High CAC Score for age (86th percentile)

IMO, you should get these non-invasive tests immediately:
- full/advanced lipid panel (like a Cardio IQ)
- stress test WITH echo
- CT Angiogram

The combination of these will provide sufficient information to determine whether you should have a catheterization (invasive, but the gold standard/certain test). Note - many cardiologists will move slowly since you don't present with chest pain or other indications. Don't let them - insist on the tests.

You don't mention your lifestyle, weight, LDL or A1C ... have you ever had chest pain?

Hi. Thanks for the note. Lifestyle generally healthy. BMI 25ish. LDL 117. Fasting glucose higher than I would like at 110. A1C 5.4%. Blood pressure goes very high in clinical setting and ok at home (not great but ok). I started BP meds a few months ago and started Lipitor a week ago after this reading.
I had an echo stress test in March 2020 and was clear. I don’t have any chest pains / symptoms.

I don’t want to go slowly especially if can get actionable data. I appreciate your thoughts.

Was your stress test with EKG or echocardiogram … with echo means echo baseline prior with heart ultrasound and then again immediately following the stress test after it has met the heart rate requirement …

It was an echo. My BP was very high so they stopped the test early. It gets very high at doctor visits (which may be part of why I have this issue…I don’t know). But they were able to complete the study as heart rate was high enough. I want to redo currently as this was almost 3 years ago but below are the results:

ECG Rest: The baseline ECG displays normal sinus rhythm.

ECG Stress: No diagnostic ST segment changes were seen.

Rest Echo: Left ventricular systolic function is normal. The ejection fraction estimate is
60-65%. No regional wall motion abnormalities noted.

Stress Echo: No regional wall motion abnormalities noted.

I appreciate all your thoughts. I want to make sure I am taking the best next steps to minimize risk.

So, I started telemisartan (hypertension) about 15 years ago, then atorvastatin following my CAC test of 1352 three years ago (to lower triglycerides and LDL ... LDL now 37-40 and trig 42, total cholesterol 94). I also started Vascepa at the same time.

Push to get full Cardio IQ panel and it will likely reassure you based in other factors.

Thank you so much for your advice. I want to get CT angiogram, the lipid panel you mentioned and do another echo stress to make sure I have full facts. I really appreciate your time and advice.

I have chronic elevated cholesterol and my former cardiologist was the inventor of the calcium score. (Dr. Arthur Agosten. Who also has written several reassuring books on heart health issues.)

Be sure that you get a comprehensive lipid analysis that includes molecule size and risk profile. Despite elevated cholesterol, a genetic marker for heart disease, a family of members who died young from heart disease and an inability to tolerate any statins yet on the market, I have low-ish risk of cardiac events because my body makes a healthy amount of the fluffy, non-sticky, large cholesterol molecules. My most-recent calcium score was 4 on a test done 5 years ago.

My point is that there are multiple variables involved in heart health (as Dr. Agotsten used to explain to me) and we can impact a lot of them. I once met a patient in his waiting room who was in his 90s and still playing tennis a few times a week. This man had his 'first heart attack' as he referred to it in his 30s. And another 20+ years later. And was alive and vital nearly 40 years later.

Cardiac medicine is one area where real progress has been made. And one where the body has tools for self-adjusting and healing with excellent doctors guiding the process.

I think the calcium score is only 1 of the factors. You have a good "good cholesterol". Facing many of the same issues I have decided to do the things I can control and try not to worry about those that are unconrollable like calcium. I don't smoke. I don't drink anymore. I am on a statin. My blood pressure is controlled. Under Drs direction i will try and lose weight and be more active. Lets see what happens.