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

Posted by steveny @steveny, Jul 8, 2022

I'm a 42-year-old male. Exercise regularly, not overweight, non-smoker. While not overweight, I will say that my diet is crap -- way too much fast food, pizza etc. I guess I still eat like a high schooler.

Anyway, I saw a cardiologist figuring after age 40 this would be wise. He took bloodwork which was basically all fine. The cholesterol was *slightly* elevated and he recommended getting a heart calcium score. Told me he expected it would show nothing but that he just wanted to be thorough. Turns out the score came back at 397.

Obviously, this caught me totally flat-footed. I figured with my diet there might be some plaque, but this number places me in the 99.999th percentile for my age. And everything I have read online sound pretty dire about my long-term prognosis now -- that significant damage has been done, that it can't be reversed and can only get worse and that the statistical linkage between a number like this and heart attack-stroke is profound.

Weirdly, the cardiologist did not seem to be conveying any alarm when he told me the score, though. He was extremely matter of fact about it. Just said it was "very, very high" and that he would put me on a statin (which I've already started) and that I should take daily baby aspirin (doing that too). He said I should focus on improving diet and continue exercising (I already run 4-5x a week) but he was also pretty emphatic that "this must be genetic." (There is a history of heart problems on my father's side of the family -- though he is 76 and has yet to have any heart trouble himself.)

This was all a lot to get hit with at once. From the doctor's casual, matter of fact tone, I left the office a little confused, wondering if maybe this score wasn't that big of a deal and was a very manageable thing. Why else would the doctor not seem that disturbed by it? But then I started reading everything I could find on the subject and it's been pretty devastating.

Obviously, I'm ready, willing and able to implement the dietary changes, but for the score to be this bad at this young of an age (and with no smoking history, not being overweight, and doing regular exercise), it seems like I'm in serious trouble here. So upsetting to read that I can't bring this number down.

I guess I'm just posting this in the hopes that others here might have some experience and insight and be able to offer something, anything that is encouraging? When I read all of the medical material online about high CAC scores, am I missing something? This has all been playing out over the last 24 hours and I feel like I've basically just found out that I could drop dead of a heart attack at any moment and that my life expectancy has been drastically reduced with this news -- and that there's no way to get it back to normal. I now have a million questions for the cardiologist, but when I called his office today I was told he's just started his vacation and won't be back until August.

Any encouragement or practical advice would be greatly appreciated. Thanks.

Interested in more discussions like this? Go to the Heart & Blood Health Support Group.

@steveny

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.

Jump to this post

Actually, trigs below 150 are considered "Normal" ... 141 is close to the break point in the scale, and prior to that particular blood test, my trigs, working backwards were: 118, 108, 136, 96, 140, 122 ... BUT, 15 years ago they were usually 135-155. Borderline high is 151-199, and High is over 200 ... so, 141 would not be considered a "problem." As you note, a LOT of folks report with extremely high triglycerides.

And, yep, statins helped in significant reduction ...

My HDL has always been lower than one would expect - even when I was working out and running, they were usually 40-50s.

REPLY
@mayoconnectuser1

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

Jump to this post

I wish there were an arbitrage market for health stuff. I'd be happy to trade you total cholesterol, but I'd keep my HDL and my triglycerides are fine. (I can't take statins.)

I got out of shape during lockdown and am having a problem getting motivated to get back on treadmill, which is the unboring option as I take small DVD player and movies to watch.

REPLY
@mayoconnectuser1

Actually, trigs below 150 are considered "Normal" ... 141 is close to the break point in the scale, and prior to that particular blood test, my trigs, working backwards were: 118, 108, 136, 96, 140, 122 ... BUT, 15 years ago they were usually 135-155. Borderline high is 151-199, and High is over 200 ... so, 141 would not be considered a "problem." As you note, a LOT of folks report with extremely high triglycerides.

And, yep, statins helped in significant reduction ...

My HDL has always been lower than one would expect - even when I was working out and running, they were usually 40-50s.

Jump to this post

Ah, didn’t realize that was the range for triglycerides. So it sounds like in terms of bloodwork your main “problem” areas were high A1c, glucose and blood pressure (controlled with medicine though)?

In my case, I do have hereditary hypertension. Was first told I had it in college, didn’t treat regularly with medicine until later in my 20s, so there were a few years there when I could have done some damage. Also even as I’ve taken lisinopril for 15 years, it does seem that in the last couple years my BP has started to climb. It’s generally about 130/80 these days. Looking back at records from doctor visits a few years earlier, it was well under 120. I even remember more than 10 years ago one doctor saying it was too well controlled and that maybe I could cut back or even eliminate taking it. Long way of saying, maybe there has been something happening the last few years metabolically that has raised my BP and contributed to this calcification. But still, it’s not like my BP is *that* high.

