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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jan59 | @jan59 | May 24, 2023

I appreciate your post. I’ve read it a several times. I’m 63. Had complimentary CAC score offered at recent health related luncheon. My score was 1800! Also, recently returned from trip to NYC, where we averaged 5-6 miles of walking per day. Asymptomatic - on statin for many years. Waiting on nuclear scan scheduled for 05/30.

hikerguy62 | @hikerguy62 | Jun 6, 2023

In reply to @jasper1072 "Hey Hikerguy62...I hope you see that drop as well! When I spoke with my PCP today..." + (show)

Both my nuclear stress test and echo cardiogram came back normal! My METS score was 10.1

After having been on Crestor/rosuvastatin for 49 days (the first 8 days at 10mg and then 20mg after that), my blood work results were quite surprising (in a good way):

Total cholesterol dropped from 221 to 137, trig. from 69 to 48, LDL from 126 to 48. Unfortunately my HDL dropped a little (83 to 78), but it's still in a good range, so not worried about that. My sodium and chloride levels (they're related) went up about 5 points (to go just over the upper recommended limits), but my primary doc said it's nothing to worry about. He also had them check CPK levels (that indicate muscle damage) and those were ok as well.

I'm very surprised my echo and stress test came back normal given my CAC score of 2534. I'm going to keep trying to eat healthy (been on a vegetarian diet since Sept. of 2022, but on rare occasion I do eat meat), and I still have 2-3 pieces of candy (mainly Dove dark chocolate & peanut butter) a day. I don't want to completely deprive myself, and considering during this time (the 49 days on Crestor) I still ate a slice of pizza on rare occasion, I think those are great results. Statins are amazing drugs! Not sure how much more it will drop before those numbers bottom out.

I really thought I'd have blockage that would require a stent(s). I'm VERY thankful I don't. I hope others have as good as luck as I had regarding a high CAC score.

lespaulrocker | @lespaulrocker | Jun 30, 2023

Late to the discussion but it appears that I have found a home of folks like me. I am 66 years old, healthy, active. Over 20 years ago, my primary care doctor decided my cholesterol in the higher 100s was too high and started me on Cholesterold Meds. I have mild hypertension so I've been on BP meds for that same time frame. I have always been active over that period, decent weight for my height and had absolutely no signs of heart issues. Three years ago, I started with a new primary care doctor and asked if I really needed to be on statins at all. My numbers were always reasonable - not high but not super low and she suggested I get the CAC. Well boom it came back over 1500 and they sent me to the cardiologist who did the nuclear stress test, Echo and all were fine. His approach is to drive cholesterol particularly LDL as low as possible and now Chol is just over 100 and LDL is 37 through max dose of rosuvastatin and zetia. The more we read the more concerned I am now that yes we might be focused on the heart but what about the brain, hormones, and other body functions that need Cholesterol. Is there not a different approach to maintaining stable plaque that does not take this to me dangerous in it's own way approach? We have really revamped our lifestyle as far as eating - cut out processed foods, seed oils and really changed the whole diet. I do remain very active with some pretty intense workouts but have yet to blow up anything. Appreciate any thoughts from others.

mayoconnectuser1 | @mayoconnectuser1 | Jun 30, 2023

In reply to @lespaulrocker "Late to the discussion but it appears that I have found a home of folks like..." + (show)

By the standards used by the medical profession, yes, based on age, high blood pressure and cholesterol - you didn't say what yours was (assuming less than 199? :-)) - you should have been on statins.

You have decided what your doctor has prescribed - after their 12-16 years of study, and then practice - is "...dangerous in it's own way ..."

You may be past the time for really intense workouts - do you think these are helpful wrt your heart health? Time to reexamine, perhaps?

Did your new PCP take you off cholesterol meds?

lespaulrocker | @lespaulrocker | Jun 30, 2023

In reply to @mayoconnectuser1 "By the standards used by the medical profession, yes, based on age, high blood pressure and..." + (show)

Actually no -- I haven't decided anything and have not changed anything. Guess I didn't make that clear earlier. I'm just looking at and exploring other possible opinions including doctors with the same years of study and experience you mention but simply are challenging the current approach. Correct - my Cholesterol never exceeded 200 with or without meds and to answer your question my PCP just deferred to the cardiologist and then left the practice. Had no PCP for a while. Working on that now. This actually may not be a good thread to discuss new approaches. Just stumbled on it. Thanks!

mayoconnectuser1 | @mayoconnectuser1 | Jun 30, 2023

Hmmm ... new approaches mean different things to different people.

