High calcium score and angiogram

[sengsational]

I've been listening to Attia since his first podcast (heard him first on Tim Ferris, I think), and I didn't know until this latest episode that he's got a calcified artery. No wonder he's pro-statin! I've actually softened on the statins in recent years. While it's true that there were greedy pharma companies pushing them, and clueless doctors not monitoring for side effects closely enough, the formulations have improved, and doctors have had time to get their schtuff together with monitoring.

One thing in that episode that bothered me a little was how a zero calcium score might miss a calcification. I got a zero about 10 years ago and quit worrying about it, even though my lipids ain't great. Things are such with me that my heart will probably be the least of my problems when I depart.

 

[Katsmeow]

One thing in that episode that bothered me a little was how a zero calcium score might miss a calcification. I got a zero about 10 years ago and quit worrying about it, even though my lipids ain't great. Things are such with me that my heart will probably be the least of my problems when I depart.

Yes, that was interesting. It was basically because the sliced image they took could miss a relatively small calcification. Of course, if it remains just that one small place then probably not an issue. But, if I had a zero score when I was younger it definitely makes sense to retest periodically. Also, even if someone really does have a zero score today that can change over time....

Oh - about statins. I do think there are many more options now particularly to take a lower dose statin and combine it with other medication if need be. And, despite all we here about side effects not everyone has any. I've never had any of any kind. Of course, if they up the dosage that could change. But, I am confident that if it does they can find some other option that will work for me.

 

[JBTX]

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.

After years of hesitation, increasing cholesterol scores, then a CAC of 159 I finally did the statins. But also other changes.

I took plant sterol supplements and Benecol chews. Lost 10 lbs and cleaned up diet. LDL went from 180 to 120 in a month. Then doctor still recommended statin and put me on 10mg crestor. I split the pills to half or 5 mg. Next six months I lost another 20 lbs to get to a 25 bmi. My next cholesterol reading was 130 and LDL was 70. If you are statin hesitant 5 mg rovistatin gives you 70-80% of the benefit of 10mg with virtually no side effects.

My goal is down the road to do the CAC again and see if I can actually lower it, understanding that rarely happens.

 

[ER Eddie]

LDL is at best a very weak predictor of heart disease. There is no real relationship between (good) saturated fat and heart disease. Meat is not bad for you; this is based on poorly controlled epidemiological research. Meat is a health food; we've been eating it, and mostly it, for millions of years. These are all dietary myths. I have high LDL, eat mostly meat, and have a CAC score of zero. I can point you to large numbers of people who have the same profile. Don't buy into the mainstream narrative about nutrition. It's what got us here.

 

[RAE]

LDL is at best a very weak predictor of heart disease. There is no real relationship between (good) saturated fat and heart disease. Meat is not bad for you; this is based on poorly controlled epidemiological research. Meat is a health food; we've been eating it, and mostly it, for millions of years. These are all dietary myths. I have high LDL, eat mostly meat, and have a CAC score of zero. I can point you to large numbers of people who have the same profile. Don't buy into the mainstream narrative about nutrition. It's what got us here.

Completely agree with you, Eddie. There is so much misinformation out there about saturated fats and cholesterol, it's absurd. Like you, I eat red meat and eggs often, and my lipid numbers are just fine. The most important thing anyone can do is reduce (or eliminate, if possible) ultra-processed foods from your diet. That includes all of the industrial seed oils, sugary drinks (cut way back on all sugar consumption), things made with flour or other finely-ground grains (bread, cookies, doughnuts, crackers, etc, etc). Humans are not designed to consume that gunk. Eat mostly whole real foods. Attia is okay on some things, but he makes things way too complicated, IMO.

 

[Katsmeow]

Completely agree with you, Eddie.

LDL is at best a very weak predictor of heart disease.

I guess I can't stop people hijacking my thread about my health, but it would have been nice to have at least given a nod to my update about my health results... Oh, well.

I don't really want to get into a debate about the issues of LDL and heart disease. You can't convince the people you can't convince. And would just as soon that debate was in some other thread.

