I have a very high calcium score. What next?

At the age of 50, I had a heart score of 280.
Passed stress test with ease. Dr said, 'get out of here'.
No one in this office can do what you just it.

I didn't take statins or change diet.

I was 5'10 @ 160 lbs. I exercise regularly. Running 1.25 miles 5 times a week, with 5 pd
hand weights.

Three years later had heart attack.

As stated before, the soft plaque that develops can be very dangerous.

floppingsets,

Here's what I did - without symptoms (this is key - if you have ANY symptoms they will likely want to take a look and perhaps stent), cardiologist was uninterested in any of these except a stress test, so I worked through my PCP. I've had hypertension and been on BP meds (telemisartan) for 15 years.

1 Advanced lipids testing - one large lab calls it CardioIQ
2 Statin
3 Icosapent ethyl (Vascepa)
4 81 mg coated aspirin (might help and normally doesn't hurt)
5 stress test with full echocardiography
6 CT Angiogram (CTA)
7 Peripheral Artery Disease testing

Mine is 2,854. Everything is fine and I'm on statins. That's it. Tons of tests, and there are lots of people like us. I'm 56 and go to the gym EVERY day of my life, triathlons, crossfit, etc. So don't worry, be happy. 🙂

My score is 2,854. Tons of tests, yadda yadda yadda, and 2 cardiologists said 5 years ago, we would have rushed to stent you. Today, your blood flow looks perfect so we'll put you on some statin drug and monitor every year. I also have an aortic aneurysm that they will monitor. So relax my friend. Just manage your cholesterol and everything will be find.

Ok.
So you must begin the "healing" of your soft plaque. This is the most dangerous, far more dangerous than the stable calcified plaque you just got bitch slapped with.
To do this you must go to Rosuvastatin 20mg or 40mg(max dosage). This should drive your ldl-c down to mid 60s-preferably lower.
Here's whats up-the soft plaque not shown (but implied) by your calcium test needs to develop a fibrous cap or a thicker fibrous cap to protect from rupture.
After 8 weeks of Rosuvastatin another lipid test to see where you are at. If not

hey there, would love to chat. I'm basically in full freak out mode at moment. Just received score and it's 430. I am 46. Non-smoker, not overweight, exercise and total lipid profile as seen attached. He suggested a 5 mg statin to start out. Didn't think a nuclear stress test was needed but I demanded it, so going in 10 days but have to pay out of pocket over $3k for it. According to the charts I'm in the 99th percentile and have the arteries of a 90 year old. Something isn't right. I've completely overhauled my lifestyle in the last week and plan on continuing. Cut out alcohol, and eating like a rabbit basically with some protein. Have lost 8 lbs. In any event, would love to hear how you are doing and any information you could provide.

I'm more of a hack player, but I've been at it a long time, since 1959. There's a clip of my sloppy playing on YouTube under my name, Jon Sterngold. My band's website is http://www.terrainband.com and I have a bunch of noodling up at http://www.soundcloud.com/bluesdoc. Enjoy. Also, I have a book of true stories from my ER career up at https://lifepathguide.com/my-stories.htm

jon

For me, a very helpful post bluesdoc. I am literally breathing easier and see a diagnostic path forward for me. I did not want to risk contrast, so you have helped with the suggestion of perfusion testing. I was a bit dubious about it, but will take it on.

And bio-electrical engineer, turned professional blues player here myself (Hacksaw Harry). 2022 NMMA nominee. It is a small world! Keep it down low amigo.

As the owner of a CAC score >2600 with normal treadmill and perfusion studies (no angio because of horrid reaction to IV contrast), and fwiw, a practicing doc for ~49 years (ie, I'm old, but still in the game), I should remind the group that 1. very high CAC scores are not understood by the cardio community 2. A few patients I know in my age cohort with high scores who have gotten an angio have not showed calcified intima plaque but rather Ca++ at the outer portions of the coronary vessels (ymmv) 3. with normal treadmill and perfusion studies we probably do NOT have a time bomb in our chest any more than age-predicted 4. Consider carotid US as carotid and coronary lesions often parallel one another. In my case with my very high CAC score, my carotids are completely clear of atheroma. Just another piece of the puzzle. The most direct way of addressing our anxieties about coronary Ca++ is to get functional studies - treadmill/perfusion testing. And, this is NOT medical advice as that is not appropriate here, but consider statins (or other LDL lowering approaches) to stabilize whatever plaque you might have, esp if lipids are high.

Hey thanks! Pretty interesting read, @50% error introduction due to increased hr quite disappointing considering no one effing mentions this when taking the test. Looking to see if the Cleerly test backs up my @900 calcium score, although it seems the calcium wont kill you before the vulnerable plaque will lol.