Another Calcium score thread, if you can stand it

[ratface]

Hello everyone, I have read every thread on hear about Calcium score tests but must say that after getting my score yesterday I am devastated and scared. My sister just went through bypass surgery so thought it prudent to have the test done based on family history, she is five years older. My score was 1170, I have pasted the results below. I have zero symptoms and exercise daily very aggressively, capable of HITT training for 30 minutes without issue. My diet is better than most, high plant based and low sugar and carb. I'm 65 and feel really well, walked 4 miles this morning. I have been on 40 mg simvistatin for about 15 years, My lipid numbers are all within normal ranges, I take 5 mg Lisinopril for hypertension and it keeps my BP pretty much normal. I did have head and neck cancer 15 years ago and received extensive radiation. I also was an avid runner for many years which seems to correlate with higher calcium scores, it seems extreme exercise actually causes more calcification than the general population.

I have a call out to my doctor about how to proceed but in the interim thought I would seek the vast wisdom of the board, interested in your perceptions, observations, recommendations , all are welcome and appreciated.

I would be interested in any education regarding type of cardiologist to follow up with as well as types of testing anyone has been prescribed and their efficacy in relation to calcium scoring. Predictions on possible treatment options are also appreciated.



" Coronary Artery Calcium Score Indication: Risk Assessment Exam DLP: 143, Total Calcium Score: 1170 Impression: The total coronary Agatston calcium score of 1170 places the patient at the 93th percentile when matched with subjects of the same age, gender, and race/ethnicity who are free of clinical cardiovascular disease and treated diabetes. Category Table: Diagnosis: Extensive plaque burden. Very high CVD risk. Clinical Interpretation: High likelihood of at least one "significant" coronary stenosis (<50% diameter). Gender and Age Issues: Greater clinical significance when score is above 75th percentile for age and sex, or if calcium present in 2 or more vessels. Recommended Clinical Actions: Very aggressive risk factor modification using NCEP guidelines as for established CAD. Consider noninvasive stress test to rule out ischemia. Please refer to radiologist report for non coronary findings. Coronary Artery Calcium Score (Agatston Score): Left Main Artery (LM): 58. Left Anterior Descending (LAD): 724 Left Circumflex (LCx): 85 Right Coronary Artery (RCA): 360 Total Calcium Score: 1170 Warning: This test is intended for patients who are not having symptoms of heart disease. The results may not be applied to patients having cardiac symptoms. This exam was designed to measure coronary artery calcifications only. Other structures in the heart and chest were not examined. These scores do not necessarily correspond to the presence or degree of stenosis"

 

[joesxm3]

The big question is whether your calcified plaque is the tip of the iceberg or has your healthy lifestyle converted most of your soft plaque to the more stable calcified plaque.

There is an ultrasound test of your carotid artery that can give a rough estimate of the ratio of soft to calcified on the theory that carotid and coronary are likely similar.

This test is called Carotid Intema Media Thickness test CIMT. This is different than the typical carotid ultrasound. The best company is cardiorisk.com. You can contact them to see if it can be done in your area. Costs $350.

A more advanced test is the Cleerly CT Angiogram with AI interpretation. This scans the coronary arteries and assesses blockages and type of plaque. Cleerlyhealth.com, about $1500.

Dr. Ford Brewer has lots of YouTube videos many about this stuff. The short summary is not to freak out. Best to test not guess. A lot of his patients have their calcium score go up when they improve their lifestyle. If you are converting soft to calcified that can be a good thing.

Best to watch the Dr. Brewer videos. Too much for me to explain and he is the preventive medicine expert, not me.

 

[joesxm3]

While severe artery blockages can cause angina or other symptoms, many or most heart attacks are caused by soft plaque (not part of a severe blockage) rupturing and causing a blood clot.

That is why I focused on finding out how much soft plaque you have.

Dr. Brewer has said that low dose statins reduce inflammation and can also help to convert soft plaque to calcified plaque. You statin use may have helped to convert.

There are also advanced blood tests that test for several markers of cardiac inflammation beyond the typical hsCRP test. These other markers are related to active inflammation and plaque formation. Highly inflamed plaque is more likely to rupture.

