VERY HIGH Coronary Artery Calcium Score

Thank you. Hope you heal quickly. My body cannot tolerate Statins I get muscle aches. So, I started taking Praluent 2 months ago. I haven’t felt muscle aches but for the last 2 weeks pain on my left shoulder. I’m just wondering if it’s coming from the Praluent Time will tell.

I had a surprisingly high CAC score (600-ish - 98% for gender and age) after decades of exercising regularly, normal weight, reasonably good diet and not alarming lipids (though not optimal). I was able to get a coronary CT angiogram. It measures roughly the percent blockage, though not as well as a traditional CT angiogram. For me it showed no blockages greater than 25-50%. It doesn't mean I am home free, heart attacks occur from non-obstructive plaques, but it has been real peace of mind regardless. It also showed that the plaques did not contain some features that they can detect that are associated with a higher likelihood of rupture. Some doctors seem to be willing to prescribe this and some don't. I am not sure why. The cardiologist I was working with at the time also had a family history so he may have had more empathy. There was some plaque in the LAD too, so that may have been a factor.

I am curious, do you have a family history? I have learned that many doctors look at slightly off lipid numbers in otherwise healthy people and dismiss them despite the family history. It seems like a mistake.

FWIW, I also seem to have some side effects from Rosuvastatin. It caused muscle soreness and had a negative impact on my ability to work out. I am trying Atorvastatin currently. Only been a few weeks.

I thought of one other thing. You may have high lipoprotein(a). This is genetic and not all doctors know seem to know about it. Statins don't help with this I believe. PCSK 9 inhibitors lower it some. There are drugs in testing now for people with very high lp(a). Given your high CAC score despite reasonable lipid numbers, you might want to at least get tested. (Though again, not much they can do about it right now, so maybe it would just be another worry.) Mine was high, but not crazy high -- maybe 85-ish percentile?

@bitsygirl
I have a very similar physical profile and test scores, but I do have a high lp(a). I just found out my CAC score (668), but am very anxious about starting statins, because of my GERD history, which I have just managed to get under control. Did you experience any digestive issues with either Atovarstatin or Praluent ?

Any input from other readers would be greatly appreciated as well !

@pia2345 I continue to take Atorvastatin. I still feel like it affects my workouts, but it's not so clear or bad that I have mentioned it to my doctor. I have decided that I'm better off with the statins than not. I added ezetimibe and now my ApoB and LDL are less than 50.

I wouldn't say it gives me digestive issues. I've started, after being on statins for a couple of years, having some indigestion when I run after a half hour or so, but I'm much more suspicious that it's from too much coffee. I've never taken Praulent, though I'd like to. My doctor won't prescribe it. Hopefully someone else that's taken it will chime in.

Good luck!

@pia2345 I continue to take Atorvastatin. I still feel like it affects my workouts, but it's not so clear or bad that I have mentioned it to my doctor. I have decided that I'm better off with the statins than not. I added ezetimibe and now my ApoB and LDL are less than 50.

I wouldn't say it gives me digestive issues. I've started, after being on statins for a couple of years, having some indigestion when I run after a half hour or so, but I'm much more suspicious that it's from too much coffee. I've never taken Praulent, though I'd like to. My doctor won't prescribe it. Hopefully someone else that's taken it will chime in.

Good luck!

@bitsygirl
I have a very similar physical profile and test scores, but I do have a high lp(a). I just found out my CAC score (668), but am very anxious about starting statins, because of my GERD history, which I have just managed to get under control. Did you experience any digestive issues with either Atovarstatin or Praluent ?

Any input from other readers would be greatly appreciated as well !

@pia2345 Repatha lowered my Lp(a) by nearly 60% more than Rosuvastatin. My CAC has still increased over 4 years since I started Repatha, but at a much slower rate than Rosuvastatin.

I don’t have any side effects from Repatha. However, I was on statins for several years and had some bad effects mainly painful joints and a memory issue. While I was on statins, my CAC score increased progressively and significantly every 18 months (I checked on the same CT scanner every year and a half) - look up “statin paradox” and you’ll be surprised. The Repatha has slowed the calcium buildup in my coronary arteries to more than 60% of the statins. There are 3 drugs in trial right now for specially lowering your Lp(a) that are looking for patients in their studies - Opasiran, Pelacarsen and muvalaplin. All 3 have excellent results so far and you can look up at ClinicalTrials.gov for all the locations where they are given. Good luck with your journey!