Extremely high calcium score at 42 - is there any positive here??

Posted by steveny @steveny, Jul 8, 2022

I'm a 42-year-old male. Exercise regularly, not overweight, non-smoker. While not overweight, I will say that my diet is crap -- way too much fast food, pizza etc. I guess I still eat like a high schooler.

Anyway, I saw a cardiologist figuring after age 40 this would be wise. He took bloodwork which was basically all fine. The cholesterol was *slightly* elevated and he recommended getting a heart calcium score. Told me he expected it would show nothing but that he just wanted to be thorough. Turns out the score came back at 397.

Obviously, this caught me totally flat-footed. I figured with my diet there might be some plaque, but this number places me in the 99.999th percentile for my age. And everything I have read online sound pretty dire about my long-term prognosis now -- that significant damage has been done, that it can't be reversed and can only get worse and that the statistical linkage between a number like this and heart attack-stroke is profound.

Weirdly, the cardiologist did not seem to be conveying any alarm when he told me the score, though. He was extremely matter of fact about it. Just said it was "very, very high" and that he would put me on a statin (which I've already started) and that I should take daily baby aspirin (doing that too). He said I should focus on improving diet and continue exercising (I already run 4-5x a week) but he was also pretty emphatic that "this must be genetic." (There is a history of heart problems on my father's side of the family -- though he is 76 and has yet to have any heart trouble himself.)

This was all a lot to get hit with at once. From the doctor's casual, matter of fact tone, I left the office a little confused, wondering if maybe this score wasn't that big of a deal and was a very manageable thing. Why else would the doctor not seem that disturbed by it? But then I started reading everything I could find on the subject and it's been pretty devastating.

Obviously, I'm ready, willing and able to implement the dietary changes, but for the score to be this bad at this young of an age (and with no smoking history, not being overweight, and doing regular exercise), it seems like I'm in serious trouble here. So upsetting to read that I can't bring this number down.

I guess I'm just posting this in the hopes that others here might have some experience and insight and be able to offer something, anything that is encouraging? When I read all of the medical material online about high CAC scores, am I missing something? This has all been playing out over the last 24 hours and I feel like I've basically just found out that I could drop dead of a heart attack at any moment and that my life expectancy has been drastically reduced with this news -- and that there's no way to get it back to normal. I now have a million questions for the cardiologist, but when I called his office today I was told he's just started his vacation and won't be back until August.

Any encouragement or practical advice would be greatly appreciated. Thanks.

Interested in more discussions like this? Go to the Heart & Blood Health Support Group.

steveny | @steveny | Sep 18, 2022

In reply to @mayoconnectuser1 "And, clearly treatable diabetes is far better than untreatable heart disease, right?" + (show)

So I hear what you’re saying, but my concern is that even diabetes that is being treated is an added risk factor for heart events. So while a diabetic with heart disease would certainty be well advised to be on statins, I’m wondering if the calculus is any different if the statin is what causes the diabetes. I’m going to talk to the cardio about whether there are other statins that may not do the same blood sugar damage to me, or maybe if cutting the dose (every other day?) or combing with metformin or something else would make sense. Every cardio I’ve seen until now has stressed that my lack of diabetes improves my outlook. So if taking this statin is causing me to become diabetic, I don’t want to just let it happen.

I think you also asked before about Budoff’s recommendations and fish oil. He told me it seems to only have an effect in those with high triglycerides and that it was fine if I wanted to take it, but that triglycerides aren’t an issue for me. He pointed to multiple studies on aged garlic extract slowing and stabilizing plaque progression though and recommended 1,200 mg/day (and specifically suggested the Kyolic brand).

mayoconnectuser1 | @mayoconnectuser1 | Sep 18, 2022

In reply to @steveny "So I hear what you’re saying, but my concern is that even diabetes that is being..." + (show)

While I characterize icosapent ethyl (Vascepa) as super oil, it really is more than that - did you ask specifically about Vascepa?

