calcium score blues

[vimwick]

got a ct calium score in oct of 2006 of 407. scared me into life style changes. went vegan except for fish once or twice a week (fishy vegan ;-). dropped from 182lb to 165lb (23.7 bmi) and lowered cholesterol from 220 to 150 with statin in first four months. kept consistant with diet, exercise, and meds for following year

just got the results from the follow on scan on feb 16th, 2008. 674. certainly changes one's planning horizon. as i understand the progression, i have roughly 3 years (plus or minus 2) until cardiac event (heart attack or sudden death)

any of you good doctors out there that might help me better understand my chances and possible alternatives?

think i'll loosen up on the purse strings a bit...

thanks in advance

[Rich_by_the_Bay]

Quote:

Originally Posted by vimwick got a ct calium score in oct of 2006 of 407. scared me into life style changes. went vegan except for fish once or twice a week (fishy vegan ;-). dropped from 182lb to 165lb (23.7 bmi) and lowered cholesterol from 220 to 150 with statin in first four months. kept consistant with diet, exercise, and meds for following year just got the results from the follow on scan on feb 16th, 2008. 674. certainly changes one's planning horizon. as i understand the progression, i have roughly 3 years (plus or minus 2) until cardiac event (heart attack or sudden death)

It's too complicated to address here, but in a nutshell CAC scores are quite reassuring when they are low. In the high range, they have some predictive value but it's highly variable depending on your other risk factors.

Importantly, I am not aware of any conclusive evidence that they have independent prognostic value over and above traditional measures, nor that instituting treatment solely on the basis of a high CAC score improves outcomes.

Your interpretation of the prognosis implies that you have a 30% chance per year of a cardiac event - that is not plausible unless there are other factors we don't know about. Even the very highest risk asymptomatic patients have annual risks well under the 10% range, for the most part.

I'd continue to follow a healthy lifestyle and diet, and since everyone is different, check with your doctor about whether further tests are necessary, and decide accordingly.

Just curious: what made you decide to undergo the test in the first place?

[Buckeye]

With such a negative result, is it worth a do-over to double-check the result?

Are you checking your c-reactive protein? Has that gone up and/or is it high?

[vimwick]

thanks for your replies

buckeye, i will ask my doc about doing the c-reactive protein test and the heart hospital about a redo

rich, i had most of the traditional risk factors. i've addresed the controllable ones. i thought the scan was the true measure of plaque (risk) and traditional risk factors only implied the presence of plaque

the charts i've seen suggest a 20-25% per year chance of cardiac event per year for scores above 1000. i should break 1000 by this time next year (woohoo ;-) unless i can find a medical or nutritional solution

don't mind dying per se, do mind living too frugally banking on a tomorrow that i likely will never see

thanks again

[Rich_by_the_Bay]

Vim,

I'm sorry for all the anxiety this must be causing you. Get some independent advice from a second interventional cardiologist.

If it were me, and if all the other factors pointed to increased risk, I'd ask about just doing a coronary angiogram (cath) which is still the gold standard. Not only would it answer questions about your true risk, but if there was critical blockage an angioplasty could be considered. If not, the reassurance would be priceless. 90 minutes of your time well spent.

Everyone's different, so only your own doctor can help you decide, but the CAC is not the last word.

[deserat]

What Rich said - I just observed to two cath procedures - one was negative (was a rule-out) and the other was a stent being placed -it is the gold standard, although I know that 64 slice CT with 3-D rendering is catching up and less invasive. In addition, I don't know that one variable can predict future incidents - in fact I find the human body amazingly resilient and the 'norm' is quite a range which depends on many factors. It looks as though you are controlling those you can, which is admirable.

[mhconway]

My calcium score is 3283; no, that's not a typo. I am 69 years old and fit by any standard, thank Heaven. If you read the literature, I should be dead. I have been over 1200 for about a decade and and my score is rising rapidly, despite a total cholesterol reading of 132, with an HDL reading of 68. But there seems to be no diminution of my cardiac capability. Indeed, I think you'd be hardput to find a sixty year old in better condition. Please don't pay any attention to calcium score, especially your low level. Exercise, watch your diet and live a good life.

[haha]

Quote:

Originally Posted by mhconway Please don't pay any attention to calcium score, especially your low level. Exercise, watch your diet and live a good life.

Great post! Although we all want to do what is right for ourselves, an overly medicalized middle age is not very attractive either.

Medical care is great; but I sometimes think that my grandfather's time (probably great or great-great grandfathers for many of you as he was born in 1866) was overall better. He just kept plowing his fields and milking his cows, till one day he took a long lunch break and died- at the age of 84.

In his long life he saw one doctor for a bad hand infection from a horse-shoeing accident.

Ha

[FinanceDude]

Quote:

Originally Posted by haha Great post! Although we all want to do what is right for ourselves, an overly medicalized middle age is not very attractive either. Medical care is great; but I sometimes think that my grandfather's time (probably great or great-great grandfathers for many of you as he was born in 1866) was overall better. He just kept plowing his fields and milking his cows, till one day he took a long lunch break and died- at the age of 84. In his long life he saw one doctor for a bad hand infection from a horse-shoeing accident. Ha

He had a good life, with less stress than many of use deal with..........

My grandfather was born in 1898, and died in 1978. He was a farmer too. One day he had a stroke and that was it. I doubt he left the world with many regrets............

[vimwick]

hey guys, thanks for the great replies. and a special thanks to mhconway. you made my day! 3283 and fit at 69. godspeed

anyone know of a higher asymtomatic calc score? before mhc's reply i was thinking that in three years at 2000+ i'd be toast

before discovering my calc score and rapid progression, i used 110 minus age as my (statistically possible ~1%) life expectancy. at this rate, i'll catch up to mhc in about 4 years. i can't conceive of the calc score being entirely irrelevant and so i seriously doubt another 55 years unless the progression can be addressed. i'm thinking a prudent number for financial planning (maximizing fun with wife ;-) now might be 8 years

for those of you worried that i'm overly concerned with the numbers (first thanks for your concern ;-); not to worry i'm an intj, health nut, optimist

as i posted before, i've successfully addressed the obvious risk factors to little (calc score) effect. my next most likely candidate is < pm2.5 pollution. i live just below a heavily trafficed main thoroughfare. thinking of installing several iqair healthpro plus purifiers. comments?

mhconway. how's the air quality in your immediate area?

thanks again everyone for your interest and concern