I have a very high calcium score. What next?

Hi, I have a 1525 CAC. Cardiologist number one didn't want to perform any stress test and said I should not waste my time and money and go for an angiogram to actually see the percentage blockage in my arteries. Sound too progressive for me. Cardiologist number two perform all tests and came back normal BUT he saw on the imaging a small dark spot. He suggested I have an angiogram so he send me back to cardiologist number one. I will have my angiogram Tuesday June 27th. It is the best way to know for sure if there is blockage or not. All other suggestions are from mortals like me who does not wish to have an angiogram, I have read "How to beat the heart attack gene" book. Interesting read. On a very good healthy diet, I exercise, and the whole bit. I had cardiologist number two swear to me that if the blockage is not high (70%) hew will let me go home. We will see. My suggestion for peace of mind get an angiogram or catheterization.

@christianzane I thought this article was very informative. Do you know if this is still considered the standard approach to dealing with this cohort of patients? I fall into this group and just received my CAC over 400. I was expecting a stress test, but this article doesn't recommend, only use of statin and controlling LDL to a low level. They also refer to "reversing" the disease which I had not thought was possible, but it sure sounds better than focusing on the high probability of bad events. Thanks for posting the link

49
5’7” 160lbs
Pretty good shape
Bp 120 75
Total cholesterol 140
Hdl 35
LDL 81
Triglycerides 120
No iq panel
Statin now for 10 years and just switched to ROSUVASTATIN CALCIUM 40 MG

Hmmm ... your CAC was obviously high, but why would you start taking a statin when you were 39 years old ... you only recently had the CAC test?

Do you any data from your stress test? It was not a stress test with echo, right? You should have had some form of data - METS, Duke score, etc? What level did you get your heart?

Your HDL (good cholesterol) is pretty low - has it always been this low?

Started taking at 39 family history and diabetes diagnosis.
Mets 10.3
Echo was yesterday and everything looked fine
Ischemia score 0
Duke score was 9

So, another of us with no symptoms, no issues on echo (did they list data?) but high CAC.

OK scores on the stress test.

Perhaps try to lower triglycerides further? Add Vascepa (icosapent ethyl)?

I would try and understand why the HDL is so low.

I believe they are likely referring to reversing heart disease - not calcium build up - ie, eat smarter, lose weight, lower cholesterol, control blood pressure, treat high A1C and diabetes, take statins if appropriate, etc.

@mayoconnectuser1 - yes, certainly reversing the course of the disease, not dissolving calcium but it is true that plaques could be shrinking as they calcify, especially soft plaques. I was hoping you may be able to help locate an article or paper that describes or quantifies the decrease in risk for cardiac events for people in our group that have calcium build-up if we take on all of the lifestyle changes and proper medications. Everything I've read so far (I'm two weeks into this journey) is very challenging to understand and also very troubling. The odds do not read well. But as another member pointed out, those statistical probabilities are just based on having the score and not doing anything about it. Astonishingly, about 95% of people with heart disease do just that, nothing. I don't have the citation for that as it came from a Dr's website, so maybe that isn't completely accurate, but what I'm getting at is if as an individual, I decide to do the hard work and take the medicines and remain proactive with my Doctor, how much does that risk decrease by? If our 10 year chance of a cardiac event is for example 25% untreated, can we reduce that by 80% with all of these interventions? So maybe it is a 5% 10 year probability, which sure sounds better than 1 in 4. Just trying to learn how to live with this and not let it consume my every waking thought. Thanks for your work on this site!

This may be the study you are referencing https://pubmed.ncbi.nlm.nih.gov/23592106/

It's talked about here: https://www.mentalhelp.net/blogs/lifestyle-changes-after-heart-attack-or-stroke-in-short-supply/

@neilyounger Thanks for those links, it really is startling. I suppose it is positive that many of the smokers quit if that is the only thing that they end up changing. Do you know of any articles that quantify risk reduction and how one would benefit by taking action and also starting statin therapy? I found a risk calculator on the Arizona State University heartseries.org site that was helpful to reassure me that making changes does have a huge impact on your longevity. Basically, cutting risk from very high (>20%) to low risk (3-8% chance of heart attack in 10 years). I think I can live with those numbers at 55yo and its worth it to do whatever I can to keep the risk in that range.