High CAC after bisphosphonates (no other cardiac risks)

https://www.sciencedirect.com/science/article/pii/S2667089526000015
The body naturally calcifies plaque wherever it is deposited and, if you take a statin, it goes faster (statins work by calcifying and 'cementing' plaque so that it doesn't get dislodged and move downstream where it can cause strokes).

Risk rises with increased scores, although I don't believe it is necessarily linear. And, for the major blood vessels, carotid and LAD, for example, the occlusion has to reach +/-70% before they will discuss bypasses and other remedial action. Even then, if you're asymptomatic, they tend to want to 'let 'er ride.'

As you must know already, each body is different, even those genetically related. My dad was having poor vision and losing ground cognitively...the latter quite apparent to his children. He was 87 at the time. He needed a hip replacement, but in the mandatory workups it was found that his right carotid was fully occluded and his left was 90%. The surgeon wouldn't touch him. Surgery (endarterectomy) followed, and he ended up with the hip replaced, and lived until six weeks short of 96. On my dad's advice, I requested a Doppler ultrasound from my PCP, who granted it. The results were very good.

I have never had a CAC score, at least not relayed to me in those terms. I had an angiogram, two MIBI stress tests on treadmill with contrast, echos.....and none of them showed ischemia, which my cardiologist felt was causing my arrhythmia, atrial fibrillation. It wasn't. It was severe sleep apnea. That, at least, was something my dad and I shared health-wise. 🙂

Do you have high cholesterol - specifically, LDL?

@gloaming

Thanks for your response. The article you posted is one of the ones that I found. There are others. I hope that the research will continue.

@njx58

Thanks for your response.

No, my cholesterol levels have always been very, very good. Until the CAC score, every other indicator pointed to minimal cardiac risk.

Hi, @notmaggie. I also had a high CAC score (600) dropped in my lap. That was three years ago. It's caused me a lot of angst because, like you, I'm not really sure where it came from. I had run 20-30 miles a week for more than a decade, never been overweight, never had high cholesterol, and had eaten reasonably well (though not perfect by any stretch). I had treated high BP and subsequently learned that I have high lp(a). So your case is even more puzzling. I also had no blockages, but scattered atherosclerosis in my carotids and abdominal aorta. I also have it in my iliac arteries.

It's caused me some angst over those 3 years. I had a CCTA around the time of diagnosis that showed no blockages > 50%. (They intervene at around 70%+ depending on some functional assessments I think.) I also had the perfusion study and it was normal. Still, without knowing exactly how I got here, I feel like I don't know exactly how to stop whatever was causing it and so it's hard to forget about.

I see a cardiologist but not a preventive one, and in my limited experience it makes a huge difference. I read "Beat the Heart Attack Gene" which was a good starting point for someone not in the medical field. I've initiated HBA1C measurements myself, through my PCP, added ezetimibe myself, also through my PCP, initiated apoB measurements myself (it's < 50!), and hired a heart health dietitian to mostly stop worrying about my diet and develop a sustainable framework. But it's a real mental burden. I want to not have to feel pressured to stay on top of this because I end up immersed in the thing that I want to forget, and I don't have a biology or medical background. So my plan is to find a preventive cardiologist I trust and let them carry the burden. I want to feel like it's not entirely my responsibility. 🙂

Hope this helps, though I guess I didn't really answer your question. I have no idea about the connection to biphosphonates. I have osteopenia, so I may end up having to learn more. Clearly there's some kind of calcium processing problem in my body. I take K2 which has some anecdotal evidence to improve calcium processing. If you find out anything about the biphosphonates, let us know. You could try perplexity.ai. It's a standard AI, but it provides references, which are useful to confirm what it tells you.

Good luck!

Hi, bitsygirl.

I completely understand the angst and the pressure to DO SOMETHING! IT sounds like you are doing very well, though. I hope that continues. I am very grateful for the good health I’ve enjoyed. I have been so lucky! Now that I am facing the osteoporosis and heart risks, I am even more grateful, and I feel for those whose issues are so much more severe.

I also understand that doctors are only human. No one human being (or one thousand human beings) can reasonably be expected to have all the answers for all the problems for all the patients. I know that I’m an anomaly. I don’t really expect that I will be able to get any information other than the standard formulaic responses that are true and useful for most cases. Still, I would be so happy if my cardiologist exhibited some curiosity about my case.

If I discover anything definite about the bisphosphonates/coronary calcium link, I will definitely post it. please do some reading on the osteoporosis section before you take bisphosphonates. They might be a good choice for you, but they were not good for me, and there are other options.

Best of luck to you, too!

I assume the CAC score ruled out HRT?

@notmaggie Hi- I took bisphosphonates for over 10 years. Had good improvement tho still borderline then took a holiday. My cardiologist, whom I was seeing for MVP, was concerned re lipid levels. I wasn’t sure re taking a statin so she dud CAC scan which was totally clear in 2020. Shortly after I had a dexa that showed some worsening of the osteopenia so I upped my calcium supplements and started back on a bisphosphonate. I had trouble tolerating GI sx w the bisphosphonate so D/C’d it but continued the calcium supplement. About 2 years later I de eloped kidney stones and imaging fir another problem showed CAC. The literature shows some data that absorption of Ca is better through dietary calcium so I stopped the supplement and focused on improving my Ca intake. Two years later, no more kidney stones, CAC lower. Just one person, so completely anecdotal but I’m continuing to focus on dietary intake and consider infusions for the osteopenia if it worsens. It’s all a balancing act;-). Good luck!

Yes, HRT is off the table. The fear is that the estrogen will cause soft plaque to erupt, dislodge, and cause a heart attack or stroke. I’m still not convinced that that is likely or that I even have soft plaque. But it doesn’t matter. I doubt that anyone will prescribe HRT now.

If I had not stopped HRT when I was told to, the likelihood is that I would not have either arterial calcium or osteoporosis, but who knows? I have both now, and I’m certainly not the only one!

It is what it is, and I will do what I can to protect myself and live my life. I am grateful for my here and now. I feel strong and healthy, and I have little pain. I have a couple of very dark clouds following me around, but I won’t let fear of what osteoporosis and arterial calcium can do to me block out the sun. I’ll continue to try to understand these issues and to improve what I can, but I won’t let this stress take over. Right now, I’m gonna go play with my big, silly dog!

Thank you, @babheart! I also took calcium supplements for many years. I discontinued them after the CAC result. It’s good to hear that your CAC score has improved after you dx’d calcium supplements. May it continue!