High Coronary Calcium Score: How do others feel emotionally?

I have not been tested for Lp(a) . My doc never suggested that. I know I have a very high CAC score, moderately high TC (total cholesterol) and have two tests scheduled at the end of May. What would the Lp(a) tell me?

Good question. The last 10 (if not 15) years, I've eaten very little red meat. I've very rarely eaten steak (at most 3x a year) and burgers maybe 15x a year (if that much). It's been primarily organic chicken (unless eating out), pork chops, fish (primarily salmon), and on occasion I'd have crab cakes or shrimp. I eat plenty of vegetables (mainly broccolli, asparagus and carrots, but sometimes cauliflower and brussel sprouts). I do have a sweet tooth and drank my share of sweet tea, but that's been scaled WAY back since I found out my CAC score. I've always maintained my weight right around 155 (I'm 5'7"). BP has always been good (typically 120/80 at the doc's office or when donating blood. I've only just recently started testing it at home with an Omron BP machine and it's been averaging 115/70. Not sure if the tea and sweets did me in or just genetics. Don't think I'll ever know.

genetics....but those individuals could have had high CAC scores...and they appear to have done pretty well.

I would like to comment on how I feel emotionally, since that was the original intent of this particular forum.

In a word, "devastated."

I had a CAC score of 1444 back in early December. The reason I agreed to the CT Heart Scan test suggested by my endo was just to rule out remote chance cardiac issues amongst post-COVID health ups and downs.

It took me four months to see a cardiologist at a major university hospital due to scheduling. No one seemed overly concerned about my high score, and after reading a lot of the comments on this forum it seemed reasonable to put one foot in front of the other.

Today, the cardiologist took me apart for questioning the validity of the CAC score. He literally told me that there is no possibility of any error in the CAC number, as it is all automated.

After I suggested that I did not want statins or stents, he basically told me that I needed to go home and die, and that was my choice. He told me that based on the numbers alone that I likely had at least one artery occluded, but then he was unable to find any signs of a heart attack with the fresh ECG.

I suggested a conventional stress test with echo and ECG, or a nuclear perfusion test with stress, and he said that I would likely pass both and that it provided no information. Further, that he could cath me (if I made the request) and look first hand to assess for blockages, then create an action plan. He thought it would rather require open heart surgery (bypass) based on my CAC score if a blockage was found.

This is a cardiologist that teaches upcoming doctors cardiology.

All of this from a single CAC test score. I am 63-years old, dont smoke, dont drink, havent eaten red meat in most of a decade (like NONE), and have no family history of heart disease. I have almost an ideal BMI for my age. What I do have is a wildly increasing number of kidney stones (calcium oxalate). I feel like there is a possibility of hyperparathyroidism, but my blood work does not indicate it. The cardiologist said that there is no possible way for calcium to play any roll in the high CAC score and it is impossible to have calcium on the outside of the arteries and not in the walls and inside.

I couldnt even get him to consider for a moment the results of the JAMA meta study on statin effectiveness released last spring. Nor a study done that showed that four different types of CT scanners showed huge positive errors when patient heart rate was over 75bpm---mine being more like 120bpm at the time (I hate tubes).

Needless to say, I am going to seek a second opinion, and that will be at Mayo. I am shaking in needless fear right now. As so many of you have experienced yourselves, a CAC score is just one view. But today, it was presented as a certain death sentence with only the possibility of slowing the inevitable.

How is one suppose to sleep??

Pete

Wow, I’d get someone with a better bedside manner. He sounds brutal and, judging on what you say and the way you’ve lived your life, I think his comments were unnecessary and certainly he’s not treating the whole patient. He’s not ‘seeing’ you. Move on to another doc. As you’ve read here, a lot of doctors, mine included, do not think the test indicates all that much and that’s why insurance companies do not pay for it.

Your cardio's response regarding "go home to die" was appalling. He said that in order to convince you to take a statin. Scare tactics.

Taking calcium supplements have been of concern about CAC scores. I don't think they actually know for sure if they do increase the calcification within the arteries.

I understand our bodies (livers) make the majority of our cholesterol (only 25% from diet) and cholesterol makes the plaque that calcifies in the arteries.

I think you are wise to seek a second opinion from Mayo clinic where they will likely do the tests your cardio is resisting. I suggest in the mean time you not get a catheterization unless you are having some symptoms of a heart attack or the warning signs which I am sure you have researched. (There are risks with the cath procedure.) I do think that Mayo will also suggest statins as the first line of defense. They not only reduce cholesterol numbers but also are heart protective and reduce the possibility of a heart attack.