Will you posting the actual results of you various tests, including stress with echo, and transthoracic cardio gram?

steveny | @steveny | Sep 18, 2022

In reply to @mayoconnectuser1 "While I characterize icosapent ethyl (Vascepa) as super oil, it really is more than that -..." + (show)

Yes, that aspect of the conversation was specifically about icosapent ethyl. And see my last post before that one for the text of my echo report. Happy to share any results that I have that might be useful - that is what I have for an echo.

mayoconnectuser1 | @mayoconnectuser1 | Sep 18, 2022

In reply to @steveny "Yes - the full report I got is below: MEASUREMENTS: Value Normal Value Normal Aortic Root..." + (show)

@steveny

Yes - the full report I got is below:

MEASUREMENTS:
Value Normal Value Normal
Aortic Root 3.0 cm <4.2 cm LVOT
LA Diameter 3.0 cm <3.8 Diameter
(<4.0) LVOT Area
LA Vol Index 19 ml/m² <34 LVOT Stroke
------------ Volume
LVOT Vmax 1.2 m/s
IV Septum 0.9 cm <1.1 (rest)
(<1.2) LVOT
LVEDD 4.5 cm <5.3 dPmax(rest)
(<6.0) LVOT Vmax
Inf-Lat Wall 0.8 cm <1.1 (Vals)
(<1.2) LVOT dPmax
LVESD 3.2 cm (Vals)
------------ ------------

LVED Vol 51 ml/m² <75
Index AV Vmax 1.2 m/s 1.0-1.7
LV Mass 58 g/m² <95 AV Peak
Index (<115) Gradient
------------ AV Mean 6 mmHg
Gradient
LVEF 58 % 50-70% AV Area 2-4
------------ Impedance <3.5
(Zva)
RAP, mean 5 mmHg 0-5 Aortic
PASP <35 Regurge P
PADP <15 1/2
RV-RA ------------
PA-RV
LA, mean <12
------------ MV E wave 0.8 m/s 0.6-1.3
Vmax
Mitral E 76 cm/s MV Mean
Mitral A 60 cm/s Gradient
Mitral E/A 1.3 MV Area 4-6
Decel Time 180 msec ------------
Mitral P 1/2 52 msec
E' (medial) 16 cm/s >8
E' (lateral) 15 cm/s >8 TV E wave 0.3-0.7
E/E' 4.9 <8 Vmax
PV S/D TV Mean
Gradient
------------

RVOT
Diameter
RVOT Area
RVOT Stroke
Volume
RVOT Vmax
------------

PV Vmax 0.6-0.9
PV Peak
Gradient
------------

BP 130/74 HR 57 bpm
mmHg

TECHNIQUE:
Complete 2D transthoracic echocardiogram with color and spectral Doppler was performed.

FINDINGS:
Left Heart:
--There is no left atrial dilatation (LA volume index 19 ml/m²).
--The interventricular septum is normal in thickness. The inferolateral (posterior) wall is
normal. There is no asymmetric septal hypertrophy. There is no left ventricular hypertrophy.
The left ventricle has normal end-diastolic diameter.
--LV global wall motion is normal. LV ejection fraction is normal (58 %).
--There is normal left ventricular diastolic function with normal left atrial pressure.
Mitral Valve:
--The mitral valve is normal. There is trace mitral regurgitation.
Aortic Valve:
--The aortic valve is normal. Aortic valve is trileaflet. There is no aortic regurgitation.

Aorta:
--The aortic root is normal in size. No aortic aneurysm or coarctation on the suprasternal
view.

Right Heart and Systemic Veins:
--There is no right atrial dilatation.
--There is no right ventricular hypertrophy. The right ventricle is normal in size. The right
ventricle has normal wall motion.
--Inferior vena cava is normal in size.
--The right atrial pressure is normal (0 - 5 mm Hg). There is too little tricuspid
regurgitation to estimate PA systolic pressure.
Tricuspid Valve:
--The tricuspid valve is normal. There is no tricuspid regurgitation.
Pulmonic Valve:
--The pulmonic valve is normal. There is no pulmonic regurgitation.
Pericardium and Effusions: --There is no pericardial effusion.

