High Coronary Calcium Score: How do others feel emotionally?

Hi, I have a 1500 score and I am concerned. I am 63 at 5’9” and 176 lbs. and according to my PCP index I am overweight. I could lose 10 pounds (working on it) not the my PCP has recommended it. He recommended a cardio (young doctor) and very pushy to place stents, he didn’t even wanted me to have an echo, stress test. His words were: “Why would you want to put $200 in my pocket?”, get the stents!!!”. I made the appts. for the tests in two weeks, well yesterday I cancel them, cancel this cardiologist and I am looking for someone I can actually have a conversation with about my well being. I am concerned, very and somewhat scared I could pass away next week. Have no chest pains, play tennis regularly, swim, etc. I have change my food intake radically. Not for sharing me second have I forgotten I have a 1500 score. My PCP (who I am about to ditch too) has told me if I like playing russian roulette!!! It looks to me I will have to get the stents at some point. I think there is No way around that. Get a 2nd opinion. I have spoken to guys in their 80’s and they all have stents, pacemakers, and the what not. Some got 2 stents, then down the road 2 more…. Best of luck. Send a response if you wish bc I am finding that the doctors in my neighborhood only listen to themselves.

@santafepete

Sorry to hear about all this anxiety...my two cents. This does not sound like a great cardiologist. 2nd opinion is definitely in order. A good physician lays out options in front of you vs. risk and works with you for a detailed treatment plan/course of action.

I paniced when I had a higher than normal score...not as high as many on this forum, but I guess it is all relative. My father in law has had a CAC of 4500+ for 5+ years with no symptoms, no pain, walks with no issue, is cognitive a the age of 79...not a care in the world. He is on a statin now and BP meds for minor elevation and eats an average diet. It took me awhile to calm down and realize this is not a death sentence, but gives you a long window of opportunity to make adjustments for a better long term outcome.

This forum is great for that and remember, this forum is to voice your experience and comments, no one should be playing doctor telling you what you should or should not do. I am triple board certified in the medical field and I would not do that...all I would say is make sure you are your own advocate and if something does not feel right...speak up. Be well and good luck.

@alaskat

How do they know you need stents without an angiogram or CTA? A high calcium score does not mean you have blockages or that you have blockages that would require stenting. 2nd opinions never hurt....measure twice and cut once! Good luck to you.

@jasper1072

That story is comforting. I found out my CAC score is 2534 a month ago (age 60). Saw a cardiologist about 2 weeks ago and I'm scheduled for an ECG and nuclear stress test at the end of May. I'm hopeful there will be no serious blockage but I know it's possible with that CAC score. I started Crestor about two weeks ago (first 8 days I did 10mg since my primary doc had prescribed that dosage), then went up to 20mg that my cardiologist recommended. So far no side effects. Scheduled for blood work in a month to check liver/kidney function and CPK level (apparently that's a check for enzymes release by your brain, heart and muscles when there's something negative going on).

You might want to take a look at the following (reputable) URL that talks about the accuracy of CAC scores. If you have links to other reputable sites that contradict this info, please share with us. I'm keeping an open mind but given that this score is calculated by a computer, I trust it's accuracy:
https://www.health.harvard.edu/heart-health/calcium-scan-concerns
Best of luck.

I dont know if this helps you any, but I designed cardiac imaging systems for NASA back in the day, so when I see all the high CAC scores on this forum I am dubious that they are without error.
The most obvious potential error is heart rate. I know for me, my heart rate was pounding fast, as I am not a great fan of getting stuck in a tube. A lot of these CT Heart Scan imaging systems were designed for a resting heart rate of 60 bpm, with the assumption that the HR would be below 75 bpm.
My rate was like 110 to 120. I imagine others on this forum have had the same experience. Nothing was said by the radiographer at the time about my heart rate.

Here is a nice paper on CT Heart Scans and heart rate. I shared it with the group back in December:

Influence of heart rate on coronary calcium scores: a multi-manufacturer phantom study
https://link.springer.com/article/10.1007/s10554-017-1293-x
The paper was published in 2017, so a lot could have improved by now, but math can only go so far in compensating for motion artifacts. That said, they were seeing up to 50% greater scores on some CT systems due to moderately high heart rates on several brands of CT systems.

All I think it indicates is that there is a potential that there are imaging errors and that it is wise to use other imaging methods to evaluate where a person is at.

My latest experience was with a cardiologist that believed so strongly in the CAC score alone that he felt that no other imaging was necessary.