 

[Dash man]

When I learned my calcium score was 1036 in 2016, I went to a cardiologist. He’s in a group of interventional cardiologists. I had EKGs, Stress tests, blood tests, echocardiogram and was put on 40 mg Atorvastatin. I was put into a routine of visits with EKGs twice per year and stress tests every three years.
I last had a stress test in Oct 2023.
About a month ago I had chest pains and went to the ER. My lab work and EKGs were all good. Because I had a high calcium score, they started giving me nitroglycerin to see if it relieved the pain. The third and last dose finally relieved the pain a bit, indicating it was a heart issue. I went into the catheterization lab and had two stents put in where they found a 90% blockage in my left circumflex distal artery. I still have a 50% blockage in another artery that needs to be watched.
Fortunately, I didn’t have a heart attack and there was no damage to my heart muscle.
My best advice to you is to find a good cardiologist near a good hospital, and follow what he tells you. Listen to your body if something doesn’t feel right. I had just seen my cardiologist in early May and had a good EKG. A couple of weeks later I started being very tired and had shortness of breath that I attributed to the spring pollen and my asthma. It all went away after my stents were put in.
Good luck to you!

 

[ratface]

Dashman I am wondering why they did not find the blockage at the onset of the high calcium test, did the diagnostic test not catch it or was it a case of the condition progressively getting worse?

It seems to me that they already suspect "High likelihood of at least one "significant" coronary stenosis (<50% diameter)" according to my test result.

 

[Dash man]

Calcified plaque is considered stable, and it’s the soft plaque that is dangerous. It can break off and cause a blockage in another location. Calcium scores tell you how much of the stable plaque you have and shows you have a propensity to build soft plaque too. The noninvasive tests mainly check for blood flow. It had also been eight years since my calcium scan. At the time I was told I had a 95% chance of a cardiac event within five years. I beat that prediction! Medicine is an art that uses science.

 

[CM]

#1 most important: Take your results to a good Cardiologist and discuss whether further testing is recommended. Everyone is an individual and there is more to assess than a Calcium Score to determine your level of risk and what your treatment plan should be.
A Calcium Score can tell you how much and generally where plaque is, but is not accurate enough to tell you where or how much arteries are narrowed.
Pay attention to symptoms and get seen promptly if any occur or worsen.

 

[ratface]

I see a cardiologist on Thursday, Should I be advocating strongly for an Angiogram at this point given my test scores?

 

[joesxm3]

The cardiologist will most likely want to do a stress test followed by a cathererized angiogram.

If it were me, given your lack of symptoms, I would rather a Cleerly CT Angiogram.

The stress test does not detect less than 70% blockage.

I would avoid a nuclear stress test since they seem to have too much radiation exposure for the benefit.

Just my opinion.

 

[ratface]

wouldn't the angiogram just cut to the chase or does the stress test provide another piece of the puzzle?

 

[RetiredHappy]

Angiogram is a fairly stressful procedure for many of my friends who have undergone it. Just wait to see what your cardiologist says.

Fortunately my CAC score came back as zero last year when I was 60 yo. My friend (wife)'s CAC came back as zero as well but her husband's 1000. His cardiologist immediately got him for an angiogram and indicated that one artery was 100% blocked and got a stent implanted. The cardiologist was surprised that he did not get a heart attack already. His CAC score turned out to be a life saver.

 

[joesxm3]

They like to do the stress test first.

My cardiologist explained that he likes a triad: chemical (lab tests), functional (stress test) and structural (angiography).

Angiography will show the artery narrowing but will not show if the blood flow is impeded. An echocardiogram stress test may show ischemia or lack of blood flow to the muscle.

Before they place a stent during cathererized angiography they should do a test called fractional flow reserve (done inside the catheter) to avoid placing an unnecessary stent.

I thought angiography would be like getting a colonoscopy, but it seems you have to stay in hospital 6 hours after, need someone to stay with you first night at home in case you bleed, and maybe take a day or two off to recover.

Studies have shown that while stents during a heart attack save lives, preventive stents don't stop heart attacks.

The way to prevent heart attack is to implement lifestyle changes that reduce inflammation and stabilize plaque. From your initial post it sounds like you have implemented that sort of lifestyle already.

Make sure that you discuss this stuff in detail with your cardiologist. I am not suggesting treatment, just listing topics you should cover when you see the doctor.

 

[CM]

I see a cardiologist on Thursday, Should I be advocating strongly for an Angiogram at this point given my test scores?

Talk with the cardiologist and see what he/she recommends. You can let them know that you are ok proceeding with an angiogram (if you are), and see if they feel that is appropriate. People can speculate what course of treatment may be advised, but every patient and every situation is different.

