First Visit to Cardiologist

I would never counsel a person who asks the question to forego a second opinion...............................................but....................................................is he wrong about the weight and pre-diabetic? If you know he isn't wrong, I would have to say, matter-of-factly, that you have your answer. And your marching orders. Lose the weight, get off the diabetes/metabolic syndrome wagon, and start walking!

It sounds to me as if you have an endocrine problem, or you're not getting out and exercising, even walking 30 minutes each day, or you're eating the wrong stuff. One of those, or a combination, maybe all three, has your LPa and calcium score higher than someone on 40 mg of atorvastatin or equivalent for the past 20 years should have.

I don't know if you'll like my response, but sure, get a second opinion. Just be working subconsciously on a cold, hard solution that buys you another 15 good years meantime. That second opinion might be as unpalatable as the first.

Hi @bearcat998
I can understand why that result would catch you off guard, especially when it was found unexpectedly and your cholesterol numbers have been well controlled for years.

A calcium score of 900 indicates a high amount of calcified plaque, but it doesn’t tell how much narrowing is present or whether blood flow is affected. It also doesn’t always mean someone needs more testing right away. Many cardiologists base additional testing on the whole picture—symptoms, physical exam, EKG, risk factors, and whether the results would change treatment.

It sounds like your cardiologist focused on aggressive risk reduction by:
* adding ezetimibe (Zetia) to lower your LDL even further,
* addressing your elevated lipoprotein(a),
* discussing weight loss and prediabetes,
* and scheduling follow-up.

That said, it’s also reasonable to ask questions if you’re unsure why no stress test or coronary CT angiogram was recommended. Sometimes understanding the reasoning behind a plan can be just as reassuring as the plan itself.

You might consider asking your cardiologist:
* “With a calcium score of 900, what LDL goal are we aiming for?”
* “Would any additional testing change how you would treat me?”
* “What symptoms should prompt me to contact you right away?”
* “How does my elevated lipoprotein(a) affect my long-term management?”

A second opinion is also a reasonable option if it would help you better understand your risk or feel more confident in your treatment plan. It also may add more stress so you will need to weigh your options. It doesn’t necessarily mean the first cardiologist is wrong—it can simply provide another perspective on a significant finding like this.

I’m also curious—did your cardiologist mention whether your calcium was spread throughout several coronary arteries or concentrated in one area? And do you have any family history of early heart disease? Those details can also help put the calcium score into context.

Just two comments.
1. If you get “shin splints “ you can suspect the Zetia. I had that reaction when I tried it and had to stop.
2. There are additional tests if you feel you’re interested including echocardiogram and stress testing (bike or treadmill).

I am 80 years old and a retired nurse. I looked up some of your information that I was not totally up to date on. I have a husband who had high cholesterol that was purely genetic. He has taken statins for years. He is also a former smoker as a younger man. He had a moderately serious heart attach when he was in his early 40s. He quit smoking cold turkey. He was on the heavier side, never obese, but he took two different medications for B/P and he did well for years, but age changes things and it isn't easy for the body to "forget" all those things you did to it year after year. So long story shortened: you doctor should have told you that the best way to make things better for your overall health is to lose that 30 pounds. Now that my husband has retired, he goes to the gym every day to keep joints moving, maintain strength and adjust for a lower metabolism that comes with age. He is off all his B/P meds. He used to wear a 38 to 40 inch waist jean. He now wears a 34 in waist jean. Yes, he's a "old" guy but he looks good and he did it the old fashioned way: exercise and stopped eating junk food--not candy and cake-- but snacks and chips and large servings of pasta, etc. Medication to lose weight is okay I suppose but it is expensive, doesn't always work and the weight comes back when you stop taking the med. How about telling yourself that you are 62 years young, you'd like to live longer and better and make those lifestyle changes that we all can make if we choose to. I have A-fib and in order to deal with it I had to stop drinking alcoholic drinks, exercise more regularly, lost weight--even a few pounds improves many medical conditions--avoid junk foods, stay hydrated and get a good night's sleep. I have been A-fib free for months. Sorry to sound preachy, I don't mean to and you may already do all those things, but if you haven't tried the easiest non-medication program for better health, it is worth the effort. You are still so young and you deserve to be enjoying your up-coming retirement! Good luck! I am rooting for you.

