High CAC Score and Current Status

Posted by mayoconnectuser1 @mayoconnectuser1, May 21, 2022

Hi All,

I am now 68, have slightly elevated BP that has been controlled with Telemisartan/irbesartan (20mg/d) for 20+ years. I am 10-15 pounds overweight and am very active, but do not “work out” - lots of walking and maintenance on rental houses. I have had both hips replaced. Father died from lung cancer at 50 yo (3 pack a day and risky work - boat paint, propellor grinding), mother died from infection at 87 yo. Sibling early diagnosis of pancreatic cancer at 64 yo - good chance of long life due to early diagnosis and quick action.

In Sep 2019, given the low cost (no health related reason), I had a CAC (coronary calcium) test - a few days later I left on a two week vacation to Europe. Got back home to find a letter from my doctor, indicating the CAC test was “abnormal” - like 1340! At this time: Triglycerides 120-140, total Cholesterol 120-150, HDL 40-46, LDL 60-110. Never any medical issues other than hips and somewhat elevated BP.

I immediately reviewed options, met with cardiologist and started atorvastatin and Vascepa (have also taken 81 mg aspirin for the last 20 years). Did walking treadmill stress test within a couple of weeks. "Bruce protocol, normal sinus rhythm at rest, 9 minutes, no shortness of breath (legs got tired on the elevated portion), METS 10.3, peak heart rate 159, peak blood pressure 195/90, no ST-not T changes diagnostic for ischemia, occasional PVC. Conclusions: 1. Negative treadmill stress for inducible ischemia to achieve workload, 2. Achieved 10.3 METS. Placing patient good for functional capacity for age, 3. Duke treadmill score of 9. Placing patient at a low 5-year cardiovascular mortality risk."

No one recommended a re-test for CAC. Cardiologist indicated they are rarely inaccurate.

Next series of blood work - note massive decrease in triglycerides
Jun 2020 - Triglycerides 56, total Cholesterol 115, HDL 48, LDL 47
Feb 2021 - Triglycerides 60, total Cholesterol 121, HDL 46, LDL 53
Aug 2021 - Triglycerides 27, total Cholesterol 99, HDL 46, LDL 39
Mar 2022 - Triglycerides 49, total Cholesterol 106, HDL 46, LDL 47

Fast forward to today - very active, just returned from a month long tour of Portugal and Germany where we averaged 8-10 miles a day walking, rolling luggage in and out of airports, trains, and cars. Walk and work on something daily - do not watch sports - ie not a couch potato. I still feel great - and have felt great for decades.

Thoughts? Another CAC test? Another stress test?

Thanks to All!

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@mayoconnectuser1

Hi Steveny,

Spoke with Dr Min - and, then asked my cardiologist in writing about using Cleerly. His response:
"The best option is to get your actual CTA and send it to HeartFlow for a measurement of FFR. Cleerly is just determining if you need treatment, but you are already having your risk factors treated. As I previously told you, the presence of calcium makes CTA imaging difficult. HeartFlow is better for determining if any stenting, etc needs to be done."

His response has a better "tone" than previously - maybe because he recognizes I'll just keep leaning into it? 🙂

What do you think about the two products/services - Cleerly vs HeartFlow (https://www.heartflow.com)? There is quite a bit more depth presented in the Professionals pulldown menu.

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I'm not as familiar with HeartFlow, but i think I did look into it briefly around the time I had the Cleerly analysis done. It looks like it's in the same ballpark as Cleerly, so maybe would provide you with similarly useful info. His comment that Cleerly is only to determine if you need treatment flies in the face of everything I've seen/read/heard. To me, the value of Cleerly is that it provides a benchmark for monitoring progress. With periodic scans, you can see if new plaque is developing (and, if it is, where it is developing). You can also see whether the plaque you have is becoming more calcified. This is the big one to me. I think I mentioned before that my Cleerly test showed that ~2/3 of my plaque is calcified, and the other 1/3 non-calcified, with no low-density soft plaque. Relatively speaking, this seemed encouraging; hopefully when I next get a scan these numbers will be better. The idea is that the denser/more calcified your plaque is, the more stable it is and the lower your event risk is. And Cleerly seems like a good way of measuring/monitoring this. But maybe HeartFlow can give you the same info.

I found the presentation from Matthew Budoff in this Cleerly video valuable and it was the main reason I got the analysis done:
https://cleerlyhealth.com/transforming-cardiac-care/?mtm_campaign=cleerly_tcc-webinar-series

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steveny,

Another update showing the goofiness of the medical system ...

Got call from staff at my cardiologist's office. She explained they had no way to provide my CTA data to HeartFlow as the hospital system they are associated with has no contract system to do so. Said perhaps I should work to get another CTA done at one of the centers that HeartFlow uses. She was technical, but kept saying - "but, the doctor is already treating you."

I'll try another couple of approaches and check back in.