I am spending a lot of time searching online for research about CAC and any data that might point to mitigating factors. I do see some research that shows regular physical activity in people with CAC does seem to reduce cardiac risk about 10-20%. I find myself wondering if there’s a statistically meaningful difference in outcomes for people who have high CAC but good lipid numbers vs. those who don’t.

And I even heard a suggestion that there may be people whose bodies are just prone to wanting to promote calcification. The hopeful implication being that a higher CAC score could in some cases mean that a person has simply converted much more of their soft plaque to dense calcified plaque — resulting in a much more stable plaque situation but also a high CAC score. Fwiw, I broke two fingers a few years back and when I had the pins taken out after a few weeks of immobilization, one of them absolutely refused to bend. It was pointed straight and rigid and no amount of physical therapy could get it to budge. The therapist said it was highly unusual and the doctor said that in the short time my fingers were immobilized there had been calcification of the tendon. So trying to move my finger was like trying to break through cement. Ended up needing a second surgery just to free up the tendon and allow my finger to move today. Anyway, thought of that today. Is there some chance I’m somehow prone to calcification in a good way?

REPLY
@mayoconnectuser1

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

Jump to this post

Good keep the trigs low

REPLY
@steveny

Ah, didn’t realize that was the range for triglycerides. So it sounds like in terms of bloodwork your main “problem” areas were high A1c, glucose and blood pressure (controlled with medicine though)?

In my case, I do have hereditary hypertension. Was first told I had it in college, didn’t treat regularly with medicine until later in my 20s, so there were a few years there when I could have done some damage. Also even as I’ve taken lisinopril for 15 years, it does seem that in the last couple years my BP has started to climb. It’s generally about 130/80 these days. Looking back at records from doctor visits a few years earlier, it was well under 120. I even remember more than 10 years ago one doctor saying it was too well controlled and that maybe I could cut back or even eliminate taking it. Long way of saying, maybe there has been something happening the last few years metabolically that has raised my BP and contributed to this calcification. But still, it’s not like my BP is *that* high.

I am spending a lot of time searching online for research about CAC and any data that might point to mitigating factors. I do see some research that shows regular physical activity in people with CAC does seem to reduce cardiac risk about 10-20%. I find myself wondering if there’s a statistically meaningful difference in outcomes for people who have high CAC but good lipid numbers vs. those who don’t.

And I even heard a suggestion that there may be people whose bodies are just prone to wanting to promote calcification. The hopeful implication being that a higher CAC score could in some cases mean that a person has simply converted much more of their soft plaque to dense calcified plaque — resulting in a much more stable plaque situation but also a high CAC score. Fwiw, I broke two fingers a few years back and when I had the pins taken out after a few weeks of immobilization, one of them absolutely refused to bend. It was pointed straight and rigid and no amount of physical therapy could get it to budge. The therapist said it was highly unusual and the doctor said that in the short time my fingers were immobilized there had been calcification of the tendon. So trying to move my finger was like trying to break through cement. Ended up needing a second surgery just to free up the tendon and allow my finger to move today. Anyway, thought of that today. Is there some chance I’m somehow prone to calcification in a good way?

Jump to this post

Abnormally increased tendency of body to calcify. I nteresting point, but haven't found anything substantive, thus far.

My story, like yours, could simply be a random point ...

Tough life with damage to right foot and both hips:
- right foot has been worked on several times over the past 25 years to remove significant calcification around big toe joint (hallux rigidus)
- both hips damaged (slid off a couple of wings and down aircraft ladders in high winds) and as normal, the damaged areas increased calcification as bones do; then first hip replaced in 2000, with second in 2019

So, maybe something there, there ... 🙂

REPLY

My body seems to like calcifying- having calcium deposits in the LAD artery plus a calcified aortic valve- getting worse as it usually happens. Will need a new valve in the future. Because of that my doctor keeps the blood pressure low enough, so the heart doesn’t have to work too hard.

REPLY
@mayoconnectuser1

Abnormally increased tendency of body to calcify. I nteresting point, but haven't found anything substantive, thus far.

My story, like yours, could simply be a random point ...

Tough life with damage to right foot and both hips:
- right foot has been worked on several times over the past 25 years to remove significant calcification around big toe joint (hallux rigidus)
- both hips damaged (slid off a couple of wings and down aircraft ladders in high winds) and as normal, the damaged areas increased calcification as bones do; then first hip replaced in 2000, with second in 2019

So, maybe something there, there ... 🙂

Jump to this post

The idea was told to me by a (non-cardiologist) doctor who knows one of the top cardiologists in NYC. His description to me was fuzzy and non-specific and like you I haven't been able to really find anything online that would fit with it. So who knows. This doctor also got me an appointment with this cardiologist later this week to consult on the situation. Given his credentials and particular expertise in imaging and risk stratification, I'm hopeful it will be a valuable session.

Also tomorrow morning I am going in to have a CT Angiogram.

I really do appreciate the back and forth on here. This has been very difficult for me to deal with, as I'm sure it is for many here.