@sjm46

Thank you. I am going to work hard on the weight. He recommended Zepbound to lower my A1c in addition to weight loss. Either way I need to exercise a lot more and stop eating Pop Tarts at night. (I love those things).

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@jlharsh “ How does my elevated lipoprotein(a) affect my long-term management?””

He mentioned he hoped in a year there would be treatments. For now aggressively lower LDL.
I was a bit surprised as I thought at least a stress test would be ordered. He felt that at this point there was no reason. The calcium is heavily in the LAD. And he said that is the typical place to get the most.
I told him I always took the steps to my office, (4th floor) and never had symptoms. He felt that was a bit of a daily stress test that I passed. But I do think I’ll ask for a basic test.

@bearcat998 The LAD is the worst place to have it. I would want an angiogram to confirm what state my arteries are in. My calcium score was much lower than yours, and my doctor had no problem ordering an angiogram (and an echo, and a stress test, and a carotid ultrasound.) He says the more data points he has, the better.

@bearcat998
Ah, it sounds like your cardiologist does not think having a stress test will provide new information or change his treatment recommendations.

My LAD is where most of my calcium is deposited as well. I’ve been told, as @njx58 comments that this is typical. Concerning, and typical.

One helpful cardiologist told me that the reason they tell patients to exercise regularly, is of course good for cardiovascular health but it is also extremely helpful for the patient to immediately recognize when something concerning changes. I also understand a stress test is a good test to show what is currently happening with the heart, though my dad’s experience was a heart attack one week after getting great results. I guess I say all this express I appreciation of your doctor’s comment about taking the stairs at your office.

Here is a summary Mayo Clinic provides about the stress test, if you haven’t seen it. I particularly want to point out the section addressing why the test is done:
“A stress test may be done to:
- Diagnose coronary artery disease. The coronary arteries are the major blood vessels that bring blood and oxygen to the heart. Coronary artery disease happens when these arteries get damaged or diseased. Cholesterol deposits in the heart arteries and inflammation usually cause coronary artery disease.
- Diagnose irregular heartbeats, also called arrhythmias. An arrhythmia can cause the heart to beat too fast or too slowly.
- Learn if heart treatment is working, or decide on a treatment. If you've already been diagnosed with a heart condition, an exercise stress test can help your healthcare team know if your treatment is working. The test results also help your healthcare professional decide on the best treatment for you.
- Check the heart before surgery. A stress test can help your healthcare professionals determine if surgery, such as a valve replacement or a heart transplant, might be a safe treatment for you.

Here is the entire summary:
- Stress Test Overview
https://www.mayoclinic.org/tests-procedures/stress-test/about/pac-20385234
Do you think you will try Zepbound to lower your A1C? What is your fav flavor of pop tarts? 😀

@jlharsh - I am getting a second opinion on the stress test. My PCP ordered the calcium scan based on a finding on a PMSA scan (prostate cancer). She made a cardio referral and told me that if it was going to take too long, she could order a stress test. So I am going to get her opinion too.

I really felt the doctor was very knowledgeable. He did an EKG, pointed to the peaks, noted how "sharp" they were, and said that if there were serious blockages, it would not look like that. (Although my knowledge base is very limited. He could have told me anything, I wouldn't have known better) Couple that with the fact that I have been asymptomatic, and I guess he felt comfortable adding Zetia and monitoring.

As for Zepbound, he is the second doctor who has made that recommendation. My oncologist also did a few weeks ago. My PSA numbers tend to be odd, and he ordered the scan to ensure that there was no further cancer. (It was negative, so I'll take that win). He believes the weird numbers are from post-radiation inflammation and said that he has noticed his patients on Zepbound have far less. He also knows I could lose weight and am pre-diabetic, but he was more interested in the anti-inflammatory effect. And the fact that having your blood sugar under control shows better outcomes for prostate cancer patients. So yes, I will meet with PCP this week. I will probably use a compounded version due to cost.

As to Pop Tarts, it's the Chocolate Fudge that I am too weak to walk past. Although I now make sure there are none in the house.