High calcium score and angiogram

[Katsmeow]

Another calcium scan thread. When there was the last big one last year, I advocated for calcium scans in certain situations. I was true to my argument recently and did advocate for one for me.

So a few months ago my total cholesterol came back as 237 and LDL was 181. Trig was 122 which is a little higher than normal, HDL was 50 a little lower than normal. Doctor told me to take 10 mg of Rosuvastatin. I did for a couple of months and then suggested to him that I do a calcium scan which he thought was a great idea.

I had a history of borderline high LDL. About 20 years ago I took a statin for awhile, then quit. Since then my LDL ranged from a low of 136 to high of 180. Mostly it was in the 150s. When it hit 180 in 2018, doctor looked at it a year later and it was in the 150s so he didn't suggest meds.

Anyway, I did the calcium scan was utterly shocked to get a score of 637 which for me is the 95th percentile! Honestly, that percentile kind of shook me up.

My diet is not overall bad. I could eat more veggies and fruit. But, I eat no beef for over 20 years. I eat pork (mostly bacon on a sandwich or something) maybe one a month. I have eaten an ounce of nuts nearly every day for many years. My saturated fat for the last few years has been around 12% of calories, sometimes a little lower or higher. That is mostly cheese. My added sugar is low, under 10% of calories. (I've recorded what I eat daily for over 8 years).

I don't smoke or drink. Family history is mostly OK. No parent had early heart disease. I am an adoptee but knew my birth mother. She died in her 90s for a non-heart related reason. She had high cholesterol and had a pacemaker put it when she was around 91. My birth father died before I found him but his family says he had no heart problems (died of Alzheimers disease).

After 2 months of the statin my LDL has fallen to 80. When the calcium scan came in my primary care doc sent me to a cardiologist. He did a carotid scan (no evidence of any blockage at all), chemical nuclear stress test (normal), and echocardiogram (normal). However, he did warn me that the nuclear stress test would only find blockages of 70% or higher. I also asked him about what higher blockages it would miss and he said between 10% and 20% of them. Cardiologist also increased the statin to 20 mg as he wants my LDL below 70 and preferably 50. He doesn't think the 20 mg will do it but we are trying it to see.

I have no chest pain, however, in the past 6 months or so I've noticed I get out of breath with very mild exertion. For example, the other day I had to sit down and rest after I took clothes out of the dryer and carried them to the bedroom (did not fold them, just carried them). It does seem to DH and I both that I am getting more out of breath lately.

On the other hand, that could be due to my being out of shape. Pre-Covid and pre house remodeling (right before Covid) I exercised regularly. When I was sitting at home, though, I got out of the habit and have been very sedentary for the last 3 years. As a result I am now about 20 pounds over my normal weight which I slowly gained over the last 3 years.

On the one hand, I had "good" test results and the shortness of breath could be from lack of exercise. On the other hand, my calcium score was at the 95th percentile. The report found 208 in the left anterior descending artery, 342 in the right coronary artery and 87 in the posterior descending artery.

Cardiologist gave me several options from waiting to see if I had difficulty (increased symptoms) when I start exercising again, to taking a medication for a month that might help determine where the shortness of breath came from, to a CT angiogram, to a regular angiogram. After discussing all of these and the pros and cons, I am going to have an angiogram in a few days.

Overall, I am glad I did the calcium scan. I realize it doesn't find the problems for everyone but my risk with the calcium score is far higher than my risk without having done it.

FYI here is the link to the calculator where you can model the risk both with and without the calcium scan. Without the calcium score my 10 year risk for a CHD event would be 3.7%. With the calcium score, it is 10.1%. (This is the risk before medication).

https://www.mesa-nhlbi.org/MESACHDRisk/MesaRiskScore/RiskScore.aspx

Using my medicated numbers (when I was taking the 10 mg) my risk with the calcium score is 8.1% and without the calcium score is 3.1%.

I am a little nervous about the angiogram. I've read all about it and know I am a low risk person for it. I do have to medicate before hand as 45 years ago I got hives from contrast media. But, I think this will give me the best information and given my calcium score and my shortness of breath I would rather know that be left in limbo.

 

[badatmath]

I had an angiogram in Nov it was quick.

I was a little nervous the wrist wound would open but it did not. They put pressure on it with a bracelet and release air slowly over the course of an hour or 2 before they called it good. I had had a blood thinner shot the day before so I think I might haven been a little more bleed-y than normal. The bruises were pretty darn colorful.

