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

Dr. Agotsten called me a 'rock star' (same statistical odds as outlier or zebra) and added. "Now don't go out and take advantage of the good luck and slug off on eating right and regular exercise!"

I went straight to an ice cream store for a hot fudge sundae and skipped the treadmill for 2 weeks. I think the Berkeley Cardio profile identified a gene predicting that I'd likely slough off or the good doctor has seen my kind before. lol

I’m sure you are aware how fortunate you are. I congratulate you. There is literally nothing in my lipid profile I wouldn’t trade for a 0 CAC score. It is far, far and away the most consequential measurement of risk.

I never paid attention to LpA before so dug out cardio blood work history only to find that I have a lot of it. (That might be the genetic marker the Berkeley tests picked up.)

I'm going to try not to worry about it, maybe cut back on ice cream and watch for any new developments in antisense oligonucleotides. Though med science is looking at mRNA technology to deliver the stuff and I'm not likely to jump on the bandwagon. You might outlive me by decades... And for reasons I don't understand, I have low triglycerides. I'll have to listen the next time cardiologist explains this stuff?

@callalloo I never pd attention to my calcium score had by pass in 1996 , haven't had any problems . Sometimes when you worry alot over an issue you make yourself worse .

I think you're right. The best we can do is ...well just that. Not that I'm close to that goal but it is the aim at least. 🙂

Figured I’d post an update. Went in for the stress test today and passed it with no issues. An. Echocardiogram was also taken that apparently looked normal.

None of this was much comfort to me, obviously, since the stress test only detects blockages and most heart attacks are from spontaneously ruptured plaques. And there is no change to the fact that I have a *lot* of plaque.

Talked with the cardiologist in his office after. He remarked again how surprised he is to see such a calcium score given all of my bloodwork. I told him I fear that the extremely high CAC level at my age coupled with an absence of just about any abnormal lipid levels makes me very nervous that there’s something driving this (thyroid resistance?) that goes beyond the usual explanations and will make it unresponsive to the usual treatment. I continue to respond very poorly to the Crestor. Can’t describe adequately how drained by body feels 24/7 now. I tried to run again today; this was a breeze just a few weeks ago. Now I’m struggling after just a few blocks, feet barely shuffling forward, had to cut the distance in half. This kind of response I believe is common with hypothyroidism.

Basically, I suspect that my body has some type of resistance to thyroid hormone. This is the opinion of the endocrinologist I’ve been seeing for years. It has made me functionally hypothyroid without the blood levels you’d get with it. So I have the right circulating amounts; my receptors just don’t/won’t process them, and supplementation will get me nowhere. And now I am discovering that hypothyroidism is a major player in developing and accelerating atherosclerosis. And that it also is heavily implicated in non-response to statins. So my body’s resistance to thyroid hormones has opened the floodgates to artery plaque, and it is also I suspect preventing the typical treatment from working.

We took a blood draw today to see if the 3 weeks I’ve been on the statin actually has meaningfully lowered my LDL. If it has, that will obviously be encouraging. Maybe it would be enough for me to put up with this fatigue, if I know it’s getting the job done. But even if it does lower my LDL, I’ll still be haunted with doubt:
* Given that my lipid profile really isn’t that bad to start with (LDL 107, HDL mid-80s), is it really realistic to think that just knocking LDL under 70 is going to dramatically change the equation for me when it comes to arterial plaque?
* Since CAC will rise with statin use and is not a good gauge to measure the progress of treatment, how will I actually *know* that I’m successfully reducing my risk even if LDL comes under 70? Do I just take it on faith that it’s working? Are there any other metrics to use?

steveny,

More good news, then.

What were the METS and Duke scale numbers from the ST? There should also be some specifics from the echo component?