CONCLUSION:
--There is no left atrial dilatation (LA volume index 19 ml/m²).
--LV global wall motion is normal.
--LV ejection fraction is normal (58 %).
--Normal left ventricular diastolic function with normal left atrial pressure.
--The right ventricle is normal in size. The right ventricle has normal wall motion.
--There is trace mitral regurgitation.
--There is no tricuspid regurgitation.
--The right atrial pressure is normal (0 - 5 mm Hg). There is too little tricuspid
regurgitation to estimate PA systolic pressure.
--There is no pericardial effusion.
--No prior study available for comparison.

Jump to this post

So transthoracic echocardiogram numbers seem to be really good.

How's the stress test metrics? You should have had both the stress test data and the echo data performed just prior to and after - different from the transthoracic. There would be some assessments re how heart performed under the stress, as well as ECG data, heart rate, etc.

steveny | @steveny | Sep 18, 2022

In reply to @mayoconnectuser1 "So transthoracic echocardiogram numbers seem to be really good. How's the stress test metrics? You should..." + (show)

This is the report from the stress test:

Exercise Stress Test

The patient performed treadmill exercise under the Bruce Protocol, completing 12 minutes 35 seconds and achieved an estimated workload of 13 metabolic equivalents (METS).

Baseline HR : 69 bpm

Peak HR: 160 bpm (90 % of max PHR)

85% of Max Predicted HR: 151

Baseline BP: 110/70 mmHg

Peak BP: 140/80 mmHg

Calculated DWP: 22400

Exercise terminated due to: Achievement of target HR

Symptoms: None

HR response: Calculated patient's HR reserve indicates a normal chronotropic response (normal is greater than 80%).

Baseline HR/BP: Normal
Heart rate response to exercise was appropriate.
The blood pressure response was appropriate.

Performance: Excellent exercise capacity for age and gender. Excellent level of exercise.

mayoconnectuser1 | @mayoconnectuser1 | Sep 19, 2022

So, steveny, a great stress test with echo ... great numbers, right? You and your heart are in great shape, the CTA supports the stress with echo, right?

CAC is the outlier, right?

mayoconnectuser1 | @mayoconnectuser1 | Sep 19, 2022

steveny,

I'm going to the "is there any positive here" ... I think, and the data shows, yes.

Shift gears and stay positive - let's talk about it!

steveny | @steveny | Sep 19, 2022

In reply to @mayoconnectuser1 "steveny, I'm going to the "is there any positive here" ... I think, and the data..." + (show)

Ha, I really do appreciate that. I know what I can sound like here. And I’ll take it. But I’m also a worrier by nature, which has made the aspects of this that are out of my control extra difficult to deal with. Mainly it’s:
- Knowing that I have a high plaque load, that spontaneous plaque rupture can happen at any time and that the stats say high CAC is the single strongest predictive variable for future event.
- Not knowing how I acquired so much plaque so early in life. As I’ve said, there’s no obvious family history or blood level that points to this. Every cardiologist who has looked at my profile has been very surprised to see that I have any plaque, let alone this much. So I fear that something is driving this in me that is not well-recognized or understood; that the current best practices for care — which I am following — won’t be effective in the face of it; and that the atherosclerotic process will continue unabated. Something to do with thyroid resistance, insulin resistance, a broader resistance to hormones — I dunno. But I do think that’s where I’ve had some I’ll-defined but serious issues metabolically for the last decade that have baffled some top doctors and endocrinologists. So I suspect there’s a link here but that any meaningful diagnosis (and a treatment based on it) will remain elusive.

tabicat03 | @tabicat03 | Apr 19, 2023

In reply to @steveny "Just in case anyone has been following this and finding it useful (or finds this thread..." + (show)

@steveny

Just in case anyone has been following this and finding it useful (or finds this thread later), I wanted to post one more update on my situation. I think this will be the last one.