I was admitted for high blood pressure so they were doing ALL THE THINGS to see what was going on. Which accordign to them, was nothing but genetic bad luck.

 

[Dash man]

I don’t see a link.
My calcium score was ~1,031 when I had it done about eight years ago. I get regular checks with my cardiologist and so far so good. I was originally told I had a 95% chance of a cardiac event within five years. I rarely beat the odds with anything, but this is a good one to beat.

 

[Katsmeow]

I don’t see a link.
My calcium score was ~1,031 when I had it done about eight years ago. I get regular checks with my cardiologist and so far so good. I was originally told I had a 95% chance of a cardiac event within five years. I rarely beat the odds with anything, but this is a good one to beat.

Oops... I edited the post to put in link but here it is also:

https://www.mesa-nhlbi.org/MESACHDRisk/MesaRiskScore/RiskScore.aspx

I do remember reading your story and knew that kind of thing was possible. I read a letter to one of those ask a doctor sites where someone had a calcium score over 3000 (he was 80 years old I think). He had an angiogram and everything was clear. The response told him he should look into the other non-cardiac things that can cause deposits of calcium. Thought that was interesting. I gathered those things are rare though.


I just felt that with the high score and the shortness of breath (which could be nothing or something) I would go the route most likely to get me the most information. Most of the other options were ones that would result in an angiogram anyway if anything turned up. And, if nothing turned up, well I would still be in iimbo.

 

[Aerides]

I agree pursue all the testing, and then talk with both your Cardio and Primary about a comprehensive plan for exercise, which seems to be missing, and alone could result in shortness of breath. Once cleared for that, start tracking and slowly increasing your activity.

 

[braumeister]

Anyway, I did the calcium scan was utterly shocked to get a score of 637 which for me is the 95th percentile! Honestly, that percentile kind of shook me up.

Something often overlooked is that although a somewhat high calcium score like that has a high relative risk (relative to a zero score), the absolute risk of a major coronary event is still small.

Compare these four risk profiles. Upper left is a zero score, upper right is between 1 and 100, lower left is between 101 and 300, and lower right is over 300. This is based on a paper in the NEJM.

 

[bloom2708]

Eat less meats of all kinds and dairy of all kinds and eggs of all kinds. Dump oils of all kinds.

Eat mostly whole/minimally processed plant foods.

Sometimes a scare can be good. Drop that 20+ pounds. Start exercising again.

 

[Accidental Retiree]

I was huffing and puffing early in the games when I started playing pickleball in November of last year. I’d just started doing some cardio Silver Sneakers “live” via Zoom classes the month before, and I was really out of shape.

My most recent bloodwork numbers were similar to yours. No statins so far and no cardiac calcium test.

I gave pickleball a rest in December but continued with 5-7 days/week cardio and other Silver Sneakers exercises, and when I returned to pickleball in mid-January, I kept my breath and have been able to keep playing for over an hour.

The change was amazing!

Yesterday I restarted pickleball classes with the teacher I had in November, and at one point in our game, she exclaimed, “You’re running!”

Results keep me going.

Find an exercise level to get yourself started back on cardio fitness, something you’ll stick with.

 

[ivinsfan]

Eat less meats of all kinds and dairy of all kinds and eggs of all kinds. Dump oils of all kinds.

Eat mostly whole/minimally processed plant foods.

Sometimes a scare can be good. Drop that 20+ pounds. Start exercising again.

I love these kind of posts, Did you read what Kats said about her diet? The old saw that heart issues are due to diet doesn't hold much water anymore....

 

[bloom2708]

I love these kind of posts, Did you read what Kats said about her diet? The old saw that heart issues are due to diet doesn't hold much water anymore....

Sure. All just bad luck and/or randomness. Nothing to do with what people eat and drink.

If it is bad luck or randomness or both, then there is no course correction for anyone. Accept the bad luck and randomness. Sounds like 2023.

Or double down and eat more meat and cheese and eggs. Maybe the bad luck will just suddenly turn like at the casino.

 

[MarieIG]

I agree pursue all the testing, and then talk with both your Cardio and Primary about a comprehensive plan for exercise, which seems to be missing, and alone could result in shortness of breath. Once cleared for that, start tracking and slowly increasing your activity.

^^^^ This.