The angiogram is considered the "gold standard" test for coronary artery disease, because it allows the doctor to actually see inside your cardiac arteries and visualize any narrowing, blockages or unusual anatomy. PLUS, if there is a significant blockage, they can immediately intervene and put in a stent since they already have the instruments in place to do that. They cannot do that with a CT angiogram or any other type of imaging test.

When you see your Cardiologist, they should give you options and explain what they feel is the best course of action. They should also explain why and let you know what the risks are of doing a test, or NOT doing a test. It's a lot of information, so take a pen and something to take notes on!

 

[MarieIG]

Dr. William Brewer demonstrated an at home plaque test. Obviously, this is not a substitute for, or meant to discourage visits to, your cardiologist. I am going to to try this over the next few days, and also inspired by this thread and some long standing - long ignored issues - will be following up with my PCP as well.

Update: I did try the "test" and obtained the following results:

Lt arm 94/65 Rt arm 95/72

Lft ankle 122/83 Rt ankle 120/77

end result was:

(left) 1.28

(right) 1.26

 

[ratface]

Updating, its Thursday, sleepless night waiting for the 8:AM cardiologist appointment. I live in Chicago, and Chicago has it's problems, but it also has some of the best hospitals in the world close and accessible to anyone. Sitting at UC Hospital at 7:30 watching who I think is the cleaning lady wipe down the reception area. Just before 8:00 She ask if she can help me. Guessing I was the first patient of the day. Back up fifteen years and just one floor up I had been treated for Head and Neck Cancer and had CT scans of the head and Neck for three very anxious years (I already knew calcium had been reported in those scans but nobody cared because we were looking for cancer) Professor of Cardiology walks in the exam room a few minutes past 8:00 am. He has already reviewed my 15 year old CT scans, My current CT scan, has memorized my blood lipid numbers and I am blown away. We proceed to discuss the Calcium score test results. He says my calcium has been there since my teens when I started smoking with half of it being deposited by my 15 years of statin use which has been doing its job, taking soft plague and calcifying it and stabilizing it from breaking off and clotting. Based on my age and Statin history he would expect my calcium score to be in the 4-500 range. Add smoking for thirty years, 39 radiation treatments to the head , and years of marathon running have all added to the total number. He draws me a picture on a brochure illustrating how it's on the outside walls and the internal structure of the arteries. Picture a drinking straw, the calcification is mostly in the straw, both on the outside and inside walls of the straw. He says the CT scanner sees the front arteries the best and the LAD widow maker is always the most calcified because it is in the front, carries the most blood, and calcifies the most as it is moving more blood around. A calcium score is generated by algorithm and does not consider any individual variables. Based on my variables I am normal. Based on my fitness level he said I would know if there was any blockage because of what I can currently do. He said he can get my chance of cardiac event down to 4 percent by adding one medicine to decrease my already low LDL. Remember the initial score report predicted a 93 percent chance of cardiac event in the next 3-5 years. Moral of the story is that a calcium score is very individualized and not always doom and gloom. I am comfortable with a 4 percent chance. I have a different cardiologist scheduled in two weeks, I believe in second opinions, but what a Gem of a Doctor I met today. Will update on the next Cardiologist consult.

 

[Trooper]

and years of marathon running have all added to the total number.

Glad you had a productive visit with your cardiologist. Any idea why running would contribute to coronary calcium?

He said he can get my chance of cardiac event down to 4 percent by adding one medicine...

Did he mention the med?

 

[ratface]

Running , or extreme exercise , think marathon running or competitive cycling , professional athlete's have been show to have up to 10 percent more calcification than the general population. What happens is that they stretch/stress the heart muscle more causing damage which needs repair, they also have a higher incidence of Afib because the stretching does something to the electrical circulatory. All of that said exercise still is more beneficial than the damage.

The medication he prescribed was Ezetimibe or more commonly known as Zetia which absorbs Cholesterol in the stomach thus lowering bad LDL which is the big risk in soft plaque.

I think the good doctor sugar coated my situation as much as he could while remaining factual. I still have serious cardio vascular disease just don't have symptoms yet and they just don't do anything until then. I have since learned that the Calcium test pretty much measures outside artery calcification and but I am not sure in which direction it progresses, i.e. , does it start encroaching into the actual inside of the artery, the artery is multi layered, or does it start inside the artery and moves to the exterior.

I also want to know if all calcification is equal, in that mine comes from multiple sources, exercise, statins, radiation, and believe it or not calcium carbonate in the form of antacids , which I was taking too many of. I had an elevated blood calcium last year in my bloodwork.

