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Cardiologist disregarded my CAC score of 595
I'm 53, I am about 30 lbs overweight, I've lost 30 lbs this year. I eat extremely healthy due to the fact that as soon as I hit puberty, the weight was just a battle to keep off. My cholesterol has always been in the normal, but the last few years my tri and LDL have went up. After losing a friend to unexpected heart attack, I decided to get all the preventive testing I could. My primary recommended the CAC to help put me at ease, I had some chest tightness with stress. Also during this visit, labs came back normal cholesterol but 126 LDL up from 90ish. So when I got a 595 CAC score I nearly lost it!! ok, since then I've done some research and found it's just part of a puzzle, but apparently it is an indicator that I have plaque build up- even with healthy diet. As I started some research, I knew my uncle died of unexpected heart attack at 51 (was healthy), my grandma smoked heavy, but had a stroke at 59, my other uncle stroke and blockage 62 - drinker and previous smoker, my super healthy uncle (my dad was 1 of 6 boys) had a heart attack at 66 and they said it was hereditary - bc no other real indicators. So I get and stress test, it's abnormal. My cardiologist (just assigned) says abnormal just means between normal heart beat and heart attack - grey area. The CAC score is not an indicator and shouldn't be used, "he's seen much higher numbers" - if my parents didn't have early heart attack, my uncles don't matter, when I said what about 126 LDL, he says "everyone has cholesterol in their blood" he then went on to let me know, I wasn't just gonna get a stent, he literally said this like 5-6 times, and I never mentioned it. Is this Dr as crazy as I feel. btw, I stated due to the many factors, a CT scan was called for - he ordered, and due to LDL and high CAC a statin would be called for - he prescribed. He seemed mad about the whole thing. YES I'm definitely seeing a new Cardiologist once CT scan is done. Why did this Dr. act to defensive about CAC info?
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Sorry you're going through this. If you had to ask for the CT and statin, your doctor's attitude is unequivocally not reasonable. The score you have is very high for your age. I had a very similar score in my early 60s, looked it up (here: https://mesa-nhlbi.org/researchers/tools/mesa-score-risk-calculator), and I was in the 98th percentile for my age. A CT coronary artery angiogram showed no blockages greater than 50%, so that was good news. I found I had calcifications in my iliac arteries (I think) but my ABI was normal. I also had my abdominal aorta and carotid arteries checked. Luckily, they also were ok ... plaques, but nothing close to a concerning blockage (yet). I am very surprised s/he would ignore an abnormal stress test given that score. (I'm not sure I entirely understand those tests though.)
It sounds like you are being proactive. There are lots of things one can do to avoid the progression of atherosclerosis. Your cardiologist should have run you through all those things. FWIW, when I was diagnosed, I found the book "Beat the Heart Attack Gene" to be helpful. It's main stream media of course, so the guy is making money and can't be entirely objective, yet I found it a good place to start learning how to monitor my own care.
Good luck. It sounds like you are a great advocate for yourself. Hope you find a great cardiologist.
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2 ReactionsNever, and I mean never, go back to that doctor again. He is out of his mind. A competent doctor would have immediately prescribed a statin, and perhaps even an angiogram to check for the extent of plaque.
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1 ReactionStains are definitely indicated. CoQ10 as well is antioxidant.
Aerobic exercise is part of the prescription. I also advocate vitamin D
and Turmeric. Are you on the Mediterranean diet. ?
When you see the new cardiologist ask about carotid Doppler to help assess
atherosclerosis risk.
I do think you need to get a second opinion.
It sounds like you are doing a great job and educating yourself, which is important. Just be careful don’t overstress yourself.
I have a family history of family members passing away at a very young age in their 30s more than one, but then I also have family members who lived to be in their 90s. A healthy diet is one of the best things you could do for yourself, I hope you are taking good care of yourself by walking and other exercises as well.
Work with your family doctor ask them if they know a Cardiologist to get a second opinion.