Anyway, I just got back my new lipid panel, 6 weeks after increasing my rosuvastatin from 10 mg to 20 mg. LDL is now 59. HDL is back to 50 and trigs under 100 (both typical for me). That was a very good result. But, it isn't where I want to be which is under 50. So I expect either adding in another med or increasing the statin. We'll see.

 

[Masquernom]

I was very happy to see your results. I too have a high calcium score. I have a stress test next week. Looking forward to the results.

How did you get the test you got instead of having to go through a stress test first?

 

[eytonxav]

I guess I can't stop people hijacking my thread about my health, but it would have been nice to have at least given a nod to my update about my health results... Oh, well.

I don't really want to get into a debate about the issues of LDL and heart disease. You can't convince the people you can't convince. And would just as soon that debate was in some other thread.

Anyway, I just got back my new lipid panel, 6 weeks after increasing my rosuvastatin from 10 mg to 20 mg. LDL is now 59. HDL is back to 50 and trigs under 100 (both typical for me). That was a very good result. But, it isn't where I want to be which is under 50. So I expect either adding in another med or increasing the statin. We'll see.

It's great your HDL went up while LDL went down from increased statin dose. Often times that increased dose can also lower HDL. One really weird phenomenon with me is that after beginning a multi-vitamin, my life long low HDL actually went from the 30s to the mid 40s.

 

[bmcgonig]

I guess I can't stop people hijacking my thread about my health, but it would have been nice to have at least given a nod to my update about my health results... Oh, well.

I don't really want to get into a debate about the issues of LDL and heart disease. You can't convince the people you can't convince. And would just as soon that debate was in some other thread.

Anyway, I just got back my new lipid panel, 6 weeks after increasing my rosuvastatin from 10 mg to 20 mg. LDL is now 59. HDL is back to 50 and trigs under 100 (both typical for me). That was a very good result. But, it isn't where I want to be which is under 50. So I expect either adding in another med or increasing the statin. We'll see.

Supposedly a very effective option if you wish to get it down further

https://www.health.harvard.edu/blog...en-to-consider-pcsk9-inhibitors-2020060819986

 

[Katsmeow]

I was very happy to see your results. I too have a high calcium score. I have a stress test next week. Looking forward to the results.

How did you get the test you got instead of having to go through a stress test first?

I did do a stress test first along with a carotid artery ultrasound and an echocardiogram. They were all fine although my EKG was somewhat abnormal. This was found many years ago and is apparently a variation that is "normal for me" although an EKG will flag it as abnormal. In fact the computer reading of the EKG said I had a prior heart attack (although I did not have one).

Anyway, I was concerned even with those results since I was having shortness of breath on mild exertion. The impression I had from the cardiologist was that he considered going straight to the angiogram without doing the prior tests. But, when I expressed concern after them he very quickly recommended the angiogram. He gave some other options as well. I really wanted to do a CT angiogram but they often give false positive results when someone has as high a calcium score as I had. While I know the angiogram was invasive I'm glad I have it as it gave me info I would not have otherwise had. And, the cardiologist was not stent happy and didn't give me one once he checked and realize my blood flow is fine.

It's great your HDL went up while LDL went down from increased statin dose. Often times that increased dose can also lower HDL. One really weird phenomenon with me is that after beginning a multi-vitamin, my life long low HDL actually went from the 30s to the mid 40s.

That is interesting! I got lab work at the end of December when I was taking the 10mg statin. At that time my HDL went down from 50 to 45. But the cardiologist increased the statin to 20 mg but my HDL went up which I was happy to see.

Supposedly a very effective option if you wish to get it down further

https://www.health.harvard.edu/blog...en-to-consider-pcsk9-inhibitors-2020060819986

Those are amazing drugs. Most insurers require pre-authorization to use them and you have to fail getting your LDL down far enough with other medications. (They are expensive drugs). I think the 2 options the doctor might do are either increase my statin to 40 mg (which is I think the max) or add another medication such as ezetimibe. That is an expensive medication that usually doesn't have side effects so I am kind of hoping the doctor tries that. We'll see.

