High calcium score and angiogram

[eytonxav]

My father had a debilitating stroke about the age I am now and was dead by 71. He was a heavy smoker and overweight but my CAC shows it wasn't all lifestyle as I had assumed (hoped). I'll be taking my SS at 62, and I've pretty much stopped worrying about cancer My mother is a very active 80, but unknown CAC.

I am turning 74, the age my father died from heart disease, so that is something in the back of my mind. My mother died of cancer at 59. I took my SS at 68.5 due to longevity concerns and fear of a government haircut coming sooner than expected.

 

[bmcgonig]

I had a calcium score test done years ago when I was about to turn 50. It was zero then. I'm 71 now and thinking of having it done again. An outfit called MDsave apparently can get me one for $130 but I'd have to drive 100 miles. A slightly closer facility would charge $172. Has anyone utilized MDsave for such tests which are not typically covered by insurance?

No experience with MDSave, but insurance doesn’t pay got it.

 

[SheitlQueen]

I never had a calcium scan, but I used to have high calcium levels in my blood due to hyperparathyroidism. It can lead to depositing of calcium into the heart and other places in your body you don't want it. Have you been checked for it?

 

[Katsmeow]

So my angiogram is scheduled for 11 hours from now. I did talk to someone who called to go over instructions with me. She did say I couldn’t use the computer for 24 hours after procedure. I do think I can use my phone to read though.

I never had a calcium scan, but I used to have high calcium levels in my blood due to hyperparathyroidism. It can lead to depositing of calcium into the heart and other places in your body you don't want it. Have you been checked for it?

I actually get my blood calcium every 6 months because I take Prolia and this test is a requirement before hand. Anyway, my blood calcium is completely normal.

 

[WFL]

covert blood sugar problems

One parent had CVD early in life so I've always been interested. The other side of the family has a lot of diabetes so I've tried to keep up with that too. I thought it was interesting that the A1c test wasn't mentioned on this thread.

Here's some details about how diabetes develops:
https://www.bloodsugar101.com/type-2-development-patterns

TLDR:
"Just how poor a screening test the fasting glucose test is is shown by the fact that 67% of the people who progressed to diabetes as measured by the glucose tolerance test did so without ever developing impaired fasting glucose.
[/I]

One example that lends support to this idea is that many diabetics have retinopathy at the diagnosis, but retinopathy is a long term complication of diabetes.

If you have an eye exam, you can ask about how "clear" your retinas are. Anything less than "crystal clear" or a non-zero CAC score or an A1c score above 5.6 indicate that you need more information about your blood sugar. One way to get that could be a CGM, or a regular blood sugar meter which is cheaper, a bit less convenient. You can even do a home Oral Glucose Tolerance Test if you like.

https://www.bloodsugar101.com/a1c-and-heart-disease
Heart attack risk more than doubles at blood sugar levels considered to be "prediabetic."

 

[aja8888]

I actually get my blood calcium every 6 months because I take Prolia and this test is a requirement before hand. Anyway, my blood calcium is completely normal.

This is surprising to me as my wife had semi-annual Prolia shots for years and never was asked to have a blood calcium test beforehand.

 

[eytonxav]

So my angiogram is scheduled for 11 hours from now. I did talk to someone who called to go over instructions with me. She did say I couldn’t use the computer for 24 hours after procedure. I do think I can use my phone to read though.






I actually get my blood calcium every 6 months because I take Prolia and this test is a requirement before hand. Anyway, my blood calcium is completely normal.

Good luck, hope the test goes well for you.

 

[boont]

Scan

I went for a calcium scan and about a week or so later I found a voice mail message on my phone.

It said, "Your calcium score was zero". At first I thought, why me? It sounded bad...zero. Like a test score,

But there was this long pause in the voice mail, then he said, "That's a perfect score."

Whew.

 

[Buckeye]

I had a calcium score scan done in Dec and it was zero. I am 64 and I have been a pescatarian since 1986.

I have a visit with my VA doc on Monday so I did labs this week. My cholesterol (total and LDL) are considered high and have been for a long time. The oldest info on my computer is from 2014 and my total cholesterol is 228. It was actually 282 in late 2016 (almost the same LDL as now but HDL was 79). My glucose, triglycerides, and HDL haven't changed much in the last 9 years. The scan and report was $100 at my local hospital. It cost me another $160 to become a patient of my husband's doctor so I could get an order for the scan.