So for me, with such a high score and the possibility of error, I want imaging that will evaluate my heart condition as if CT Heart Scans didnt even exist. A completely independent view. I was greatly surprise when the cardiologist would not do so (echo with stress, nuclear with stress), and would cath me only if I insisted on it---else he would not order ANY imaging.

There are a lot of different views on diagnostics for heart disease, and then again treatment. The most conservative methods have been the use of statins on the assumption that cholesterol is the culprit, and angioplasty and stents on the mechanical side. It is a tried and true method, and it works for some people and not for others. The cardiologist I saw falls into this camp. That is ok. But his bedside manner and condescending view that all other methodologies are seriously flawed was not welcome (at least to me).

If a cardiologist is going to be poking around in my heart arteries, I am interested in intravascular lithotripsy. This uses shaped ultrasound shock waves to break up the calcium and plaque both in the artery and the wall. It is not exactly a new idea, but the ShockWave execution of the idea is novel and refined, and to me appears to work well.

The cardiologist I saw literally said IVL "its garbage!" He is entitled to his opinion, but I find hope in the technology, and there are a growing number of cardiologists that feel similar. So I will be seeking one out that shares my enthusiasm towards the technology in case I need it.

As for statins, there are a lot of great alternative medications available now that will lower cholesterol. The emerging question is what roll does inflammation have as the primary cause of heart disease, with cholesterol being an interim component of the bigger picture.

I imagine skipping forward to a nuclear perfusion test with stress is the likely first step for me. If that indicates immediate concerns, then I would like someone capable of IVL in the room if they are going to go into my arteries for a look---might as well get on with it if they see a blockage or the need for pipe cleaning.

That is my plan. I was widely taken back at the veracity of the cardiologist I met with last week. It was his way or the highway. That is ok if he feels that way, but to suggest to the patient that they should go home and live out their short life for not following their personal methods was just ridiculous.

Every one has to find something that is comfortable to their own needs. You are betting your life on it. It is a personal decision.

We make cholesterol even if you don’t eat meat. We all need cholesterol. Some people have a predisposition to make more cholesterol. My ex husband had a heart attack at 35 and still in good health at 65. Our children were tested and my middle child is skinny , vegetarian and she makes a higher amount of cholesterol. A friend of ours had a zero calcium score but with chest pain and had other tests that showed her arteries were badly blocked and she needed bypass surgery.

Did your husband get tested for LP(a)?

@santafepete

That is a very interesting article. Thanks for providing that link. That's something they don't mention when getting the heart CT scan (and my cardiologist didn't mention that either). They do tell you to remain still, but that's about it.

If my cardiologist had said he didn't want to run any additional tests, I would have found another one. I agree you can't count on a single test for something this important.

What other alternatives are out there for lowering cholesterol? I came across PCSK9 and one other that I can't recall now. That one or PCSK9 were taken together and showed a big drop in cholesterol when used together.

Hi there sports fans with high CAC scores. This is Dr Jim member of the OMG CAC club. Thats "oh my GOD- Calcium Angotstrom Count". I am an MD though not a cardiologist and its gratifying to see all you 1000 plus persons, jogging, losing weight, controlling your blood pressure and taking your statins just like me.
Any doctor that told you the CAC score is never wrong is wrong.
Its important to know that the CAC score needs to be age adjusted i.e. If you are 50yrs old with a CAC over 500 thats very likely a problem. If you are 77 like me it may or may not be a problem. Medical Science does not yet understand the paradox of very very high CAC scores in folks who have controlled BP with beta blockers and taken their Lipitor religiously for decades like me. The calcium scan is only one of a number of risk factors that can be measured. Its not rubbish but its value may be in screening high risk high responsibility MEN like airline pilots, firefighters or astronauts. The CAC can be positive when cholesterol, EKG, ECHO and even stress tests are negative. Whats good about it is that its cheap, safe and easy to do so its a good screening test. But its just a screening test. One of many other risk factors like age, sex,lipid levels, smoking history,male pattern obesity, blood pressure and who your grandparents were. Here is a modified prayer that may help:
G-D help me to control what is in my power[ smoking, vaping,eating fast food,overeating, being a couch potato, being non-compliant and forgetting to take my medicine] and to forget about the things not in my. power [ my genetics, my sex at birth, my age, and my CAC score] and the wisdom to know the difference. If G-D cannot help there is always the MAYO CLINIC. JRM MD