Extremely high calcium score at 42 - is there any positive here??

Appreciate this reply. It is striking to me how many of the stories I’ve seen here are like yours - folks in their 60s and 70s finding out they have 1,000+ scores. I’ve had the same thought that potentially they would have had a number like mine decades ago and that everyone’s is just going to go up with time no matter what (and apparently statin use will actually further raise the number by promoting calcification).

Anyway, I’m going to inquire about a stress test. I see that for many here it was the next step after getting a high score. Although I wonder if the scan my cardiologist is ordering — another calcium CT scan of the heart, but this time with due contest — will get us to the same place that a stress test would?

I’ve listened to my cardiologists’s voicemail many times this weekend. It’s just so bizarre to me to contrast his confident reassurance with everything I have digested online about these calcium scores - especially when the number is for someone my age and is so (relatively) high. It’s been an emotional roller coaster the last few days.

CTA is a CT Angiogram and uses dye.

A stress test is common across everything I’ve read - almost everyone has them as they do actually stress you to look for abnormal heart activities.

My ex-cardiologist co-invented the CAC as a possible predictor of stroke or coronary issues within five years. He doesn't think it's the only test that people should base treatment on but obviously a low number is better than a high one. I mean 'some' kind of deposit(s) are seen via the technology and can be measured. Short of everything being an 'artifact' or malfunction of the hardware, 'stuff' has accumulated in arteries that is, no matter how one looks at it, potentially constricting if the process continues. [I've read the posts here that suggest that it could be plaque breaking down and a good sign but my current cardiologist thinks that's a quixotic notion.]

I think that this test is like many other tests in that it's a source of data that, added to other data, helps provide a point-in-time picture of one's coronary health. If everything else looks great, I wouldn't put too much weight on it. Or would have it redone...

But friend with a high CAC of 653 score had a full exam by my cardiologist. He does not have high cholesterol. My cardiologist nonetheless put him on a better diet cutting back on highly-prosessed junk carbs, more fresh vegetables and fruit, etc. And has him exercising more frequently. He already was on Eliquis after a few AFIB incidents.

She also prescribed an abdominal ultrasound that identified an issue that led to a stent procedure. He would not have had the abdominal ultrasound, had a highish CAC score not persuaded him to see a cardiologist so maybe it was analogous to the canary in the coal mine. (He had two uncles die of abdominal blood clots in their late 20s yet no previous doctors had prescribed the ultrasound.)

My understanding is the stress test will detect blockages starting at 70%. So a good tool but could miss some pretty significant stuff too. That's why I'm wondering/hoping if this CT scan with dye contrast might actually be more thorough in terms of what it reveals. But definitely would like to do the stress test too. As it is, I run 4-5x a week and I don't *think* I notice any issues. (Although I started taking the statin last Thursday and right away on Friday my 3.2 mile time went up 4 minutes -- felt a lot more sluggish through the whole thing)

Just to follow-up - I've scheduled an appointment with a second cardiologist for this week, since mine is on vacation through the end of the month and I now have many questions and would like to get some different expert perspectives on options. (I mentioned earlier in this thread that my current cardiologist told me of the high calcium score just before leaving for vacation; after I read up on what this apparently means, I called his office and asked them to convey to him that I was very concerned. He did call from his vacation and leave a voicemail *emphatically * telling me -- three times -- that it was nothing for me to worried about, that it was "nothing for me to worry about" and that he was "just identifying me as someone who needs a little more aggressive attention.")

I did get the full results sent over from his office today. They are:
Agatson score: 397
Left main: 69
LAD: 256
LCX: 72
RCA: 0

I have since Thursday been on 20mg of Crestor. I am trying to determine what dietary changes make the most sense; there is just so much contradictory info out there on that front. And I'm trying to determine if there are additional medications to push for. Today, for example, I found a lot of info on PCSK9 inhibitors. If I'm reading it right, the idea is that combined with high-dose statins, they have been shown to potentially reduce plaque? This seems like a huge deal if so. I saw in one review of studies that the "target" range for achieving plaque reduction is LDL <80 and HDL >45.

On top of all of this, I'm just trying to figure out how alarmed I should be and how dramatically I need to change my life, especially when it comes to diet.