Total Cholesterol - 249
LDL - 177
HDL - 71
Triglycerides - 61
Glucose - 91
BMI of 26.8, just into the Overweight category although I've lost 25 pounds since the beginning of COVID.
Normal BP without meds.
A1c - 5.2

 

[badatmath]

Katsmeow I don't want to sound nosy but I don't see where you checked back in after this. Hope all is well.

 

[Katsmeow]

Katsmeow I don't want to sound nosy but I don't see where you checked back in after this. Hope all is well.

Thanks for asking. I was actually really tired (more than I expected) for a couple of days after the angiogram. And, then my wrist ached for several days (they went in through the wrist artery) so I didn't use the computer much.

Good News - I did not need any stents. Also, I did not have an allergic reaction to the contrast media.

Bad News - I do have 4 blockages!

I have a 60% blockage in the LAD. It is in the upper part but not right at the top. I have a 60% blockage in the left circumflex artery -- similar upper area but not at the top.

I have two blockages in the right coronary artery. One is in the upper part and was 30 to 40%. The other was lower down and was 40%.

While the procedure was going on someone came out and told DH that the angiogram was taking longer than usual. At one point, DH said that they said they were going to get another "tool" to use. At another point, DH told me that they instead said they were going to do another pressure to check something. He doesn't actually recall exactly what they said. Basically they were going to do something additional to find out more information.

I didn't know about this until after we left so I couldn't ask doctor about it. He did speak to me but given I had been under the medication for the procedure he kept it short and basically told me about the blockages and told me when to see him again (I have an appoint next week).

From researching on the internet, I think it is possible that they might have been measuring the blood flow to see if the larger blockages were impeding any of my blood flow. Anyway, will find out next week.

Rationally, I know that if blockages are like that and not impeding blood flow that medical treatment is fine and generally preferable to a stent. At the other hand, it definitely feels weird to know that these blockages (especially the two at 60%) are just sitting there. On the third hand, I realize I could have a plaque rupture anywhere that could cause a heart attack and that it could well not be at the site of any of the blockages. So the best thing is to reduce the chance of that happening.

I've definitely had a crash course in researching heart disease and LDL and medication, etc. In a way, I do feel better now. I recognize that the modern combinations of meds can do amazing things to reduce risk. So I do feel that between medication and lifestyle stuff that there is a lot to be done here to reduce my risk of an adverse event. In the past, I did do well on the lifestyle stuff and kind of slacked off the last 3 years. So, it is not that hard to get back in that mindset.

I do feel that I have genetic factors that impact this and it isn't just lifestyle. I am adopted and some of those genetic factors I only learned about 6 years ago though.

The other thing is sort of a hard thing to wrap my head around. I've always thought of myself as healthy. Until 3 years ago, I took no regular medications of any kind. I went to a doctor's office once and saw I didn't fill any medications and said I needed to bring a list of them. I told her I had none which surprised her. Then I got the osteoporosis diagnosis and I do Prolia for that. And, now this. It reminds me somewhat of so many people here talking about being healthy in terms of their plans for the future. I sort of feel like I was "healthy" and now, suddenly, I'm not. Just an odd feeling....

Anyway -- I have lots of questions for the doctor that I will look forward to asking him next week.

 

[Buckeye]

Could Prolia side effects be contributing to your current cardiovascular health issues?

 

[bmcgonig]

You might be interested in listening to Peter Attia’s latest podcast. They talk about, among many other cardiac related issues, when it is deemed necessary/useful to stent etc.

Best of luck!

 

[braumeister]

HDL - 71
Triglycerides - 61
Glucose - 91
A1c - 5.2

These are the numbers I care about for myself, and I consider all yours to be good. The most important thing IMHO is the Trig/HDL ratio, which just needs to be less than 3, the lower the better. Yours being 0.85, I wouldn't be worried about anything.

 

[Buckeye]

These are the numbers I care about for myself, and I consider all yours to be good. The most important thing IMHO is the Trig/HDL ratio, which just needs to be less than 3, the lower the better. Yours being 0.85, I wouldn't be worried about anything.

I totally agree with you.

I had my scheduled visit with my Dr. yesterday and she, again, recommended a statin because of my elevated LDL. She said it's an indicator of inflammation and the statin would be anti-inflammatory (which I understand to be true). I already knew the answer but I asked her whether I had any other indicators of inflammation. "Well, no, you don't." "Are you really happy with my other numbers, especially my triglycerides?" "Well, yes." They are typically under 80 but they were really low this time.

