I have a very high calcium score. What next?

I don't agree with the reading. If your CAC is 400+ It is not necessary to have the stress and EKG tests but the risk of a stroke or heart attack exists. It will exist forever although you can stabilize your condintin by improving life style (diet, exercise + statins). I am asymptomatic but my score is close to 1600. Numbers don't lie. My liver produces too much cholesterol.
As far as the angiogram the imaging of the blockage in your arteries are facts as well. I didn't run to the angiogram believe me but with a score like the one I have I needed to know the exact blockage percentage on my LAD.

That study was released in 2019 I believe so it's fairly recent and most likely still the standard. The most important thing it states is "referral for stress testing and cardiology consultation should be delayed until evidence of unstable angina exists. No immediate or long-term benefit to such individuals from either stress testing or coronary angiography has been documented in the literature." I see a lot of folks here running to do these things after getting a CAC score and it's really not needed, according to that study anyways. Since you are over 400 however they do suggest getting your LDL below 70 along with the dietary and lifestyle changes for everyone else under 400.

I typed in "Arizona Heart Risk Calculator" and the first citation is: https://heart.arizona.edu/heart-health/heart-attacks/heart-disease-risk-assessment

I tried to find the Arizona Risk Calculator.. do you have a link? I’ve been living this for 18 months and like most of you there is always this dark cloud hovering. I’ve made the changes, now I’d like to be optimistic of the outcome.. at 63 with a cac of 2418.. it sometimes seems overwhelming. If someone has the link that would be great.

@neilyounger Thanks for those links, it really is startling. I suppose it is positive that many of the smokers quit if that is the only thing that they end up changing. Do you know of any articles that quantify risk reduction and how one would benefit by taking action and also starting statin therapy? I found a risk calculator on the Arizona State University heartseries.org site that was helpful to reassure me that making changes does have a huge impact on your longevity. Basically, cutting risk from very high (>20%) to low risk (3-8% chance of heart attack in 10 years). I think I can live with those numbers at 55yo and its worth it to do whatever I can to keep the risk in that range.

This may be the study you are referencing https://pubmed.ncbi.nlm.nih.gov/23592106/

It's talked about here: https://www.mentalhelp.net/blogs/lifestyle-changes-after-heart-attack-or-stroke-in-short-supply/

@mayoconnectuser1 - yes, certainly reversing the course of the disease, not dissolving calcium but it is true that plaques could be shrinking as they calcify, especially soft plaques. I was hoping you may be able to help locate an article or paper that describes or quantifies the decrease in risk for cardiac events for people in our group that have calcium build-up if we take on all of the lifestyle changes and proper medications. Everything I've read so far (I'm two weeks into this journey) is very challenging to understand and also very troubling. The odds do not read well. But as another member pointed out, those statistical probabilities are just based on having the score and not doing anything about it. Astonishingly, about 95% of people with heart disease do just that, nothing. I don't have the citation for that as it came from a Dr's website, so maybe that isn't completely accurate, but what I'm getting at is if as an individual, I decide to do the hard work and take the medicines and remain proactive with my Doctor, how much does that risk decrease by? If our 10 year chance of a cardiac event is for example 25% untreated, can we reduce that by 80% with all of these interventions? So maybe it is a 5% 10 year probability, which sure sounds better than 1 in 4. Just trying to learn how to live with this and not let it consume my every waking thought. Thanks for your work on this site!

I believe they are likely referring to reversing heart disease - not calcium build up - ie, eat smarter, lose weight, lower cholesterol, control blood pressure, treat high A1C and diabetes, take statins if appropriate, etc.

So, another of us with no symptoms, no issues on echo (did they list data?) but high CAC.

OK scores on the stress test.

Perhaps try to lower triglycerides further? Add Vascepa (icosapent ethyl)?

I would try and understand why the HDL is so low.

Started taking at 39 family history and diabetes diagnosis.
Mets 10.3
Echo was yesterday and everything looked fine
Ischemia score 0
Duke score was 9