REPLY
@steveny

The idea was told to me by a (non-cardiologist) doctor who knows one of the top cardiologists in NYC. His description to me was fuzzy and non-specific and like you I haven't been able to really find anything online that would fit with it. So who knows. This doctor also got me an appointment with this cardiologist later this week to consult on the situation. Given his credentials and particular expertise in imaging and risk stratification, I'm hopeful it will be a valuable session.

Also tomorrow morning I am going in to have a CT Angiogram.

I really do appreciate the back and forth on here. This has been very difficult for me to deal with, as I'm sure it is for many here.

Jump to this post

CTA is good ... some indicate issues with it in cases of really high calcium levels ... calcium interfering with the scan, supposedly. Gotta be done, though.

Has there been discussion about the more invasive, but hold standard, angiogram?

REPLY
@mayoconnectuser1

CTA is good ... some indicate issues with it in cases of really high calcium levels ... calcium interfering with the scan, supposedly. Gotta be done, though.

Has there been discussion about the more invasive, but hold standard, angiogram?

Jump to this post

No discussion of the cath lab at all, at least not yet. The cardiologist who set this up (and who initially recommended the CT scan) has been emphatic this entire situation is nothing for me to be worrying about -- that "you don't have a problem right now. You have the potential to have a problem. And we know what to do to stop it from becoming a problem, and that's what we're doing." He has told me that he doesn't think the CT-angiogram is necessary "but I would like to have it anyway, so that we have something to compare to in the years ahead." And he's told me that he expects the results from tomorrow's CT-A will be reassuring to me.

I've mentioned this in other posts, but I have found his seemingly casual and not-too-worried response to my 397 score to be very confusing. I want to be reassured by it -- he's very well-credentialed, it was *his* idea to even have the CAC scan in the first place, and he's talking about this is an entirely and easily manageable situation that I shouldn't be losing sleep over. But I am having enormous difficult squaring that with all of the available literature on CAC scores and their meaning -- especially at levels this high in people as young as me. I did see a second cardiologist for a second opinion. He looked at the scan, confirmed its accuracy, and advised the same approach -- statin and diet/lifestyle modification -- and he also didn't communicate alarm/urgency in how he talked about the situation.

I would really like to believe that there is more nuance and complexity to these CAC scores -- room for them to be benign and only truly alarming under specific conditions. The way my cardiologist has handled this gives the impression that that's how he views them. But again, the data just seems so overwhelming here. There have been major studies with very large sample sizes, and they uniformly point to my situation being...very bad. I don't know if I am permitted to post links on this forum yet, but I just keep staring at this particular study in shear terror: Among my age group -- 32 to 46 years old -- those with CAC scores over 100 had an incidence of death of 22.4 per 100 people over a 12.5 year follow-up period. Almost 1 in 4. And then I remind myself that my score isn't just "over 100" -- it's basically 400.

STUDY:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397328/

REPLY

Steven, I think when a doctor has a patient with a not so good prognosis, they try to ease them into the right direction. I’m in the same type of situation but caused by a 1 in a million heart birth defect. If you think about it, if they told you the dire position you’re in, you just might drop dead right in their office. That’s what happened to me, except I didn’t drop dead but he scared the he!! out of me.

I went for a stress test and they found a problem. The doctor said I needed a CT Scan immediately because he saw something wrong with my heart. He walked me over to the CT room and explained to the technician exactly what he wanted and then told me he’d be back as soon as he read the results.

I was sitting on a chair in a small room when he came in. He looked real serious as he came over to me and sat next to me. I have some bad news for you, “you’re going to die in your sleep!” OMG, I cried out. I thought he meant that very night but he proceeded to explain that I have this birth defect in my heart. That’s when he explained that about an hour after I fall asleep, the defect would cause me to go into tachycardia(beating real fast). If I didn’t wake up to get help, I’d go into A-fib(out of sync) triggering a fatal heart attack. Gee doc, thanks, now every night I close my eyes, I don’t know if I’ll ever open them again. I was told that in 1997, it’s 2022 and as you can see, I’m still here, birth defect and all. Only problem, I woke up 3 times to get help, plus the defect has triggered 3 heart attack but I’m still here Steven.

Do you get what I’m trying to say? Even if your prognosis is poor, stressing yourself out won’t help, in fact “Stress Kills”. Your doctor has you on the right medication, a statin. It may be to late to reverse the damage but you’re still alive aren’t you! Make the best choices you can and learn to live. In 1997 I made this motto for myself. “ If it’s my time to die, I shall go. But if it’s my time to live, I shall live my life to its fullest.” I was 53, I’m 78 now, my heart is so damaged and fragile, my doctors say I could die at any second. In fact, I’ll die between the first half of a heartbeat and the second half. So what am I doing right now, listening to oldies of the 50’s & 60’s and passing along my knowledge to the younger generation, YOU!!!

REPLY
Please sign in or register to post a reply.