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@neirbookeik1

Greetings to all you Very High Calcium Score folks. I am 76 years old and still gainfully employed as a physician though not of course a Cardiologist. I recently had a scan that showed a CAC score of 1029 and have an appointment with a Cardiologist in a week to decide what to do. I am "asymptomatic" but a recent EKG showed a Left Bundle Branch Block. It had always been normal sinus rhythm before and led to the calcium scan. I was surprised when it was very high because I have been on statins for 20+ years (5mg of atorvastatin takes me from 240 to 90 with an LDL of 60 but an HDL of only 35 which is probably the problem) My blood pressure has been 120/70 or lower whenever tested at Doctors office. I don't smoke, don't drink but I have been obese ( recently went from 270 to 228)
What to do? Here is my analysis There is no value to repeating a high score CAC because it will only get worse over time. A younger person with a score of 0 but symptoms or a strong family history probably deserves a rescan but intermediate >100. maybe but probably not.
Now the question I ask my cardiologist is WTF do we do now? Will she say "lets do coronary angiography"? Should I add an ARB to my antihypertensives which are already working? Should I increase the intensity of lowering my LDL which is already below 70 and I am not Diabetic. There is no way to raise HDL Stay tuned for Chapter 2

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Not a Physician, but a Chemist at 75 years of age. I had angioplasty back in 1986 at the age of 39. I am asymptomatic and only found out that I had multiple blockage because I did a stress test as part of a physical conditioning test. I suffer from what killed Jim Fix a runner back in the 1980s.
Since then I have always taken statins, as well as blood pressure meds. I have always exercised and believe that is really important. I maintained a low fat diet for a number of years. We moved from Santa Barbara to Orange County back in 2002. After a while I found myself eating more meat products and cheese, and even whole eggs for a while. My weight went up to around 185+. We were part of the Kaiser Perm and I recall my Cardiologist telling me that my disease was progressive and that I was doing everything I should be doing. I was taking a beta blocker, Ace inhibitor, and a Calcium channel blocker.

We moved back to Santa Barbara in 2016 and I got a new primary Physician in a local HMO. He wanted me to see a cardiologist. The cardiologist wanted to do an angiogram. I agreed and when it was over, the Cardiologist said that the blockage was severe and I should pursue CARB. I ended up scheduling open heart surgery, but backed out a couple of days later. I began doing a lot of literature review of various medical periodicals etcetera. In the end, I found some interesting studies comparing medication vs surgery and long term longevity. Because I am asymptomatic there is not a lot of benefit to be gained from open heart surgery in terms of feeling better. Obviously if I had a heart attack that would be a different story.

Bottom line, I changed my diet from a generally low fat diet to no more then 10% of calories from fat. I began to follow Dr. Dean Ornish’s recommendations on reversing heart disease. So since mid 2017 I have become a low fat Vegan. My lovely Wife joined me. I lost weight and ended up at around 165 from around 190. We walk in the hills of Santa Barbara twice a day.
My blood work is much improved.
My HDL has always been at 40 which like yourself is probably a determinant. I had smoked from age 15 to 30 and then quit, but I am sure the damage was done. My cholesterol is around 100, my triglycerides are around 80, and my ldl is around 50, with very low ldl at 20.

To see if I was getting better I had a cardiac PET scan which showed a 20% reversible blockage. I did a cal score same time and the score was around 1000. Two years later I did same tests and nothing changed, but the cal score increased to 1200.
I am taking max 80 mg of statin which helped lower my numbers to what they are now. My cardiologist thinks the high statin may somehow be why higher cal score. However the higher score may not mean more blockage but perhaps density has increased. In the end it is not the old calcified plaque that breaks off and blocks your artery. Generally it is new plaque that is unstable that does you in.
So for now I am continuing to follow a 10% or less of fat in my diet, exercise, take my meds.
I do wonder about whether Vitamin K2 can reduce calcium in the arteries, and if so would the plaque become less stable?
Tell us about chapter 2?

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Very glad you found Dr Dean Ornish. He and Dr Esselstyn were the first ones to show you can prevent and reverse heart disease. Even Medicare now pays for Dr Ornish’s program.

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@rochelle369

Very glad you found Dr Dean Ornish. He and Dr Esselstyn were the first ones to show you can prevent and reverse heart disease. Even Medicare now pays for Dr Ornish’s program.

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Again, rochelle369, please moderate your assessments of various "solutions" in this area which relates to high CAC.

There are no studies I have seen that indicate CAC is reversible.

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@mayoconnectuser1

Again, rochelle369, please moderate your assessments of various "solutions" in this area which relates to high CAC.

There are no studies I have seen that indicate CAC is reversible.

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The CAC score is not reversible. You can reverse heart disease which Dr Ornish and Esselstyn have demonstrated.

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Heres an article by Dr Ornish -https://www.ornish.com/zine/will-reversing-my-heart-disease-with-the-ornish-lifestyle-medicine-program-change-my-calcium-score/

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@rochelle369

Very glad you found Dr Dean Ornish. He and Dr Esselstyn were the first ones to show you can prevent and reverse heart disease. Even Medicare now pays for Dr Ornish’s program.

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CAC is not reversable but you halt and even reverse heart disease

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@rochelle369

CAC is not reversable but you halt and even reverse heart disease

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rochelle, you continue to make extremely broad statements based on the talk of online and "celebrity" doctors.

This is a site to share, but most medical sharing relates to scientific, peer-reviewed, and independently tested information.

The material you present does not pass these basic tests.

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@mayoconnectuser1

rochelle, you continue to make extremely broad statements based on the talk of online and "celebrity" doctors.

This is a site to share, but most medical sharing relates to scientific, peer-reviewed, and independently tested information.

The material you present does not pass these basic tests.

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Since the moderators haven’t objected, I think her views should be heard.
You may not agree with them, but others here might.
It’s everyone’s forum, not just yours.

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