stroke out or have an MI.

My PCP says these scores are deceiving because people with low scores have heart attacks and people with high scores may not.

My advice? Yes go for Rosuvastatin 20 mg, test for really bad lipids (ApoB & Lp(a). Read Peter Attia MD on this for levels.

Consider a CT Angiogram.

I want to know how clogged my arteries are and what the speed and volume is of my blood flow.

Am seeing a cardiologist next week and want an aggressive plan for understanding my true risk and if I have to give up wilderness hiking and paddling (Newfoundland paddling this June I hope).

Happy to keep in touch.
Paul F-M

I, too, decided to have a CAC done only because of family history of cardiac issues. Have never had high colesterol and all bloodwork has always been normal. 80 yo, exercise regularly, normal weight, etc. Score put me at 85th percentile... totally shocked and surprised! PC doc ordered an echo stress test which was totally normal...in fact 99th percentile on the good side. I have a cardiologist appointment next month and am going to request angiogram as I really want to know exactly what blockage I might have before committing to drugs with very likely side effects. Completely asymptomatic.

The cardiologist will obtain more testing to determine extent of calcification and next steps weighing medication management vs. surgical intervention. As you indicated a life time of bad habits pays us back eventually. Hopefully your change in life style and the end outcome of your issue will help you live a lot longer. Good luck in this new journey.

@carlnh If you're talking about statins, most people have no side effects. It's not "very likely."

The purpose is to prevent further buildup. Nothing will remove what's already there, unfortunately.

P.S. being asymptomatic doesn't mean anything. I was asymptomatic, too. In fact, I was (and still am) a runner. I've been on a statin for 1.5 years. My cholesterol is now 130.

@njx58 Thanks for your input! A couple of friends had been on statins and got off after a few months due to side effects. My cholesterol has never been above 140.

@carlnh be careful what you request. Let the cardiologist do his job. You dont think an angiogram has complications? As a nephrologist I did not like it when patients dictated their care. If it was severe i sent them a discharge letter.

@njx58 i am on a statin and Ezetimibe my cholesterol went from 240 to 105. My ldl went from 140 to 35. My Hdl 40 to 65. If you get the cholesterol and ldl levels low enough it is possible to see regression in the plaque size. Please research if you dont believe me on the regression of plaque size .
Ask your cardio doc or GP to consider addiding ezetamibe to your program.