 

[athena53]

I love these kind of posts, Did you read what Kats said about her diet? The old saw that heart issues are due to diet doesn't hold much water anymore....

It's a factor, probably not as much as they used to think it was. I listen to Dr. Peter Attia podcast interviews with cardiologist and other researchers on cholesterol and it's so much more complicated than the 4 numbers (HDL, LDL, Triglycerides, Total) most people monitor. I have a friend with very good numbers who's on a keto diet. He eats eggs, nuts and animal fats freely. In a recent episode Dr. Attia said that we may have been overlooking the major effects of stress on cardiac health and it might outweigh diet as a factor.

Excess weight does add to your risk of heart attack and puts a strain on your heart, your hips, your back....Pick up a 20-lb. child and walk upstairs carrying them and tell me you don't feel anything. Now imagine doing that all day.

I'm 70 and I've also got shortness of breath and do everything "right"- BMI under 20, over an hour of low-impact cardio every day, rarely eat meat, low BP (no effort in my part- it just is). I passed a treadmill test with flying colors and my calcium score was 1. I have mitral valve regurgitation and my cardiologist tells me it's a Stuff Happens thing- nothing I did.

You really need to change the things you can, and keep an eye on the whole picture.

 

[Katsmeow]

Yes, I plan to get back to the exercise. I know what to do just need to do this test to make sure it is all safe to do it.

I had an angiogram in Nov it was quick.

I was a little nervous the wrist wound would open but it did not.

I haven't got my post angiogram instructions yet but I read online that said nto to use a computer for 24 hours. I mostly sit at a desk at home and use a keyboard. So think I will be reading a lot for 24 hours.

Something often overlooked is that although a somewhat high calcium score like that has a high relative risk (relative to a zero score), the absolute risk of a major coronary event is still small.

The MESA calculator which I linked showed my risk with my high LDL and calcium score was over 10% which doesn't seem like a lot but seems like it to me when I apply it to myself. High enough that I want to get it down as much as I can.

Eat less meats of all kinds and dairy of all kinds and eggs of all kinds. Dump oils of all kinds.

Eat mostly whole/minimally processed plant foods.

Or double down and eat more meat and cheese and eggs. Maybe the bad luck will just suddenly turn like at the casino.

Honestly this is kind of ... Well let's just say it makes assumptions about what I eat. I haven't eaten beef in over 20 years. I eat pork maybe once a month at most (as it happens I've had none in the last 3 months). I often don't eat any chicken or fish for a few days. (I was a vegetarian for two years in the past). I overall eat a much lower saturated fat diet than most people. During the last 2 months I've eaten reduced fat feta cheese a few times. Even before that, most days I didn't eat much if at all.

FWIW, I do not believe that all oils are bad. I think olive oil, for example, is fine. And research supports the healthfulness of a Mediterranean diet which is not a no fat diet.

I talked to the cardiologist about my diet and he said it was fine and, in fact, may have helped me to have not already had an event.

 

[Dash man]

Yes, I plan to get back to the exercise. I know what to do just need to do this test to make sure it is all safe to do it.




I haven't got my post angiogram instructions yet but I read online that said nto to use a computer for 24 hours. I mostly sit at a desk at home and use a keyboard. So think I will be reading a lot for 24 hours.



The MESA calculator which I linked showed my risk with my high LDL and calcium score was over 10% which doesn't seem like a lot but seems like it to me when I apply it to myself. High enough that I want to get it down as much as I can.





Honestly this is kind of ... Well let's just say it makes assumptions about what I eat. I haven't eaten beef in over 20 years. I eat pork maybe once a month at most (as it happens I've had none in the last 3 months). I often don't eat any chicken or fish for a few days. (I was a vegetarian for two years in the past). I overall eat a much lower saturated fat diet than most people. During the last 2 months I've eaten reduced fat feta cheese a few times. Even before that, most days I didn't eat much if at all.

FWIW, I do not believe that all oils are bad. I think olive oil, for example, is fine. And research supports the healthfulness of a Mediterranean diet which is not a no fat diet.

I talked to the cardiologist about my diet and he said it was fine and, in fact, may have helped me to have not already had an event.

Many plant based foods have a lot of fructose in them, which my digestive system cannot tolerate. I’m also lactose intolerant, but can handle some hard cheeses and butter. So I eat a lot of meat and eggs, but mostly lean cuts of meat (except occasional bacon [emoji39]). I also take fish oil which keeps my triglycerides down and reduces inflammation.