I also mentioned my zero calcium score. "Well, are you going to do a scan every year to check your coronary arteries?" she asked. I mentioned I was 64 years old and I'd had high LDL (especially since the acceptable number seems to go down every year) for quite a few years and, therefore, wouldn't she have expected to see my calcium score at least SOMEWHERE above zero if the elevated LDL (basically, alone) was causing any issues with my coronary arteries? "Well, yes." The push for statins is amazing but she knows from our prior discussions I won't be taking them. She's probably obligated to push for them since they are standard of care.

She's always open to discussing things which I like about her and she's always open to my "can we try this, and then check that" suggestions. I have been lucky to have had her as my PCP for 5+ years even though I get my care at the Orlando VA. My husband has both a civilian and VA doc and I think he's been through 6 or 7 VA PCP's in the last 5 years.

 

[Buckeye]

You might be interested in listening to Peter Attia’s latest podcast. They talk about, among many other cardiac related issues, when it is deemed necessary/useful to stent etc.

Best of luck!

He has some excellent podcasts. I haven't listened to him in awhile. I don't know how he turns out so much in depth material so often. I don't think the guy ever sleeps1

 

[Gremlin]

He has some excellent podcasts. I haven't listened to him in awhile. I don't know how he turns out so much in depth material so often. I don't think the guy ever sleeps1

He has a book that will be released sometime this week, I think. He is definitely a very busy guy!

 

[badatmath]

Hey, glad you got back to us. The blockages sound scary but now that they know about them they can be worked on.

The other thing is sort of a hard thing to wrap my head around. I've always thought of myself as healthy.

I totally get this part. I have added 4 pills for blood pressure in the last couple of months (and they still do not appear to work). That and a few other problems that have cropped up make me feel pretty decrepit even though logically I know I am not.

 

[bmcgonig]

He has some excellent podcasts. I haven't listened to him in awhile. I don't know how he turns out so much in depth material so often. I don't think the guy ever sleeps1

I find him very interesting. Hes definitely pro statin and would definitely be pushing a statin on you Buckeye [emoji16]. In actual fact he doesn’t really look at cholesterol but APoB, and takes statins himself just to optimize it, even though his bloods are good enough. Just an interesting point of view.

I also like his idea of a centenary decathlon. Not a real decathlon but approx 10 things that he want to be able to do at 100, or however old he becomes. Simple things like pick up his grandkids, get out of a swimming pool without a ladder, put a suitcase in the overhead in an airplane. His thesis is that since we lose muscle every year we need to practice/exercise for this stuff as soon as possible. So if you want to lift a 40lb carryon into the overhead at 90, you should be able to lift 60 now. I’m sure I have the numbers wrong but you get the idea.

Just listening to him has put a small fire under my butt to accomplish some health related things that I wouldn’t have thought about.

 

[Katsmeow]

Could Prolia side effects be contributing to your current cardiovascular health issues?

I do not think that is a concern at all. I think the main negative things going for me are some negative genetics that increase risk and the fact that for a good part of my life my eating and activity were very subpar. I have gotten much better at eating over the last 20 years or so but it was bad before that and the early part of the last 20 was better but not great. And, I have been sedentary most of my life. Yes, I did exercise consistently for several years pre-Covid. But, I think a lot of the damage was done long before that.

You might be interested in listening to Peter Attia’s latest podcast. They talk about, among many other cardiac related issues, when it is deemed necessary/useful to stent etc.

I actually just listened to it yesterday! I found his guest very, very helpful to many of the questions I've had. I've spent a lot of time recently trying to learn this stuff and still had questions and this answered many of them. In other cases it confirmed what I thought. Even though he is very pro CT angiogram, for example, he did allow as how it is not as valid in people with lots of plaque.

I am, honestly, not a fan of Attia in many ways (I think he is too quick to sign on to non-mainstream ideas that have not been proven to be scientifically valid. He takes studies at time and extends them far beyond where the actual evidence takes you). I do think he is good on some things and he does talk about some things that are interesting to me. And, I thought this cardiologist that he interviewed was very level headed and helpful. Well worth a listen.

I totally agree with you.

I had my scheduled visit with my Dr. yesterday and she, again, recommended a statin because of my elevated LDL. She said it's an indicator of inflammation and the statin would be anti-inflammatory (which I understand to be true). I already knew the answer but I asked her whether I had any other indicators of inflammation. "Well, no, you don't." "Are you really happy with my other numbers, especially my triglycerides?" "Well, yes." They are typically under 80 but they were really low this time.