So I have the echo report but I don’t know what the key metrics are, and there is a lot of data on it. The cardiologist said it looked “completely normal.” This is from the conclusion section of the report:

CONCLUSION:
--There is no left atrial dilatation (LA volume index 19 ml/m²).
--LV global wall motion is normal.
--LV ejection fraction is normal (58 %).
--Normal left ventricular diastolic function with normal left atrial pressure.
--The right ventricle is normal in size. The right ventricle has normal wall motion.
--There is trace mitral regurgitation.
--There is no tricuspid regurgitation.
--The right atrial pressure is normal (0 - 5 mm Hg). There is too little tricuspid
regurgitation to estimate PA systolic pressure.
--There is no pericardial effusion.
--No prior study available for comparison.
****
Additionally, I got the bloodwork back. I’ve been on Crestor at 10mg for the last few weeks and my lipid levels are:
Total cholesterol: 147 (was ~215 pre-statin)
LDL: 67 (was 107 pre-statin)
HDL: 65 (was ~85 pre-statin)

So it seems like the Crestor, despite my physical reaction to it, is doing what it is supposed to from a numbers standpoint.

What concerns me, as I said, is that every doc I’ve now consulted has expressed surprise that my calcium score is 400 given that the baseline lipid level wasn’t really bad. It’s not like I inherited super-high LDL that was running through my system for decades. In fact, based on the current standards, I shouldn’t have even had the CAC test at all: It is only recommended as a tiebreaker for those whose lipid profile puts them in an intermediate risk category on one of the traditional risk calculators. But my blood levels put me in the very low risk (<1%) category. My cardiologist suggested it anyway, basically telling me I could pay $100 for peace of mind and that it would show nothing.

And yet it showed ***massive*** amounts of plaque. It just seems there has to be a root explanation here that is different from just saying it’s genetic. This is an extreme level of plaque at 42. If I had a score of, say, 80, I think I could make more sense of this. But I’m literally in the 100th percentile for my age and I strongly fear that whatever is driving this won’t be addressed by the standard treatment of hammering LDL and modifying lifestyle.

I’m glad to see the numbers go down but I still have a very uneasy feeling that something else is afoot here.

All good news - did they provide METs number or Duke scoring number for the stress test component? Yours would likely be off the charts, but they are scaled based on age.

Here's what my non-echo stress test read:

"Resting EKG - normal sinus rhythm. Resting heart 89, resting blood 132/78, exercise 9 minutes. Leg fatigue for stopping. Patient denied chest pain or shortness of breath. METS 10.3, peak 159 beats = 102% max. Peak BP 195/90. Conclusions: Negative treadmill stress for inducible ischemia to achieve workload. Achieved 10.3METS. Placing patient good for functional capacity for age. Duke treadmill score of 9, placing patient at low 5 year cardio mortality risk."

Remember - two hips, very active, walk but don't run.

I believe this is why the cardiologist said - meh.

Prior to ST this was panel:
Trigs - 141
Total Cholesterol - 122
HDL - 41
LDL - 57

Six months later after statins and Vascepa:
Trigs - 56
Total Cholesterol - 115
HDL - 48
LDL - 47

Two years later:
Trigs - 49
Total Cholesterol - 106
HDL - 46
LDL - 47

It doesn't look like I have any data from the stress test in my patient portal. I just did the tread for about 12-15 mins at increasing speeds and he said, "Well, you passed the stress test easily," and then we moved on. I'll see if I can track down any numbers.

Interesting to see your numbers. Looks to me like you did have a clear problem area in your bloodwork -- high triglycerides -- that has been well-addressed with the statin. Obviously, your total and LDL cholesterol was already in a really good place.

This is what I keep getting at about the strangeness of my situation: There was nothing in my bloodwork that suggested a potential problem. All I've had is slightly (~100-110) elevated LDL cholesterol, with normal triglycerides, high HDL, low lipoprotein (a), low hsCRP. So no doc I'd previously done bloodwork with ever even suggested a calcium scan -- and I can see why now: my lipid profile put me at <1% risk in the traditional calculators. So while I'm glad to get the LDL down under 70, I have a hard time wrapping my head around the idea that it's what was driving this in the first place. I see people here sharing LDL levels that are near or above 200. I could see how that could lead to significant plaque accumulation. But I've never had anything like that. I just would really like to understand the root cause of this, because it doesn't seem to mesh with how these high calcium scores are typically explained.