 

[athena53]

I love these kind of posts, Did you read what Kats said about her diet? The old saw that heart issues are due to diet doesn't hold much water anymore....

Actually, it does, but not for the reasons you think. Read either or both of Dr. Robert Lustig's books, "Fat Chance" and "Metabolic" or look up metabolic syndrome. Carbs, it seems, are a worse villain than most fats, and sugar (or worse, high-fructose corn syrup) is in EVERYTHING.

From Wikipedia:

"Metabolic syndrome is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL).

Metabolic syndrome is associated with the risk of developing cardiovascular disease and type 2 diabetes. In the U.S., about 25% of the adult population has metabolic syndrome, a proportion increasing with age, particularly among racial and ethnic minorities."

 

[ivinsfan]

Sure. All just bad luck and/or randomness. Nothing to do with what people eat and drink.

If it is bad luck or randomness or both, then there is no course correction for anyone. Accept the bad luck and randomness. Sounds like 2023.

Or double down and eat more meat and cheese and eggs. Maybe the bad luck will just suddenly turn like at the casino.

Genetics isn't random last time I looked.....I'm not going to debate with you.. should you eat a bag of sugar no.

 

[ivinsfan]

A53...one thing I have noticed shopping at Aldis is that they don't use the HFCS...

 

[Katsmeow]

"Metabolic syndrome is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL).

FWIW, I don't have this. I might now, with the extra 20 pounds meet the abdominal criteria (35 inches waist for women). Pre Covid I did not meet it but I might now. I don't have high triglyderides, low HDL (it has been lowered a little by the statin but was OK pre that), increase blood pressure (mine was 114/75 just last week), or elevated fasting blood sugar. That said I personally believe that heart problems are affected both by added sugar and by saturated fat. This is why I've tracked both of them for years.... But, I don't really think that diet is the main driver. I think that genetics are more important. I do think diet can help or hurt.

 

[bmcgonig]

Did he explain why a real angiogram is better than a CT angiogram? Just wondering.

 

[eytonxav]

From Wikipedia:

"Metabolic syndrome is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL).

Metabolic syndrome is associated with the risk of developing cardiovascular disease and type 2 diabetes. In the U.S., about 25% of the adult population has metabolic syndrome, a proportion increasing with age, particularly among racial and ethnic minorities."

That would be me and have had that hanging over my head for a long time, plus a family history of heart disease and I am a type 2 diabetic. I am on 10 mg of Rouvastatin which as driven my LDL into the 50s. I also take lisinopril for blood pressure. I've had a calc scan a few times and it was negligible, although the last one was maybe 5 years ago. I put my numbers in the calculator using the old calc score with my current other numbers and came up with a 4.4% risk. I am not sure I should feel safe or not.

 

[Katsmeow]

Did he explain why a real angiogram is better than a CT angiogram? Just wondering.

He did give this option. However, the high calcium I have makes it harder to read the CT angiogram to find blockages. The calcium creates shadows, for example. I did some research on this and found out that many places won't even do a CT angiogram if your calcium score is above 400. Others will but warn you of the risk it will miss stuff.

 

[badatmath]

I don't think they told me not to type but I probably would not remember. I seem to think it was like don't lift xx lbs.

 

[bmcgonig]

He did give this option. However, the high calcium I have makes it harder to read the CT angiogram to find blockages. The calcium creates shadows, for example. I did some research on this and found out that many places won't even do a CT angiogram if your calcium score is above 400. Others will but warn you of the risk it will miss stuff.

Interesting. Thank you.

 

[Ian S]

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?

 

[HenryD]

That would be me and have had that hanging over my head for a long time, plus a family history of heart disease and I am a type 2 diabetic. I am on 10 mg of Rouvastatin which as driven my LDL into the 50s. I also take lisinopril for blood pressure. I've had a calc scan a few times and it was negligible, although the last one was maybe 5 years ago. I put my numbers in the calculator using the old calc score with my current other numbers and came up with a 4.4% risk. I am not sure I should feel safe or not.

I'd feel safe with your numbers. I've got a 20 BMI, very low blood pressure, no diabetes, and a very healthy diet for 10+ years. 20 mg of Atorvastatin has made my LDL better, but with my family history and 243 CAC I'm at 7.9%. 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.