Basically, I have:

* A lipid profile that looks completely normal (and even good), except for *slightly* elevated LDL

* No direct (parents/sibling) family history of heart attack, but there is some heart disease further out in the family tree (great-uncles on my dad's side, diabetes in my grandfather, bypass surgery for my dad's brother)

* A 10-year event risk score of <2% on all traditional calculators -- meaning that I never met any criteria for getting a calcium test and no doctor ever looked at my bloodwork and thought I might have any issues with my heart

* Nonetheless, a cardiologist this spring suggested that -- for peace of mind -- I pay 100 bucks and take a calcium test. He expected it would come back 0. Instead it came back 397.

* Since then, I have been on a journey to try to understand my situation/prognosis. I was placed on a statin, which almost immediately brought my lipid levels to the target range (<70 LDL), passed a stress test with an echo, and had a CT-angiogram. I've also made significant changes to my diet. Pretty much terrified of eating sugar, meat, dairy, processed/fried foods etc.

I have also consulted with several cardiologists and have gotten some mixed signals. The main cardiologist, who initially suggested the CAC test, is well-credentialed and experienced and has been adamant since the score came back that I shouldn't be worrying. He insists that I don't have a problem, only the potential for one, and that aggressive statin use and diet/exercise will prevent me from having a problem. He said that when the initial calcium score came back and said it even more adamantly this week when the CT-angiogram results came back. In fact, he told me that the angiogram showed only a minimal amount of plaque in my arteries, nothing that he would even consider out of the ordinary for someone my age. I was encouraged by his assessment but also confused, since none of the material I've read has suggested that a sky-high CAC score is as easily treatable as he says it is.

So I followed up with another very well-credentialed cardiologist yesterday. He reviewed all of the tests and materials. Overall, he agreed with the approach of aggressive statin use combined with diet/exercise and did talk about this as a condition that I can potentially live a long life with - provided that we arrest the plaque progression now. But he disagreed with the other cardiologist's assessment that the CT-angiogram only showed "minimal" plaque in my arteries. He said it looks to him like a significant amount, especially for someone my age. So while it's good news that the angiogram showed nothing even close to a blockage, it did show plaque that could at some point rupture and cause an event. He stressed that my day to day odds of this are "negligible," but I then asked him if he could put some numbers on what my risks are. He said that my case is unusual in that -- as I mentioned -- there's nothing in my lipid profile that would normally even prompt a calcium test and that without the CAC score, he would calculate my 10-year risk for an event at less than 1%. But with the score of 397 factored in, he says it takes my risk up to 8-9%. I asked what statin use could lower it too. He guessed that we could get it back closer to 3%, but then actually used his risk calculator and told me the number is 5%.

I think I am going to accept this as the last word on what I'm dealing with. I found this second cardiologist to be very knowledgeable and willing to explain and talk through everything. So I think that is my risk: There is a 1 in 20 chance that I will have a heart attack in the next 10 years. For someone without my CAC score, it would be more like 1 in 120. This seems much more realistic to me than the first cardiologist's adamant/data-free assertions that "we know how to treat this and there's nothing for you to be worrying about here." The reality is that I have about a 6-fold increased risk of a heart attack over someone my age with no CAC. Overall, of course, I have a 95% chance of no heart attack in the next 10 years too, and that's what the cardiologist I saw yesterday wanted to stress. So my challenge will now be try to think of it that way and move forward. But it will be tough for me. When I think of 1 in 20, it doesn't sound so remote. I imagine being one of 20 people lined up in front of an execution squad, where they get to pick one to kill. I'd be very uneasy that it would be me. A lot more uneasy than if I was 1 of 120 people. That's the kind of stuff going through my mind right now. The only thing I wish I had asked him before leaving was if that computed 5% risk (which is based on statin use) might be further reduced with diet/exercise. I imagine the answer is that it can't hurt, but obviously I'd love if there might be a quantifiable reduction. Mentally, I could probably process a 2-3% risk much better than a 5% risk.