I'm still very anxious about the whole thing because I just don't know what the level of blockage is, has anyone had a CLeery angiogram done with CT and can elaborate on costs and results?

 

[SJ1_]

The big question is whether your calcified plaque is the tip of the iceberg or has your healthy lifestyle converted most of your soft plaque to the more stable calcified plaque.

There is an ultrasound test of your carotid artery that can give a rough estimate of the ratio of soft to calcified on the theory that carotid and coronary are likely similar.

This test is called Carotid Intema Media Thickness test CIMT. This is different than the typical carotid ultrasound. The best company is cardiorisk.com. You can contact them to see if it can be done in your area. Costs $350.

A more advanced test is the Cleerly CT Angiogram with AI interpretation. This scans the coronary arteries and assesses blockages and type of plaque. Cleerlyhealth.com, about $1500.

Dr. Ford Brewer has lots of YouTube videos many about this stuff. The short summary is not to freak out. Best to test not guess. A lot of his patients have their calcium score go up when they improve their lifestyle. If you are converting soft to calcified that can be a good thing.

Best to watch the Dr. Brewer videos. Too much for me to explain and he is the preventive medicine expert, not me.

Highly recommend Dr. Brewers videos

Running , or extreme exercise , think marathon running or competitive cycling , professional athlete's have been show to have up to 10 percent more calcification than the general population. What happens is that they stretch/stress the heart muscle more causing damage which needs repair, they also have a higher incidence of Afib because the stretching does something to the electrical circulatory. All of that said exercise still is more beneficial than the damage.

The medication he prescribed was Ezetimibe or more commonly known as Zetia which absorbs Cholesterol in the stomach thus lowering bad LDL which is the big risk in soft plaque.

I think the good doctor sugar coated my situation as much as he could while remaining factual. I still have serious cardio vascular disease just don't have symptoms yet and they just don't do anything until then. I have since learned that the Calcium test pretty much measures outside artery calcification and but I am not sure in which direction it progresses, i.e. , does it start encroaching into the actual inside of the artery, the artery is multi layered, or does it start inside the artery and moves to the exterior.

I also want to know if all calcification is equal, in that mine comes from multiple sources, exercise, statins, radiation, and believe it or not calcium carbonate in the form of antacids , which I was taking too many of. I had an elevated blood calcium last year in my bloodwork.

I'm still very anxious about the whole thing because I just don't know what the level of blockage is, has anyone had a CLeery angiogram done with CT and can elaborate on costs and results?

I found Dr Ford Brewer's videos very helpful. full of great information

 

[joesxm3]

I am considering Clearly but have not done yet. The cost is about $1500 cash pay. They classify the type of plaque but Dr. Brewer said that it was not as easy to understand as the cardio risk CIMT results. They also show the blockages.

You either need a doctor to order the Clearly or the company can hook you up with a group that will order it and discuss the results.

I have had the CIMT and that was $350. No need for a doctor order. But they gave me a sheet for insurance that required me to find a doctor willing to put his ID and diagnosis codes. I just self paid.

 

[PointBreeze]

wouldn't the angiogram just cut to the chase or does the stress test provide another piece of the puzzle?

There are risks to an angiogram - my spouse had a small stroke as a direct result of the angiogram - the wire apparently dislodged some plaque which travelled to her brain.

 

[GLM]

When I have an issue I always crave information so I can consider my options . I read a lot of medical information ( Retired Cardiac RN ) and forwarded this to a family member a while back . If I recall correctly they cover a test beyond the calcium scan, discuss drugs, supplements and supplements to help various issues. I think it might be informative.

Perhaps the best 90 min cardiac talk I've ever heard, in that its understandable, easy to listen to and covers the gamut pretty well . (Although I broke it up into 4 sessions to truly listen)

The Latest Science on Preventing Heart Disease and Atherosclerosis: Best Heart Tests, Supplements, and Lifestyle Changes

Hopefully it will be worth a listen.....

 

[ratface]

These are responses from the Cardiologist to my question on my prognosis. I have to think this is a difficult question for them to answer walking a very fine line. I had stated that I felt like a ticking time Bomb and asked him for a prognosis.

"Calcium occurs when there is any inflammation or damage to the wall of the artery - usually the calcium is just underneath the endothelial layer of the artery which is the part of the artery that is next to the blood stream. You should not feel like a ticking time bomb. Your prognosis is excellent since you have no symptoms at a high exercise level and you are controlling your risk factors. This makes the possibility of a heart event low. "


"Since you are having no exertional symptoms at a high exercise level, we can conclude that you have no plaques that are limiting blood flow and that the calcium we are seeing is in the walls of the arteries."