I don't envy you trying to get definitive answers as, yes, there is a ton of conflicting information out there. And excellent doctors who don't necessarily agree either to make it harder.

One of the good things about exercise, which you're already doing, is that it can cause the body to make, not only more HDL, but more fluffy, non-sticky cholesterol according to my cardiologist. I have proof of that in own medical history, which made my cardiologist say, "See, how well that works? It's exactly what we tell patients it'll do." [She thought I was trying to get healthier buy I was just trying to look good for a college reunion. Meaning that I'm more motivated by vanity, or insecurity, than health? lol]

The other thing that changed my lipid profile was when I was eating a lot of fresh vegetables with every meal. My personal theory, based on zero science, is that the pectin in the vegetables adsorbed a lot of fats as it went through the GI tract analogous to those goofy 'colon cleanse' kits. And a friend lowered her cholesterol considerably by doing the same thing by the way. Eating a lot of vegetables, of the best quality you can find, is an easy enough thing to try while getting better answers. Almost any vegetable can make a decent smoothie if chunks of apple are included. Which also increases the pectin.

I am a very active ( 60 yrs) , run and play hockey. NO cardiac symptoms but High cholesterol and calcium score motivated me to get an CT angiography. I was wise to push for this test as it showed a 75% LAD blockage which required statins and a stent. That was six months ago in which time my cholesterol has dropped from to 240 to 150, and the LDL from 147 to 55, HDL steady at 65. Hope this helps.

steveny,

Most cardiologists immediately go to a stress test ... my sense is to assess how serious your condition MIGHT be - some add an echo test component, as well. Not prescribing a stress test with high CAC is unusual, it seems to me - unless your cardio believes your exercise regimen would have pointed to serious blockages, already?

My interest with doc consult in a few weeks will be for a stress test plus echo, and probably CT angiogram. My diet has always been pretty balanced - moderate in most respects. Never smoked, occasional beer or mixed drink, exercised quite a bit prior to hip replacements (have worn the friction surfaces on the first one down a bit), very active lifestyle, Already taking statins as I noted previously, and icosapent ethyl (Vascepa) with good cholesterol, LDL and trigylceride numbers ... so, not much more possible in that regard. Glucose and A1C tests have always been higher than my diet or lifestyle should dictate so likely genetic.

That's a good tip on the veggie smoothies, thanks.

Would the fluffy, non-sticky type of cholesterol work against the plaques that I already have? Just curious what it's exact benefit is, or could be if I do have it, since I already know that I have such a high level of calcified plaque.

I am going to pursue the stress test. I have an appointment with a second cardiologist tomorrow and it is one thing I will press on. One issue here is that my main cardiologist is off the next two weeks - I think I was literally his last patient before his vacation. So there's no stress test to be done in his office until he returns. And as I said, he did order a new CT scan, this time with dye contrast. My understanding is that this might even be better than a stress test in terms of revealing potential blockages/build-up? That test is set for the first week of August - when he is back.

Interesting to hear your description of your lifestyle. I think I'd describe mine similarly. No smoking, not a heavy drinker, have a long history of exercise, and not overweight; I think my diet has probably been worse than yours. But it does seem that genetics have to be heavily implicated here to get me to such a high score at such a young age. I can imagine someone without my genetic load scoring a 0 with my lifestyle. Really seems like this calcium score is the major dividing line between who is and isn't vulnerable to heart attacks and stroke; not that it can't happen to someone with a 0 score, just that it's *vastly* more likely in our group. Real luck of the draw element to this, I think, and we both drew lousy hands. (I saw one general population study that estimated that 93% of people at age 40 have CAC scores of 0; so even to get a 1 would have put me in a small minority. To be at 397....)

I did also want to share this from some UK research that I stumbled on yesterday. It apparently came out last summer and it's a little confusing, but it seems to raise the possibility that high CAC scores could be related in some way to higher levels of exercise. It raises some interesting potential questions. I can't apparently post the link here because this system doesn't allow URL's from new members. But if you google "
Exercise may contribute to narrowing of arteries, research suggests," I think you may find some articles about the study.