58 year old healthy, active female with high coronary artery calcium

We are the same age and on somewhat on the same marathon. My score on an initial calcium scan was 398 about 8 years ago. It wasn’t until I connected with my current cardiologist (and care team) that my true risk factors have been identified, and then improved. Instead of a ‘spray and pray’ approach they are figuring out how my specific body works. I can tell you my body like this approach much better.

You mention you do not have symptoms. Why did your primary doc recommend getting a calcium scan? What is your cardiologist looking at to think you should cut your exercise? I guess my suggestion would be to ask questions before changing any habits. I listened to doctors who told me diet and exercise don’t matter in my situation, turning out to be bad information.

It may help you to ask, given this new information what your LDL target should be. Questions are good and your blood can answer a lot of them. I am certainly not an expert but I can provide a few places to get your started (Maybe these are already posted in the thread-sorry if repeating):
There are blood tests that break down your lipid numbers even more. One example is Apo B that is part of your lipid panel LDL number. https://my.clevelandclinic.org/health/diagnostics/24992-apolipoprotein-b-test
There are additional genetic factors that can be easily checked https://www.heart.org/en/health-topics/cholesterol/genetic-conditions/lipoprotein-a
My doctor periodically checks my ceramide score, an independent risk factor for inflammation. What goes into the score seems complicated to us but it does give our doctors more information to work from. https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease/art-20049357

I would place my money on two betting surfaces, genetics and inflammation. Your doctor may have read your last blood assay and saw a high spike in CRP )C-Reactive Protein), or in other markers for inflammation. Inflammation inside of blood vessels is deleterious over time and it is the inflamed surfaces below which the calcium finds its way as a form of scarring. The calcium isn't deposited on the inner endothelium. It's found in what is called the 'lumen', a layer below the endothelium.

High calcium scores should be treated as diagnostic, but also as prognostic. However, they are still only a snapshot of what is extant, or what was at the time of imaging. It really isn't a very strong predictor of eventual cardiac death, ischemia, or even of further deposition. But to ignore it would be a fool's game...it indicates that something is permitting the deposition, and we don't want the deposition to continue if at all controllable. And that is where statins come in. They inhibit inflammation some, and they stabilize the deposition of calcium so that it stays put...doesn't travel. Statins also inhibit the body's ability to synthesize its own co-enzyme Q10, so the wisdom for two or three decades now is that the patient should supplement with ubiquinol (best) or ubiquinone (if that is what one can purchase and/or is most affordable).

You should always run these ideas past your physician to ensure you can do this safely. He/she may be aware of another 'part' of you that makes this impractical or even dangerous.

@nonna2four Welcome to Mayo Connect! I know people will come here under less than the best of circumstances, but it is great that you are reaching out.

You and I are about the same age. I think you are doing all the right things. Sounds like you lead a healthy lifestyle. I am not an expert, but your numbers look pretty good to me. Yes, your calcium score is high, it sounds like genetics may be playing a role in your heart health. My family tree gave me high triglycerides and wide feet...LOL.

Right now, I would say be patient and wait for the stress test results. Not sure if you are having chest discomfort (pain or tightness)...even if you think it is stress (that's what I thought) or having shortness of breath, I would be more concerned. If they see anything from your tests, you may want ask about an angiogram. Overall, you taking all the right steps! I think you are leading a healthy lifestyle!

Nice to meet you. Right now, keep going through the test, monitor your health (blood pressure, glucose, blood tests, etc,) and I hope all goes well.

Mike

Hi Mike, thanks for your reply. I'm not having any chest discomfort and only experience shortness of breath when exercising at a high intensity. I'm just ready to get the stress echo behind me so I can quit worrying and address any potential issues. I'm working on the whole patience thing lol!

Thanks for your reply! My new primary doctor recommended the calcium scan because my father had a heart attack in his 60s, my grandmother had a stroke in her 70s and died, and my LDL is a little high. My previous doctor had always looked at the cholesterol ratios and said they were all excellent so there was nothing to worry about.

I asked tons of questions which my cardiologist, thankfully, took time to answer thoroughly. The reason she suggested I reduce the amount of exercise is that I was exercising 6 days a week for 1-1.5 hours a day. She said exercise by nature is inflammatory, and I was not giving my body enough recovery time. She recommended that I follow the AHA guidelines of 150 minutes per week with my heart rate not surpassing 138. And all these years I thought I was doing wonderful things for my body for being dedicated to working out vigorously and often!

Thank you for the suggestions. I just ordered a free Lp(a) test this morning and plan to ask my doctor about the Apo B test the next time I see her. I haven't heard of the ceramide score, so I will be looking into that as well!

I looked at my most recent lab work, and it appears that CRP wasn't tested. Is that something that I should ask for on future labs?

It sounds like you are doing everything you possibly can, and have doctors that are in tune with what you need. That has to be a huge relief! For whatever reason my body requires a high level of consistent activity (a well as pretty strict consistent eating). I’m currently doing my best to spend 60 minutes/day on an elliptical, 6 days a week resistance training and yoga 5-6 days each week. Doing this helps me function better and is part of what is improving my numbers. Go figure, we are all different. 🙂 I guess that just proves there can be a variety of things going on in our bodies. I am interested to hear how your lower exercise level impacts you.

I hope it goes well! I have a stress test I think next week. Just a routine follow-up. Would love to know your test goes if you are ok with sharing.

It couldn't hurt. Or whatever your consulting cardiologist feels will tell him/her, and you, what type of inflammation there is...if any. Maybe another test or diagnostic will tell the tale, and you can modify your overt behaviors accordingly. Just a suggestion...but something to run past your cardiologist in case it's something you can do yourself, but not have to give up exercising if it turns out to be due to some other cause.

ask for the high sensitivity (sometimes called cardiac) CRP test. It's more sensitive at lower numbers and ideally, you should have an inflammation number of 1.0 or below. Mine is 0.3 but hasn't stopped me from having a calcium scan putting me in the 75% percentile. My understanding is that every molecule of Apo B carries one molecule of LDL that can attach to the artery walls, so having that test, as mentioned here, is another helpful tool to understand your risk profile.

I was recommended to be on a mostly plant-based diet, still exercising around 6 days/week for 30-40 minutes and I look to get my heart rate in the 150's each time, and with the 3 drug regimen, it seems to be working for me (statin, ezitimibe, Repatha), having all the major levels down in normal ranges, probably for the first time in my life.