my Cornary Artery calcium score

Good day, and welcome to Mayo Community fora.

There isn't much you can do at this point. I don't imply any judgement, just stating what I understand dispassionately from your shared information. You have combined genetics and phenotype (your lineage and the influences of decisions made by yourself and by others, including pursuits, habits, other interests) working for and against you, but to what extent either way is unknown to me. A history of substance abuse might be a large factor, but it could just as easily be your emotional control, disposition, lifestyle....anything that might raise cortisol to the point where it began to encourage deposition of plaque.

To me, if one has to have substantial deposition of plaque, then you'd also want it to be at least moderately calcified so that it is immobile, fixed, and not friable and liable to travel to where it can do substantial harm. Your numbers say you have several near-occlusions that could cause trouble before long, although the caclification should give you some comfort that you're just likely to have to be concerned about blockages in time, and they would follow a period of dangerously low flow past the narrowings.

Has anyone offered an opinion about bypassing, stents, whatever? Any arrhythmias showing up, aneurisms, dissections?

@gloaming
thank you for taking your time to respond to me. i am an alcoholic and cant undo that, just trying to do the right thing for my body going forward. Now that i have the info from the CAC screening (other than " you have severe atherosclerosis") maybe we can focus on specific areas like you mention. Can some of the things you mention be done prior to a cardiovascular event or do i have to wait until i have a heart attack? No one has mentioned stents, bypasses, or dissections. i will though. thank you again.

@ewcm20 The general policy across the field is that a mechanical intervention like a stent or bypass procedure is undertaken when the obstruction nears 90%. That seems 'faint-of-heart' to me, like the risks of the intervention are about equal to just letting the heart run up to and beyond 90% obstruction/restriction. Or is it that the insurance industry won't fund until the 90% mark is reached with the hope that the patient will infarct or spontaneously kick the bucket before they incur the liability of the reimbursement/payment? Yes, call me cynical if you must. It 's apt.

A heart attack, also known as a myocardial infarction, occurs when blood flow to the heart is blocked, causing damage to the heart muscle. This blockage can lead to tissue death if not treated promptly. The main cause of a heart attack is coronary artery disease, which narrows the arteries supplying blood to the heart. Symptoms may include chest pain, shortness of breath, and discomfort in other areas of the upper body. Immediate medical attention is crucial to restore blood flow and minimize heart damage.
You don't want a heart attack!
Your doctor could recommend a cardiac catheterization to see the degree of blockage.
Maybe a stent or two or a bypass. I had a calcium scoring test of 1350 and shortly after a bypass.

yep pretty sure i dont want a heart attack! my doc just is so set on statins....very frustrating....

My husbands’s CAC IS 5,185. He has zero symptoms. Because none of his arteries are at least 70% blocked, there is no need for a stent. His Statin was increased to the max dose and an Aspirin 81mg daily was added. Statins stabilize the plaque and thus can increase your calcium score , but at least you don’t have plaque floating around to cause a blockage. Statins also decrease inflammation. My husband has gone on a strict cardiac diet and exercises regularly. The cardiac diet is a BIG change because we always atewhatever we wanted, and he loves red meat. He hasn't had red meat since he got the high CAC score. He’s lost 20 lbs ( he was not overweight) . We went to a dietician and have drastically changed our eating habits. His 3 month follow up is coming up soon. I’ve requested a CAC from my PCP, and she referred me to a cardiologist. I have an appointment coming up soon too.
My husband has checked out U-Tube high CAC scores and there was one in there by a cardiologist who suggested other means besides a statin. Sorry he can’t remember which one it was though.

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@lenmayo
Did they do a cath or wait to you were having symptoms . That's what's scary to me they keep saying call if you have symptoms now I think I have them ugh

@missy123
Hi,
A long story.
I was out walking and stopped to talk with a neighbor. I felt lightheaded . I never had this feeling before. I saw my GP and he recommended a cardiologist. I had never seen one before and I had not taken any pills yet. I was 75. The cardiologist put me through some tests and recommended a Calcium scoring test. The Calcium scoring test was 1350! I was now on Atorvastatin for cholesterol and Metoprolol Tartrate for blood pressure.
Time went on. One Wednesday night as I was going to be I had heavy indigestion. I had had light indigestion for a week but this was heavy, I drove myself to a local hospital. An enzyme in my blood was indicating heart problems. I was moved to a regional hospital. The next day I had the CARDIO CATHERIZATION. I was awake during it. My cardiologist did the procedure. He went in through a wrist. They were amazed at the blockage. The head of cardio surgery told afterward that some one with this much blockage usually doesn't survive a heart attack. That was a Friday. On Monday I had a triple bypass. That was 2018! No heart attack! Since then I had an Inguinal hernia repair, left Kidney removal for a large cancerous growth, and my appendix removed. Each of those also has a story. Good luck to you and God bless you.

You might wish to ask your doctor about a cardiac ct scan with contrast, which is a less invasive test than a cardiac catheterization. It lets them get a sense of where the plaque is in your arteries (sometimes much of it is along the sides, with little blockage), how much uncalcified plaque there is (which is what is actually more dangerous since it can become dislodged and catch on the calcified stuff and block blood flow), and the degree of any blockages. It can tell them if you need a more significant intervention. They might also want to do a stress test and/or echocardiogram to assess your heart health and see if there is any damage from an unknown previous heart attack. They should probably do more tests to more fully understand your heart health.

In terms of medications, statins can really help and most people don't have side effects. If you have never taken them before, you might want to try them to see if you experience side effects or not. Zetia also lowers cholesterol and is not a statin, so you could try that. Repatha is expensive, but if you don't tolerate statins, it can also lower your cholesterol.

For treatment, the idea is to use medication and lifestyle to get your circulating cholesterol low, since that prevents further build up and blockages. You can't change what is already calcified - calcified plaque is essentially old plaque that has healed and stabilized. It's not really a problem as long as it's not blocking an artery more than 70% and as long as you are taking steps to reduce soft plaques and avoid blood clots, which are things that might end up in your bloodstream and get caught on a calcified plaque and cause a heart attack. Statins do increase calcified plaque, but that is actually good thing as what they are really doing is sealing that plaque in place and preventing new plaques from forming as quickly - so this reduces your overall risk of a heart attack.

Good luck as you work through your results!

@ewcm20
I would definitely take those statins. Perhaps another one, different than the one you were taking? You may have hypercholesterolemia (familial), but if you have blockages, then you need the help of statins. Better to put up with a few side effects from statins than to wait for a heart attack. I think the side effects also lessen after awhile as your body adjusts to them.
Best wishes!