Point Breeze, I have also read what you have stated that there are risks of breaking off plaque and causing more damage with an Angiogram.

I still have an upcoming appointment with a different Cardiologist but I suspect he will echo what the first one said. I have made significant changes to diet which was already good, I plan to lose at least another 20 pounds but am still having a hard time wrapping my head around the initial CAC score report with such dire predictions vs. a very premier Cardiologist who it seems sees it a bit differently. This has become a Wake up call for sure with much uncertainty at the moment.

 

[ratface]

Updating on second Cardiologist consultation/opinion. I was somewhat expecting the same opinion as my first cardiologist consultation but what a different approach this doctor has. First an in office EKG which I failed. To my astonishment if your heart beats at less than 60 BPM or higher than 100, you will automatically fail an EKG, mine was 59 BPM, nonetheless I am officially classified as failing an EKG, he shrugged his shoulders giving me the impression it was non significant. Dr. Google states it can actually be a sign of a healthy heart since it can accomplish it's work with less effort. Then he scheduled a nuclear stress test which I have next week, an ultra sound aorta screening (which Dr. Google says is recommended for men over 65), an ultra sound of the Carotid arteries, a litany of bloodwork and a return visit in two months to discuss findings. I am ambivalent about it, relieved someone is looking further and concerned about what they may find, at least it's proactive and I will gain some insight into my heart health instead of feeling like a walking time bomb all the time. I walked out trying to understand how two highly respected cardiologists can have two widely different opinions. I have a busy two months of scheduled diagnostic testing, any insight/experience with any of the imaging tests would be of interest to me?

 

[RetiredHappy]

Updating on second Cardiologist consultation/opinion. I was somewhat expecting the same opinion as my first cardiologist consultation but what a different approach this doctor has. First an in office EKG which I failed. To my astonishment if your heart beats at less than 60 BPM or higher than 100, you will automatically fail an EKG, mine was 59 BPM, nonetheless I am officially classified as failing an EKG, he shrugged his shoulders giving me the impression it was non significant. Dr. Google states it can actually be a sign of a healthy heart since it can accomplish it's work with less effort. Then he scheduled a nuclear stress test which I have next week, an ultra sound aorta screening (which Dr. Google says is recommended for men over 65), an ultra sound of the Carotid arteries, a litany of bloodwork and a return visit in two months to discuss findings. I am ambivalent about it, relieved someone is looking further and concerned about what they may find, at least it's proactive and I will gain some insight into my heart health instead of feeling like a walking time bomb all the time. I walked out trying to understand how two highly respected cardiologists can have two widely different opinions. I have a busy two months of scheduled diagnostic testing, any insight/experience with any of the imaging tests would be of interest to me?

My spouse who has a stent put in more than 20 years ago for one blocked artery, ungoes these scans and test every 2 years, ordered and reviewed by his cardiologist. I believe this second cardiologist is using the right approach.

 

[aja8888]

Updating on second Cardiologist consultation/opinion. I was somewhat expecting the same opinion as my first cardiologist consultation but what a different approach this doctor has. First an in office EKG which I failed. To my astonishment if your heart beats at less than 60 BPM or higher than 100, you will automatically fail an EKG, mine was 59 BPM, nonetheless I am officially classified as failing an EKG, he shrugged his shoulders giving me the impression it was non significant. Dr. Google states it can actually be a sign of a healthy heart since it can accomplish it's work with less effort. Then he scheduled a nuclear stress test which I have next week, an ultra sound aorta screening (which Dr. Google says is recommended for men over 65), an ultra sound of the Carotid arteries, a litany of bloodwork and a return visit in two months to discuss findings. I am ambivalent about it, relieved someone is looking further and concerned about what they may find, at least it's proactive and I will gain some insight into my heart health instead of feeling like a walking time bomb all the time. I walked out trying to understand how two highly respected cardiologists can have two widely different opinions. I have a busy two months of scheduled diagnostic testing, any insight/experience with any of the imaging tests would be of interest to me?

My last cardio visit, it was determined my resting heart rate varies between 30 and 40 BPM. After several tests (treadmill stress, nuclear stress, EKGs), my heart is fine, it's a Level 2 heart block which is being addressed tomorrow AM with a pacemaker install. Old heart in an old body, but still OK except for a few electrical problems!