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

I had a similar experience. I'm a few years older. Similar LDL/HDL, but higher BP and slightly lower A1C. Regular exerciser and normal weight for decades. Got an x-ray for other reasons and my PA suggested the CAC. It came back at almost 600! I was lucky enough to see a cardiologist that scheduled a CT coronary angiogram. It showed that the most severe blockages are (well, were - its been 1.5 years now) between 25 and 50%. I don't think all cardiologists will schedule this unless you have physical symptoms. Perhaps because my score was so high, he did. It has been real peace of mind. I wasn't at my deductible, so I paid for it, but it was definitely worth it. A couple of cardiologists and a heart health dietician have told me that the progression can be stopped, so knowing there were no blockages yet was a real comfort.

The exercise comment by your cardiologist is interesting. I ran 5 or 6 days a week. Did some marathon training, but intermittently. I'd guess I averaged 5-7 hours of running a week over 5-6 days. Perhaps that was a contributing factor.

My mother had a triple bypass at 62, which is early for a female. I am bewildered that our story is so common. I can't help but think that some physicians look at people that are fit and normal weight and assume that there can't be any cardiac issues. I wish I had been on statins 10 years sooner. The genetic component seems to be dismissed by many/most PAs/GPs. Or is it just sour grapes on my part?

Your wonderment in the last para applies equally to sleep apnea. After you spend a few weeks on apneaboard.com, you realize that sleep apnea can afflict anyone...ANYONE! Fat, thin, young, old, female/male/indeterminate, no matter the ethnicity....and I was myself fit for my age when I was diagnosed and not near being overweight (although I had been retired 12 years and gained about 10 pounds).

And, as to your last statement and the question that follows it: Modern medicine is largely, not entirely, about patient discomfort and anxiety. IOW, how you feel, and also how you convince the practitioner that you feel the way you claim to feel, is what they use so often to assign a level of care or remediation...including the statins and SSRIs that are handed out like jelly beans. A high CAC is like atrial fibrillation, which I have/had. It can be present, but it isn't a great indicator of imminent danger. Any one person selected at random from your CAC score pool and from my 'severe obstructive sleep apnea' pool can expect to live a long time, perhaps a decade or longer. If you want to live it well, with little anxiety and less danger, then use what the medicos offer, albeit with a heavy dose of self-teaching. You should wield just enough relevant knowledge that you're close to being annoying during doctor's visits. Let them know you're taking you seriously. 😀

No, I don’t think it’s just sour grapes because many doctors are dismissive of concerns when you are generally fit and appear healthy. I do feel like my doctor took the genetic factor into consideration as it was one of the reasons she recommended the test for me.

I had researched everything extensively before my cardiologist appointment so I could ask some intelligent questions. When I asked the doctor about the link between high intensity exercise and CAC, she was aware of the studies and seemed to concur with the findings. She told me that unless I was training for something I should keep my exercise at 150 minutes a week. I tried to post a link to the study for you to read, but the site would not allow me to do so. The study is found on ahajournals.org and the title is “Exercise Volume Versus Intensity and the Progression of Coronary Atherosclerosis in Middle-Aged and Older Athletes: Findings From the MARC-2 Study”

@nonna2four That study sounds interesting. I have never had a doctor recommend a limit to my exercise.

I imagine for you that the hardest part is not knowing right now. The feeling that something is not right, but no one can say for sure what it is. I worry that you might find out that the tests are inconclusive. The maybe or maybe not answer...ugh. To be fair, doctors cannot predict what will happen and much of the science of medicine is based on probabilities. X symptoms means the likelihood of Y disease.

Glad you are doing your due diligence on this. You know your body better than anyone. I also think it is good that your doctors are running you through these tests.

Oh Boy, do I know how you are feeling. I was about 62 when I had a calcium scan and it came back at 535, "imminent danger of a heart attack". I too was a daily exerciser and ate a low fat diet for weight control. Most of my calcium was also in the LAD, the worst place for it. My Dad died at age 50 of a myocardial infarction (heart attack) and my Mom had bypass surgery at age 78 so I was truly worried. Fast forward 15 years and I started to have discomfort in my left arm, went to the ER and two stents were placed in the LAD and RCA heart arteries. I feel fine now, still exercising, hope to make it a few more years. I'm 80 and I believe stents are expected to do the job for at least 10 years and if they get clogged up, the next step is bypass surgery which I might decline at age 90.

My cardiac issues are congenital. I am on Repatha injectable cholesterol lowering med as I couldn't tolerate statins. I continue to be careful of my diet and my cholesterol is below 150. I'm happy I have not had a heart attack and that all of this was discovered before such an event.

We do what we can with the cards we are dealt. I wish everyone good health and a stellar cardiologist!

Donna

You said you had chest pain 15 years after the calcium scan. What type of testing was done during those years, and what interventions, medications or lifestyle changes were recommended/implemented?

Not chest pain, left arm discomfort. It would arise with minimal exercise and take about a half hour to resolve. Before I realized what it was, I had minor left arm discomfort when walking up hills and I attributed it to a pinched nerve in my neck.

I have a blood test and an echocardiogram and see my cardio every 6 months plus every couple of years, a cardiac MRI. I also have two leaky valves which they check at the same time and for which I must limit lifting to no more than 25 lbs..

I continue to exercise every day, inject with Repatha every two weeks, take blood pressure meds and I maintain a healthy diet with lots of fruit and veggies, legumes and small portions of chicken or fish and on rare occasions, a 2 oz portion of the leanest red meat, filet mignon. I'm feeling fine and hope this continues for the next 10 years or so.

Donna

Sounds like you’re doing everything right so you can enjoy many more healthy years!

I sure hope so!!!