I have a very high calcium score. What next?

Well put @christianzane! I'm still struggling to mentally get past the original diagnosis from June, but I've dropped from 250 to 228lbs, I jog/walk 2 miles a day, take a statin and aspirin (with some muscle spasms during long drives) and eating a med. based diet. I'm still needing guidance from a nutritionist as there are many perspectives on how we should be eating, but so far low carb and low fat is getting the weight off and I'm starting to come off blood pressure meds too. I think it isn't stated enough that your risk is greatly reduced if you follow the 7 things you state in your post. Really, your risk is very close to that of the general population if not better because you will be in such great physical shape and other causes of disease and death will also be greatly reduced.

So, given numbers are important to avoid misunderstanding, your stress tests (you don't say if they had an "echo" component which is recommended with heart disease) should have provided some scoring - like a METS number.

And, same point wrt triglycerides - what number?

My sense is that many folks reporting in on this forum have forced their cholesterol to around 100, and their LDL and triglycerides to around 50 ... usually with a statin, better eating, and perhaps icosapent ethyl.

Re red yeast rice - here's a link to a Mayo article -https://www.mayoclinic.org/drugs-supplements-red-yeast-rice/art-20363074

Here' what it said - please note the specific warning on drinking alcohol with red yeast rice.

"Overview

Red yeast rice is the product of yeast (Monascus purpureus) grown on white rice. The powdered yeast-rice mixture is a dietary staple in Asia and has been used in traditional Chinese medicine.

Red yeast rice is also available as an oral supplement.

Red yeast rice might contain compounds that appear to lower cholesterol levels. One of the compounds is monacolin K, the same ingredient that is in the prescription cholesterol-lowering drug lovastatin (Altoprev).

As an oral supplement, people take red yeast rice for high cholesterol and heart disease.

What the research says

Research on red yeast rice use for specific conditions shows:

High cholesterol (hyperlipidemia). Research shows that red yeast rice containing considerable amounts of monacolin K can lower your total blood cholesterol level, your low-density lipoprotein (LDL, or "bad") cholesterol level and your triglyceride level.
Our take

Yellow light: Caution
Caution

Red yeast rice is capable of lowering blood cholesterol levels and total blood cholesterol levels. While the supplement is generally considered safe, it might carry the same potential side effects as statin cholesterol drugs.

Red yeast rice might cost less than a statin. However, with a supplement, there's less assurance regarding quality and how much active ingredient is actually in the product. Some red yeast products might contain only small amounts of monacolin K and potentially have little effect on cholesterol levels.

Safety and side effects

Red yeast rice can cause mild side effects, including:

Abdominal discomfort
Heartburn
Gas
Headache
Dizziness
Red yeast rice might contain monacolin K, the same ingredient that is in the prescription cholesterol-lowering drug lovastatin. Lovastatin side effects include liver damage and muscle disorders (myopathy).

Don't take red yeast rice if you're pregnant, trying to become pregnant or breast-feeding.

An older study raised the concern that some red yeast rice products contain a contaminant called citrinin, which can cause kidney failure. However, a more recent study that analyzed 14 red yeast rice dietary supplements didn't find citrinin in any of them.

Interactions

Possible interactions include:

Alcohol. Don't drink alcohol if you are taking red yeast rice. The combination might increase the risk of liver damage.
Cyclosporine (Neoral, Sandimmune). Taking this immunosuppressive drug with red yeast rice might increase the risk of myopathy.
Cytochrome P450 3A4 (CYP3A4) inhibitors. Taking red yeast rice with drugs, such as erythromycin, that inhibit this enzyme might increase the risk of harmful red yeast rice side effects.
Grapefruit. Drinking grapefruit juice and taking red yeast rice might increase the risk of the supplement's harmful side effects.
Gemfibrozil (Lopid). Taking this cholesterol drug with red yeast rice might increase the risk of myopathy.
Hepatotoxic drugs, herbs and supplements. Red yeast rice might contain monacolin K, which can cause liver damage in some people. Taking red yeast rice with these types of drugs, herbs and supplements could increase the risk of liver damage.
Niacin. Taking red yeast rice with high-dose niacin might increase the risk of myopathy.
St. John's wort. Taking this supplement with red yeast rice might reduce the effectiveness of red yeast rice.
Statin. Taking red yeast rice with other statins might increase the risk of harmful side effects."

Perhaps consider changing to a different statin, or an injectable that avoids the side effects of oral statins, but has less potential side effects and is more "pure" than OTC red yeast rice?