So that's that. I'm 42. I have atherosclerosis. It's a mystery why I got it. And the plaque load I have is extensive for someone my age. I will follow the guidance om statins and hope that my current dedication to a healthy diet/exercise regimen will persist. But even with this, there's no getting around the plaque that I already have. It's there, it could rupture for reasons unknown at any minute, and the chance that it will in the next 10 years -- while low in the grand scheme of things -- is much higher for me than for most other 42 year olds. I've just known of too many "healthy" people in their 40s and early 50s having sudden heart attacks; it will be difficult for me to try to live my life with this knowledge. It's just the way I'm wired, I think.

Good luck to everyone here dealing with high CAC issues and to any others who might read this in the future.

Jump to this post

@steveny

I've read your story and it's really uplifting- I am a 41 year old female "almost" 42 and I went to the ED with Chest pain- it was noted on my CT that i had a small focal calcification in my LAD- needless to say I have done ALL you have done as far as researching. It will def. make you think about your prospective on life at our age!! I have done the stress/echo and all the labs- which all came back fantabulous! I was put on Crestor 10mg- and a beta blocker- I was the one that pushed statins b/c of my research..anything to try and stabilize the "Hot Plaque" is my concern. My cardiologist will not send me to have a CAC- he says he knows by looking at the CT my CAC is low...however...I pushed for a CTA- I am scheduled for that in June. I to hope I have Clean arteries and my deposits are on the outside. He did tell me though if it comes back with a blockage which he says he is 98% positive i won't have one- but heck by looking at statistics I'm already in that 1/2% for calcium in my age group who knows- I PRAY I am in the 98% for no blockage....It's all so scary. I have a Duke Cardiologist and he seems to really know his stuff....

Anyways I am rambling- I just wanted to say I am glad I have at least one person close to my age I can relate to...as far as age goes and the unwanted Calcium- I thank God for a new day everyday!!! I hope you are still doing well.

degarden_girl | @degarden_girl | Apr 20, 2023

I am 78 YO female. Because my cholesterol was in the high normal range, in 2007 my cardio sent me for a CAC just to assure there was no calcified plaque. We were both shocked when it came back in the mid 500 range. I immediately went on a statin and removed all eggs, red meat, butter from my diet. I wasn't able to tolerate statins so was without them for several years until Pralulent was approved for reducing cholesterol and heart attacks. Fast forward maybe 5 years and I developed left arm pain with minimal exercise. Into the hospital and received two stents. I am back at the gym, doing vigorous exercise. I must continue to watch my diet and use the Pralulent but I'm doing fine. My father died of his one and only heart attack at age 50 (in 1962 before all these advanced cardio testings were available) so I feel fortunate to have made it to this age. My Mom had by-pass surgery when she was 79 so I am glad I didn't have to go that route.

I am one of 7 children and two of us have calcium scores above zero. I guess we got the problematic cardio genes. And we can't beat ourselves up about this. Only 25% of cholesterol is from diet. The remainder is made by the liver. And cholesterol is different in different people. One sister has cholesterol of over 300 and a zero CAC score. I have an abundance of LPa (L P little a) which is a low density lipoprotein with a little tail on it which burrows into the artery wall. She has light and fluffy LDL which just floats through her blood stream. It is indeed genetic.

Steveny, I understand that you are feeling heartsick and betrayed by your body. If you hadn't already been taking such good care of your body I think you would be in a far worse situation. I suggest you see a nutritionist to discuss healthy eating choices and then just know you are doing everything you can to keep your heart healthy.

Do you know where your calcified plaque is located? Some arteries are of less concern than others.

I wish you peace and good health.

Donna

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