 

[RS53576GG]

Kat,


Thanks for the update on your angiogram results. It sounds like you're in pretty good shape. I mentioned in a thread last year that I had three stents done in 2021 which I believe you commented on. I have the extra artery as well. It's called the Ramus Intermedius and it's present in 15-20% of the population. It can vary in size from fairly small to the same size as the LAD and LCx.

I think having 60% obstruction isn't a huge problem because your heart arteries have lots of capacity. Cardiac docs don't usually mess around with your heart arteries unless they are at least 70-75% obstructed.

I think you've learned some important things. First is that having a Ramus Intermedius is a nice thing to have. Second is that your inner artery walls let LDL pass through and lodge behind them where it can accumulate and eventually cause a problem. I imagine there are people who have high cholesterol and don't have plaque problems because their inner artery walls don't let cholesterol pass through them. Unfortunately you and I aren't part of that lucky group. The good news is that now that it's known that your inner artery walls are leaky (for lack of a better description) you can take medications that will push your LDL very low. My LDL was around 110 and now that I'm taking medications it's down to 37. My total cholesterol was around 170 and now it's 108. This should reduce the likelihood of plaque building up in my artery walls and causing a problem.

Hopefully you'll have a similar result. As time passes the plaque that's already leaked through your inner artery walls should dry out and eventually turn into calcium. I have no idea how long this takes or whether it happens to everyone every time. My cardiac calcium test score was 21 so the plaque that had built up in my arteries over many years doesn't seem to have dried out very much and turned into calcium. In your case a good amount of plaque has already calcified so maybe the remaining plaque will do the same. I have stents in the regions where my LAD, LCx and Ramus Intermedius were obstructed so those regions shouldn't present me with any problems in the future. The rest of my arteries are absolutely clear. Now that I'm on cholesterol reducing medications the odds of me having a problem in the future are probably fairly low. It seems like you should be in the same situation. LDL will no longer collect in your artery walls and the existing plaque will gradually calcify and become benign.

I think you did the right thing in having an angiogram done. Now you know exactly what your situation is and can get things in order so you will hopefully never have a heart attack. How many people can say the same thing?

 

[eytonxav]

I am not sure if this has been mentioned in this thread, put just saw this article indicating that CRP might be a better indication of heart disease vs ldl cholesterol:https://www.health.harvard.edu/heart-health/c-reactive-protein-test-to-screen-for-heart-disease

I don't think Dr has ever testing this on me, but I am going to ask at my next visit.

 

[Katsmeow]

Heard from Doctor's office and he increased my statin to 40 mg.
I've been doing it a few days and so far no problems.
We'll see how it goes. Wants me to retest in 2 months.

I am not sure if this has been mentioned in this thread, put just saw this article indicating that CRP might be a better indication of heart disease vs ldl cholesterol:https://www.health.harvard.edu/heart-health/c-reactive-protein-test-to-screen-for-heart-disease

I don't think Dr has ever testing this on me, but I am going to ask at my next visit.

I had this tested a few years ago. Mine was elevated then but so was LDL (not high enough for my primary care doc then to put me on statins. At the time, I thought I was just barely over the normal range. However, I have since read that what labs report as the normal range is really high so my barely high level was actually pretty high.

I just read something yesterday on Twitter of a new study that found that for people who are already being treated with statins and have a low LDL as a result that hs-CRP is a better predictor of adverse events than just LDL. One doctor responding asked basically what are we supposed to do if someone's LDL is below 50 and they still have high hs-CRP.

I think one problem with hs-CRP is that a lot of things can cause it to be elevated. I commented to the cardiologist about my result a few years ago and he was fairly dismissive about it. His comment was that it was mostly good for getting people sent to cardiologists.... That said, I could see looking at it but being aware of its limitations.