The weather is getting cooler get out of the house and enjoy the weather
Wishing you the very best
I also had a cac score in the 600’s at age 68. I didn’t do anything about it and my PCP didn’t think about it. Now at 70 I have shortness of breath and heart palpitations. I do take a statin and zetia. I get my stress test on October 14 which I expect to be abnormal due to the heavy feeling in my lungs from exertion. Can’t wait to get this done. I’m not overweight and do exercise.
in medical studies they found statins yield a 1% increase of preventing heart attacks verus the placebo group. Side effects of statins are intense, best to do with.
New study suggests benefit-to-harm balance of statins for healthy adults “generally favourable”
https://bmjgroup.com/new-study-suggests-benefit-to-harm-balance-of-statins-for-healthy-adults-generally-favourable/
Millions fewer people may need statins, a new study suggests. But guidelines have yet to agree
https://www.statnews.com/2024/06/10/cardiovascular-disease-statins-aha-guidelines/
Have the benefits of statins been overstated?
https://www1.racgp.org.au/newsgp/clinical/have-the-benefits-of-statins-been-overstated
@seniormed
Go to Utube and find Dr. Pradip Jamnadas MD He is amazing and he is the best teacher that I have found. There are other great Doctors there who can inform beyond your last Doc.
I'm 70 years old, had an angiogram yesterday because of the CAC score I received earlier....2659. I don't now, and never have exhibited symptoms, so I didn't freak out completely, but my doctor nearly did. The only reason I had the CAC was, I kept hearing my friends talking about it, and their scores. I casually brought it up to my doctor up at my yearly checkup. He agreed it would be kinda nice to see where I'm at.
So....the angiogram revealed I have minimal narrowing of the arteries, one of the smaller ones had a 70% blockage, two other small ones were at 50 and 30%, but blood flow is strong. I've always been VERY active and I do eat right. My dad had a very similar condition, and he lived to be 92. He did have a triple bypass at age 74, however he was not active at all! I will improve my diet, and get on an organized exercise program and I expect to be just fine!
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1 ReactionSorry about the score. I have a zero calcium score, but my carotids are blocking and my aorta has calcification. I recently read that a 0 calcium score means that perhaps I have plaques, but they can't be seen because they aren't calcified. They are the kind that rupture. Once they are calcified they are more stable. You may want to get your ApoB and LP (a) checked. I have high LP (a) that's why I am blocking. Look up the lipidologist Tom Dayspring. He is on YouTube. He has a great interview with Dr Carvalho.
Best wishes.
Karen
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1 ReactionI think you are right to be concerned - this doctor does not seem to providing the usual standard of care for your CAC score. I am in a similar situation (on the younger side with an unexpectedly high CAC) and have shared my story here, so I won't share it again: https://connect.mayoclinic.org/discussion/any-people-in-their-40s-with-very-high-cac-scores/
I think you were right to advocate for the CCTA - there is a big study showing people with angina did better if they got CCTAs alongside the usual tests and treatment (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02679-5/fulltext).
Based on my experiences: As you go through this process, you might also ask for an Lp(a) blood test, since that might be why your CAC is so high even if your other cholesterol numbers haven't been that high for a long time. It would also explain your family history. If you have high Lp(a), a cardiologist would do more to lower your risk factors than they would if you don't have it (usually daily aspirin if you're under 60 and whatever it takes to get your LDL-C below 55). There will also likely be treatments for high Lp(a) in the next few years and you want to be ready to get them once they are available.
Like me, you also are possibly a good candidate for Wegovy if you would like help losing the weight and want the extra cardiovascular protection it provides. It can be hard to adjust to with the side effects, but I have found it to be life changing. That is also something to ask about if you are interested.
But my real point is that there is a lot that can be done. What I've suggested might not be right for you, but you need a doctor who listens and whom you trust to provide the best care possible. You should trust your gut on this and find someone else.