I've heard it used a lot by the anti-statin crowd. And, by folks who simply want to believe something different from what their doctor says because they had read something on the internet 🙂

My opinion only - if your cholesterol is near 200 and your BP is elevated enough to need medicine to reduce it, and you are 66, then you should be on statins. Sure, you can do other things, but nothing other than statins is going to help as much as the statin.

I'm getting stuck on the …dangerous in it's own way …" comment - what do you believe is dangerous?

jasper1072 | @jasper1072 | Jul 1, 2023

In reply to @lespaulrocker "Late to the discussion but it appears that I have found a home of folks like..." + (show)

@lespaulrocker

Sorry to hear of your troubles with the high CAC. I am glad you say your feeling good and active. I think I understand your concern regarding having a low LDL...but IMHO, having it low outweighs it adding to your heart issues. Cholesterol as some studies state is an essential component of brain function etc....but with the millions of individuals on statins, I think you would have seen a much higher issue with cognitive function in the population. I do think Statins are a great drug...I don't buy in to all the paranoia out their where big pharma is out to get us. Don't get me wrong big pharma is not the most scrupulous of industries, but in the long run the drugs they have produced have made people live longer and fuller lives.

mayoconnectuser1 | @mayoconnectuser1 | Jul 19, 2023

Hi All,

So, I need to restate my CAC and statin chronology! After watching too many whodunnit British mystery shows I think my brain just went "ding" ...

I started this thread and had stated in my initial summary the circumstances of my initial CAC test ... in part - "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)."

Last night I rechecked the chronology of my CAC test. We had just moved and I had a new PCP. He did an initial evaluation and continued micardis for BP control, and noted I was of age for standards of care approach, so prescribed atorvastin - in October of 2018. My initial CAC test was September 2019 - 11 months AFTER starting statins! Hmmm ... based on everything I have read since then, statins calcify existing plaque so those 11 months of relatively high dosage (40mg) of atorvastatin likely calcified my plaque - unless I had existing calcium and then additional calcification.

Given my should-have-been-obvious, newfound knowledge, is this another interesting discussion point? Forensic, but relevant? "Compare the timeline - when you first CAC tested, were you already on statins, if so for how long, what were your lipid numbers, and how did lipids and CAC respond to various types of statins over various timeframes?"

I am sorry I only came to this epiphany so late ...

lp77 | @lp77 | May 25 8:22am

In reply to @drmanny3 "Not a Physician, but a Chemist at 75 years of age. I had angioplasty back in..." + (show)

@drmanny3

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?

Jump to this post

Thank you for all this info .
How are you doing ?
How are your numbers ?

mayoconnectuser1 | @mayoconnectuser1 | Nov 19 4:06pm

Hi All,

Quick status from next stage of investigating my high CAC score.

Still asymptomatic, but cardiologist thought time for nuclear stress test (Myocardial Perfusion Imaging (MPI).
- Walked for 8 min 18 sec
- 9.9 METS
- 135 bpm heart rate
- High functional capacity for age/gender.
- Images show small defect/inferior wall. Very small and mild.
- Gated post stress LVEF was normal, with calculated EF of 78%. During graded exercise testing, the patient did not have chest pain with no angina during exercise. The ECG did not demonstrate ischemic changes.

So, my quick read says 78% EF is high (above 75% is considered concerning) and might be associated with Hypertrophic CardioMyopathy (HCM). Not sure what other causes there would be, but still reading.

My previous stress test with echo had for the baseline component, an "estimated LVEF in the range of 55-65%," and for the peak stress component, "appropriate reduction in left ventricular size ... EF estimated at 70%." However, further into that report, this: 2D, EF biplane 80.4, and LVEF MOD A4C 78.4. My understanding is the A4C means it uses this method to determine the EF.

Thoughts?

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