I also mentioned my zero calcium score. "Well, are you going to do a scan every year to check your coronary arteries?" she asked. I mentioned I was 64 years old and I'd had high LDL (especially since the acceptable number seems to go down every year) for quite a few years and, therefore, wouldn't she have expected to see my calcium score at least SOMEWHERE above zero if the elevated LDL (basically, alone) was causing any issues with my coronary arteries? "Well, yes." The push for statins is amazing but she knows from our prior discussions I won't be taking them. She's probably obligated to push for them since they are standard of care.

The cardiologist I see commented to me that had my calcium score come out as zero and I had 181 LDL then it would have made sense to have a discussion about whether it made sense for me to take a statin. However, in the absence of a calcium score he would have felt it was absolutely important to take the statin.

One thing I have come to believe through the research I've done since I learned of my calcium score almost 2 months ago is that much of my concern about statins in the past was misplaced. I certainly wish now that when I took a statin off and on for a couple of years about 20 years ago, that I had continued to do it. I don't think I would be where I am now if I had. I think that I didn't really understand the benefits of statins and I over estimated my risk of side effects and didn't really under the reward/risk ratio on the statins.

I do think someone with high LDL and 0 calcium score is a difficult situation to be in. If it was me I might go and do some of the other tests such as ApoB and maybe hs-CRP, also LP(a) I had all of those about 4 years ago when my LDL was around 170. My ApoB was elevated (but not truly scary), my hs-CRP was elevated and my LP(a) is very low. But, let's say you did that and you were high on some of those then maybe a statin might make sense. On the other hand, it might say all those were fine.

I do know there are some people who don't have calcified plaque so have a 0 calcium score but do have soft plaque and still have a heart attack. However, my understanding is that is very rare.

 

[badatmath]

I wish I could remember where I read statins are not of benefit to women in the same way they are to men. Not to say I even believe but it was interesting to me at the time.

 

[jmmec]

I totally agree with you.

I had my scheduled visit with my Dr. yesterday and she, again, recommended a statin because of my elevated LDL. She said it's an indicator of inflammation and the statin would be anti-inflammatory (which I understand to be true). I already knew the answer but I asked her whether I had any other indicators of inflammation. "Well, no, you don't." "Are you really happy with my other numbers, especially my triglycerides?" "Well, yes." They are typically under 80 but they were really low this time.

I also mentioned my zero calcium score. "Well, are you going to do a scan every year to check your coronary arteries?" she asked. I mentioned I was 64 years old and I'd had high LDL (especially since the acceptable number seems to go down every year) for quite a few years and, therefore, wouldn't she have expected to see my calcium score at least SOMEWHERE above zero if the elevated LDL (basically, alone) was causing any issues with my coronary arteries? "Well, yes." The push for statins is amazing but she knows from our prior discussions I won't be taking them. She's probably obligated to push for them since they are standard of care.

She's always open to discussing things which I like about her and she's always open to my "can we try this, and then check that" suggestions. I have been lucky to have had her as my PCP for 5+ years even though I get my care at the Orlando VA. My husband has both a civilian and VA doc and I think he's been through 6 or 7 VA PCP's in the last 5 years.

Hi, I think you would appreciate this interview with Dr. Lustig - the best explanation on cholesterol levels:

https://youtu.be/C3rsNCFNAw8

 

[Buckeye]

I find him very interesting. Hes definitely pro statin and would definitely be pushing a statin on you Buckeye [emoji16]. In actual fact he doesn’t really look at cholesterol but APoB, and takes statins himself just to optimize it, even though his bloods are good enough. Just an interesting point of view.

I also like his idea of a centenary decathlon. Not a real decathlon but approx 10 things that he want to be able to do at 100, or however old he becomes. Simple things like pick up his grandkids, get out of a swimming pool without a ladder, put a suitcase in the overhead in an airplane. His thesis is that since we lose muscle every year we need to practice/exercise for this stuff as soon as possible. So if you want to lift a 40lb carryon into the overhead at 90, you should be able to lift 60 now. I’m sure I have the numbers wrong but you get the idea.

Just listening to him has put a small fire under my butt to accomplish some health related things that I wouldn’t have thought about.

I think he would put me on a statin because I can't remember if my other numbers would change his mind. I've never had ApoB tested so I don't know that number. It would be cool to have as many smart and interesting friends he has.

 

[Buckeye]

I do not think that is a concern at all. I think the main negative things going for me are some negative genetics that increase risk and the fact that for a good part of my life my eating and activity were very subpar. I have gotten much better at eating over the last 20 years or so but it was bad before that and the early part of the last 20 was better but not great. And, I have been sedentary most of my life. Yes, I did exercise consistently for several years pre-Covid. But, I think a lot of the damage was done long before that.



