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!

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

jasper1072 | @jasper1072 | Apr 1, 2023

In reply to @hikerguy62 "Thanks for that info jasper. For those (like myself) who found out they had high CAC..." + (show)

Absolutely Hiker--

I think forums like this is to let people communicate with individuals who may be facing similar circumstances---not to say what is right or wrong. I think its great that the Mayo Clinic provides this forum---I have worked a large portion of my career in Medical Academia mostly in Radiology aka Diagnostic Imaging and Oncology aka Cancer Care. I personally don't like to hear what "I should or should not do"---that is between my physician(s) and me. Everyone's situation is different...even with potentially the same exact variables (age, test scores etc.)...anything can happen. Being positive I think is a big part of that...stay active, eat a well balanced diet, allow yourself to experience life's little pleasures now and again etc. Hey...I am a big traveler and when I go on vacation I allow myself to partake in things I normally do not in moderation. Why do all this life saving measures if we are not really going to "live". Having said that...I am going to go run my 2.5 miles today and then go out to a nice fish dinner with a martini. =:)

SteveSH | @steveny9 | Apr 2, 2023

In reply to @jasper1072 "Absolutely Hiker-- I think forums like this is to let people communicate with individuals who may..." + (show)

Well said. After 9 months of being pro-active after a negative ABI, I can finally breathe. In my case, finding the cause, the risks and how to live long life with quality took time. But I agree, it is time to experience life and all it's wonders!

neirbookeik1 | @neirbookeik1 | Apr 8, 2023

In reply to @mayoconnectuser1 "My cardiologist was upset that I would waste the scan - clearly a post de facto..." + (show)

HI There sports fans, Latest tests results are Calcium scan 1200, TRiG 114, Cholesterol 86, HDL 31, LDL 32, Alpha Lipoprotein A & B are both very low. What's abnormal is new onset of LBBB. This led to Cardiac Cath with mild diffuse calcification of the coronary arteries with 0 to 40% max internal compromise. No need for angioplasty OK for non cardiac major surgery ( which I underwent successfully). What was seen on cardio cath was non obstructive calcification. What does that mean? I am waiting for the answer.
Here is my opinion about an upset specialist " Hey this is 2023 boobie! Its not expected to be RIGHT 100% of the time. Drs are merely Drs, not fortune tellers, palm readers and certainly not Gods. What is expected is to listen and explain (if you can.) It's the era of interactive medical care and mutual decision making. " That's what I expect from my doctors and that's what I try to provide to my patients. Oh Yes I am one myself. I got my MD in 1973.

jasper1072 | @jasper1072 | Apr 22, 2023

Hey Folks--

Well, I changed my diet and exercise routine when I had an intermediate Calcium Score.
My total cholesterol was 218, HDL was 31, LDL was 150 and Triglycerides at 230.

I started an exercise routine that was nothing crazy, but consistent and when on what I called the Portfolio diet, which is 60% Mediterranean and then a mix of more healthy foods such as almonds, fruit etc. + 10mg Crestor
The results....
TC is now 89!!!!!
LDL is now 35....holy cow.
Triglgerides went down to 107
HDL I got up from 31 to 35...which is a 13% increase in 11 weeks.

I lost 18lbs, with my BMI now at 23.5
As a reminder I have no symptoms, I run without any shortness of breath or pain etc.
I am going to have a Nuclear Stress Test in 2 weeks even though technically I don't meet the Criteria, but...I work in the field and know enough people. My cardiologist still put me at lower risk compared to who he sees in his practice, and he is a very progressive Academic physician who is very blunt...which I prefer, he doesn't sugar coat anything.
I eat red meat 2-3x a month, but very lean as in 94%...and I don't eat pounds of it just a moderate portion.
I do drink Alcohol...man cannot live on bread alone LOL....but I drink alcohol that has no sugar which helps.
My AC1 is VERY low, and my BP is also normal to actually low...

I do take supplements; I am happy to discuss those if people have interest.

mayoconnectuser1 | @mayoconnectuser1 | Apr 23, 2023

Statins are pretty incredible, huh?

Sure, the diet change doesn't hurt, but I suspect the predominate component of reduction is the rosuvastatin.

jasper1072 | @jasper1072 | Apr 23, 2023

In reply to @mayoconnectuser1 "Statins are pretty incredible, huh? Sure, the diet change doesn't hurt, but I suspect the predominate..." + (show)

They are pretty amazing, however, Rosuvastatin can have some variability of how well it reduces cholesterol. Generally speaking---easy literature search that 10mg of Crestor will hopefully reduce LDL as a mean of 46-49% if lucky. Mine was reduce by 76% from baseline. So even if I low balled it...diet/exercise probably had to account for about 20+%...that is not bad. Also, rule of thumb with Crestor even if the dose was doubled to 20mg, most studies show only a further decrease of about 6%. It would be nice if doubling reduced LDL by the same margin as the 1st 10mg dose. The true test will be 3 months from now when I do bloodwork again.

I am also a believe a pill or pills is not the silver bullet...it needs to be combined with other positive changes to have a long term good outcome. I do wonder if having such a low TC is good though...not a lot of discussion around this and what literature does exist is very vague....I don't think medicine totally knows yet.

jasper1072 | @jasper1072 | Apr 23, 2023

PS...I still would like to get my Triglycerides lower, but going from 230 to 107 is a good start.

hikerguy62 | @hikerguy62 | Apr 26, 2023

That's impressive. My TC is 221 / LDL is 126 (checked this past March). My CAC came back at 2534, so I was immediately put on 10mg of Crestor (along with baby aspirin) by my doc, but when I saw my cardiologist three weeks later, he upped me to 20mg. I'll be curious to see where I'm at in 3 months. I hope I see the results you saw jasper1072.

jasper1072 | @jasper1072 | Apr 26, 2023

In reply to @hikerguy62 "That's impressive. My TC is 221 / LDL is 126 (checked this past March). My CAC..." + (show)

Hey Hikerguy62...I hope you see that drop as well! When I spoke with my PCP today he asked if I wanted him to reduce the dose from 10mg to 5mg.....I said heck no! If I can maintain a LDL of 35 that would be great...he agreed so I am staying on 10mg. I will also keep my diet going...its not bad...heck I ate 3 hamburgers this month and it still was that low. I am doing alot of beans and fiber...maybe that helps also.

hikerguy62 | @hikerguy62 | Apr 26, 2023

Thanks. I was actually considering what I would do if I got below, say 50. I'll probably ask my cardiologist if I can go back down to 10mg and closely monitor. I really don't like being on drugs, but I know it's necessary in my case.
I'll post back here in roughly three months with my new numbers. My numbers back in March were:

TC 221
LDL 126
HDL 83
Tri 69

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