And if this puts your mind at ease, I have a friend who had a CAC about 10 years ago. The score was about 2100. He went on a statin and continued on with his life. He is now 81 and still no sign of a heart attack.

I wish you good luck. You have taken a pro-active approach to your health.

Cholesterol is found in all animal products. You want to stay away from all oils as well. The LP(a) shows if its hereditary. You may want to see dr ornish studies who shows it can be halted or reversed (https://www.thelancet.com/journals/lancet/article/PII0140-6736(90)91656-U/fulltext) and https://jamanetwork.com/journals/jama/fullarticle/188274)

Thank you so much for your kind posts---it really helps A LOT. I am not sure what I would do without the support of the people on this forum. It is such an emotional battle to deal with these high CAC scores.

I have signed into Mayo to request scheduling for a second opinion. I am trying to have the courage to get back to my normal life and just deal with the cardiac issue with priority, but not and end-all.

I am sure there are other people on this forum that have had the brick wall experience of a cardiologist that is un-to-themselves, so say it pleasantly. I am not sure there is much more to do, but RUN. 🙂

That said, it sure makes it hard to walk into the next doc's office with your head up.

I wonder how long it will take before the cardiology world will begin to realize that these exceedingly high CAC scores are an indication of something wrong with the imaging, not the patient. It is scary how deep these guys believe in their machine.

I brought up this forum to the doc, and his response was that since there were no dead people with high CAC scores on the forum, then what is being said is invalid. You cant make this stuff up. My science mind says that every discovery starts with having oddities that form a pattern, and if these CAC scores aren't just that, I dont know what is.

Pete

I'm going to go a different direction, Pete.

I find it hard to believe that any doctor would tell any patient to go home and die - perhaps you are paraphrasing? You also sound as if you might be in the category of "difficult patient" who knows more than the doctor?

I do find it believable that someone would decide, without any training except for internet interactions, to decide they know more about medicine than the person they have been trusting (usually for years) to decide whether or not they should be on statins. (my opinion - based on what you have shared, you should be on statins).

There are a lot of tests you can have done - via your PCP - if desired: CTA, advanced lipids panel, peripheral ultrasound. However, the standard of care, based on your age, your physical condition (although you don't mention blood work numbers), and signs of abnormal calcium is usually a stress test with echo. If this is OK, most cardiologists would send you home for a year and then see you with recommendation to repeat the stress test. Caths are invasive - and rarely prescribed if one is asymptomatic.

And, BTW - I disagree with the binary nature of rochelle369's assessment of diet - and, especially, the repeated mentions of Dr Ornish. As always they refer to something being reversed - it isn't calcium, which thus far cannot be reversed, so I am assuming they mean heart disease, or cholesterol (easy to lower).

Again, this is all opinion.

If I were you, I would change my cardiologist.
Read information below and don’t stressed out.
The largest research study of its kind has found that drugs can be just as effective as stents and surgery for treating blocked arteries. Results of the study, sponsored by the National Heart, Lung, and Blood Institute, were released on November 16.

Calling the findings “profound,” Mukul Chandra MD, FACC, of Premier Cardiovascular Institute says he is eager to share the news with his patients. “We have all the information we need. You don’t have to have stents or surgery for stable chest pain. If you’re not having a heart attack, we have another option,” he says he’ll tell them.

The study followed 5,179 people with moderate to severe blocked coronary arteries. None were experiencing a heart attack during the study, but many had angina (periodic chest pain). “Angina is the discomfort in your chest when you’re walking up steps or hiking, for example. It’s due to blockages in one or more of your heart arteries,” says Dr. Chandra.

The traditional means of treatment has been to open blocked arteries using bypass surgery or a procedure to insert stents (small metal mesh). Half of study participants received stents or bypass surgery. The other half received medication and instructions on weight loss, diet, and lowering blood pressure and cholesterol.

Results showed that “at the end of five years, the patients who did not have surgery were living as long and had a similar quality of life as the patients who had procedures,” says Dr. Chandra.

The news is especially exciting, says Dr. Chandra, because “one in a thousand patients may die during these procedures. There’s the risk of stroke, and procedures are very expensive. Without surgery we’ll save about half a billion dollars in the U.S. each year while maintaining the same quality of life for patients.”

I will be going to Mayo Scottsdale for a second opinion. The moderator said it would be ok for me to ask on the forum for recommendations of specific doctors there. I would like a doctor that is human first, not hung up on CAC scores, and is willing to go forward with new treatment options---there are many such treatments.