I actually just listened to it yesterday! I found his guest very, very helpful to many of the questions I've had. I've spent a lot of time recently trying to learn this stuff and still had questions and this answered many of them. In other cases it confirmed what I thought. Even though he is very pro CT angiogram, for example, he did allow as how it is not as valid in people with lots of plaque.

I am, honestly, not a fan of Attia in many ways (I think he is too quick to sign on to non-mainstream ideas that have not been proven to be scientifically valid. He takes studies at time and extends them far beyond where the actual evidence takes you). I do think he is good on some things and he does talk about some things that are interesting to me. And, I thought this cardiologist that he interviewed was very level headed and helpful. Well worth a listen.



The cardiologist I see commented to me that had my calcium score come out as zero and I had 181 LDL then it would have made sense to have a discussion about whether it made sense for me to take a statin. However, in the absence of a calcium score he would have felt it was absolutely important to take the statin.

One thing I have come to believe through the research I've done since I learned of my calcium score almost 2 months ago is that much of my concern about statins in the past was misplaced. I certainly wish now that when I took a statin off and on for a couple of years about 20 years ago, that I had continued to do it. I don't think I would be where I am now if I had. I think that I didn't really understand the benefits of statins and I over estimated my risk of side effects and didn't really under the reward/risk ratio on the statins.

I do think someone with high LDL and 0 calcium score is a difficult situation to be in. If it was me I might go and do some of the other tests such as ApoB and maybe hs-CRP, also LP(a) I had all of those about 4 years ago when my LDL was around 170. My ApoB was elevated (but not truly scary), my hs-CRP was elevated and my LP(a) is very low. But, let's say you did that and you were high on some of those then maybe a statin might make sense. On the other hand, it might say all those were fine.

I do know there are some people who don't have calcified plaque so have a 0 calcium score but do have soft plaque and still have a heart attack. However, my understanding is that is very rare.

Elevated hs-CRP would have been concerning to me. Mine was low the last time I tested it but that's been 10 years ago. Probably time to do it again. I'll see if I can talk my Doc into ordering it since we were talking inflammation wrt LDL level. I might even try to talk her into Apo(B). My husband had a scan done about 2.5 years ago at 71 y/o and his score was 3. His LDL runs very close (slightly less) to mine. His mother always had high cholesterol (no treatment) and lived to 95.

 

[Katsmeow]

So, I had the follow up with the cardiologist. More below, but basically we are going to redo my labs to see how the higher dosage of the statin is working and to see if I am at our target. If not, will need to change dosage and/or add another med.

But -- before I get into that -- I was absolutely gobsmacked by one thing. Essentially my coronary arteries are...different. Most people on the left have the left main artery with the left anterior descending artery (LAD) and the left circumflex. Then on the right they have the right coronary artery. They have more arteries, but those are the main ones. I am different. Apparently about 20% or so of people have an intermediate artery on the left side that is sort of in between the LAD and the left circumflex. I mentioned in a prior post that I had a 60% blockage in the left circumflex. This was because that was what was on the diagram I got after my angiogram. Printed diagram of the heart and that was what was marked. However, that blockage was actually in the intermediate artery which they don't show on the diagram.

Now about my left circumflex artery. I have one. But, it does not come from the left main artery. For me it comes from right coronary artery. Apparently about 1% of people have this and it is usually benign. Still, was just very surprising to hear.

I mentioned in the previous message that I thought that perhaps the cardiologist checked my blood flow during the angiogram. In fact, he did a Fractional Flow Reserve (FFR) to measure the blood flow to see if it is impeded. He said he did it because of the blockage in my LAD which is a more dangerous location. Basically, though, my flow was fine. He commented that it actually takes longer to do the FFR than it would take to do a stent. But, you don't want to do an unnecessary stent.

So, the good news was that my blood flow was fine. I have no exercise restrictions. Basically we are on the same page of wanting to see my LDL below 50. While many would say 70 was good enough I am convinced by the reading I've done that people have better outcomes below 50.

I am still glad I did the calcium scan. Without it, I would have had no idea that I had this level of plaque and needed to treat it so aggressively. My elevated LDL had mostly elicited advice to eat more carefully (which I do anyway). My primary care doctor last fall when my LDL went up to 181 did prescribe a low dose statin. That was certainly called for. However, I don't need a low dose statin with a goal of 70. In many cases, people never get to that level and it can take a long time to ramp up enough (if that is ever done). I need a high intensity statin and need a far more aggressive medication approach to try to quickly get this done.