Thank you for the comments, I should have mentioned that all my stress tests have been exemplary. My triglycerides are normal and my HDL is 59. I have been plagued with anxiety the last 10 years (PTSD) and this CAC score seems to trigger it! I am trying to put it in the “informative” category, however anytime I feel something weird in my chest I become so anxious not knowing if that is a precursor to something bigger. Has anyone tried the red yeast rice as a natural cholesterol reducer?

Hi @sjy70. You may notice I edited your post to remove your email and changed it to "private message me." Mayo Clinic Connect is a public site and we don't want our members to get spam mail from unwanted solicitors so we encourage you to not share private contacts in the public post. Sharing via private message will keep your information private between you and whoever you are communicating with.

deb,

Agree with christian, above. While better, you should probably get you LDL and total cholesterol much lower. Many report good results from injectable's to lower both.

- advanced lipids panel done, called cardioiq by some
- stress test with ultrasound should have been one of first things

You don't mention your triglycerides ... need to reduce, as well.

You have taken action to repair damage done by known risks - please keep working it!

A CAC score is just informing you about your arterial health. Soft plaque (which is usually the stuff that will get you in the end) doesn’t show up on a CAC score, but what lights up is the hardened calcification. Since a high CAC score is a proven predictor of increased CAD events, it should just be used as a guide to make lifestyle changes. My doctor has told me repeatedly he has patients in their 90s with CAC score in the 1000s.

Elevated CAC scores have also been associated with increased risk of other noncardiovascular diseases including cancer, kidney disease and obstructive pulmonary disease.

So a high CAC score is not a death sentence. It’s just an informative tool to nudge many of us into a healthier lifestyle. And your LDL still seems on the high side, ideally get it under 70, if you had issues with a statin before try another manufacturer and lower dose and try to ride out any muscle spasms for a few months to see if they go away.

So any of us with calcified arteries should just go about our lives but make necessary lifestyle choices and forget about it. Exercise, quality sleep, low blood pressure, minimal stress, a plant based diet when possible, a statin to lower LDL and no smoking are simple ways to live to 100 with a high CAC score.

I am in the same boat, 60 yr. Old female, have always been healthy, CAC of 585, (472 in my LAD) of my total score, statins have not agreed with me at all, I am doing red yeast rice 600 mg/day, my chol. numbers have decreased in 6 weeks, cholesterol is 201 down from 238, LDL 126, down from 151, I walk 36 miles a week and quit smoking 8 weeks ago, and cut out diary. I wish I had never taken the test, I live in fear of a cardiac event daily (certainly no way to live). I asked my cardiologists if we should do a cath or stent, he said no, Cath’s are too dangerous and no symptoms to indicate needing a stent, sadly when you have symptoms it might be too late. There seems to be a big void in testing AFTER the calcium test to know if you are actually okay. They don’t want you to repeat the test, but they say the score can only get worse, it cannot decrease no matter what medications you take. The scary thing is that you can hopefully keep it from progressing but if you are already at a “high risk” level you just feel like a walking time bomb, there has to be a better way to test patients at high risk levels on a monthly basis so that we don’t live in fear. Does improving your numbers really help? I have seen where people have normal Chol. numbers but have high CAC scores, and no real explanation. Also, testing for hard plaque versus soft plaque would be helpful after you get a high CAC score. I really enjoy this forum as I find it very informative hearing from others that are enduring the same health issues. Has anyone had good results from the red yeast rice?

Has anyone had an angiogram done after a high calcium score

@tylindy
I read that article early on when I received an abnormal Ca Score. It did make me think a bit.
I also took the Arizona Score...I received a score of 7 which they consider low risk...made me feel better also.
Let me point the group to another article...it really hit home for me, because this journalist had almost the EXACT same profile as me...and he had a follow-up article about his experience 10 years later. Article: "I thought my heart attack risk was low. A coronary calcium scan told me otherwise." in the Washington Post... https://www.washingtonpost.com/health/i-thought-my-heart-attack-risk-was-low-a-coronary-calcium-scan-told-me-otherwise/2019/07/19/893da806-774b-11e9-b3f5-5673edf2d127_story.html

I sometimes wonder what would have happened to me if I hadn't take this test and gone on Crestor. Would I have died in five years or 20 years if I hadn't gone on statins? I'm healthy otherwise, asymptomatic, still do sandbag training at 61, walk a mile around the neighborhood at least 5x a week and no family history of heart disease except my father dying at 84 from a heart attack. My nuclear stress test and echo both came back normal. I sometimes question if this was a good thing or not. Guess there's no real way to tell.