 

[Katsmeow]

So I did the retest after taking 40 mg rosuvastatin for 2 months. I was happy to find that my LDL went from 59 to 45. My goal was to be under 50. I had a small increase in VLDL but my overall non-HDL Cholesterol went down and is now under 70.

So I started at 181 LDL with no statin. 10 mg rosuvastatin got me to 80. 20 mg got me to 59 and 40 mg got me to 45.

I have never had any side effects from the rosuvastatin at any dosage.

We are getting ready to move 1500 miles away in 2 weeks so one of my main priorities when we get to northern Delaware will be finding a cardiologist who is in line with my goals.

 

[MuirWannabe]

Good for you. Been following this thread. I want to thank you for being so open and sharing your experience and what you’ve learned. It has helped me.

A couple months ago I received a high CAC score of 198. Puts me in moderate risk category for age 60. I’ve been on rosuvastatin 20mg for years. LDL has been kept in the 80’s and 90’s.
After getting the CAC score I jumped to a 40mg dose. Just got my blood work back and LDL is at 53. Not below 50, but I’m pretty happy with that number.

Anyway, wishing you the best and just wanted to say thanks.

 

[Chuckanut]

So I started at 181 LDL with no statin. 10 mg rosuvastatin got me to 80. 20 mg got me to 59 and 40 mg got me to 45.

Statins are interesting. The first small dosage gives the most reduction in cholesterol. Each doubling after that reduces cholesterol by lesser amounts. I believe the British have something called the 6% rule. After the fist minimum dose is taken, each doubling of the dose after that knocks another 6% off the total LDL count.

This article explains it better than I can.

https://primarycarenotebook.com/simplepage.cfm?ID=x20130329085000685340

“if the dose of a statin is doubled then there is an approximate 6% increase in LDL lowering efficacy by doubling the dose - the so-called 6 percent rule

for example
rosuvastatin statin 5mg produces an approximate LDL reduction of 40% - if the dose of rosuvastin is doubled to 10mg then there is an approximate 46% LDL reduction expected with this dose of rosuvastatin
pravastatin 20mg produces an approximate LDL reduction of 24% - if the dose of pravastatin is doubled to 40mg then there is an approximate 30% LDL reduction expected with this dose of pravastatin

the "6 percent rule" holds approximately for all statins (1,2)


Reference:

J Am Coll Cardiol. 2003;42(2):398-399
Personal opinion - Jim McMorran (29/3/13). GP with Specialist Interest in Diabetes and Lipids (Coventry PCT) and Editor GPnotebook.
Related pages:

Efficacy of different statin drugs”

 

[badatmath]

Statins are interesting. The first small dosage gives the most reduction in cholesterol. Each doubling after that reduces cholesterol by lesser amounts. I believe the British have something called the 6% rule. After the fist minimum dose is taken, each doubling of the dose after that knocks another 6% off the total LDL count.

This article explains it better than I can.

https://primarycarenotebook.com/simplepage.cfm?ID=x20130329085000685340

“if the dose of a statin is doubled then there is an approximate 6% increase in LDL lowering efficacy by doubling the dose - the so-called 6 percent rule

for example
rosuvastatin statin 5mg produces an approximate LDL reduction of 40% - if the dose of rosuvastin is doubled to 10mg then there is an approximate 46% LDL reduction expected with this dose of rosuvastatin
pravastatin 20mg produces an approximate LDL reduction of 24% - if the dose of pravastatin is doubled to 40mg then there is an approximate 30% LDL reduction expected with this dose of pravastatin

the "6 percent rule" holds approximately for all statins (1,2)


Reference:

J Am Coll Cardiol. 2003;42(2):398-399
Personal opinion - Jim McMorran (29/3/13). GP with Specialist Interest in Diabetes and Lipids (Coventry PCT) and Editor GPnotebook.
Related pages:

Efficacy of different statin drugs”

Doesn't seem worth it to me?! IDK I don't need them as yet so I am sure my opinion could change. But a lot of people who have first heart attacks don't have high cholesterol anyway.