Mine is 780 but 0 in RT Main. So other 5 arteries have a bit of calcium. I would ask for proper stress test. I have had all the tests but Contrast CT to determine amount of soft plaque which is the most important.

My contrast cardiac MRI showed heart wise everything is perfect. The fact that I ran both stress tests 5 min beyond level 3 protocol with no EKG, BP or lung gas anomalies gave me and my cardiologist a bit of comfort. My blood work has been excellent until we looked into the makeup of my LDL which showed LPa to be off the chart. So after 6 month of Statins and PCSK9 inhibitor it has come down to just a little higher than normal. So for me at age 60 it is about arresting any more artery damage.

Hopefully for me if I have soft plaque and throw it causing a heart attack - I am lucky like some folks on the forum to be near an ER and just get a stint. So I am hypersensitive to any strange pain that typically we dismiss as… oh must be the swim workout I did yesterday that is causing chest pain.

Great thing about this community, you read things and they light a spark, and sometimes we act on those sparks. Good for you after all these years of us talking about those scores, making the effort to finally go get one.

SO now you know, which is what dotce, myself and many others have been saying for a long time. Knowledge is power, and with your family history, you can now be proactive. I only found out about calcium scores about 6 years ago, chastised my heart doc a little on why he had never told me about them, until I had badgered him into other metrics I could use to see how I was doing. Too many healthy friends just dropped dead in workouts or races, I need more of an explanation of what that would be.

So for sure you are going to be given statin advice, and likely a pretty good dose with your score. I'm of course no doctor, just a 23 year heart patient who is trying his best to be able to continue to train, and even compete once in awhile when the stars align. This is good timing as there is a thread on the front page now with someone else asking about this, and dtoce linked several sites that you just plug in your numbers, and it gives you some therapies to look at. I know you must be really shocked to see that number, but just remember others see 2 to 3 times that number, and are still walking around, so dont panic.

You got it early, no doubt part of your family history, and now you get to mitigate and keep doing what you are doing. I will leave it to the real experts here to point you in the right direction, you are going to be fine once you get on the program. Just watch your anxiety in the meantime, that is the real killer...

Sorry to hear what you are going through

As for vertigo I had it to where it was a bit of a chore to walk a straight line.

This helped me with my vertigo tremendously

I can feel when I need a ‘time up’ and do the simple exercise. And am good to go foie a couple months




Best of luck with all of it

If you use the search function you will see a lot of great questions and answers from DTOCE on the subject of calcium scores etc. He is a great cardiologist and you will likely find many answers to any questions that are ticking over in the numerous threads on here.
I appreciate how anxiety provoking having a test come back like this can be. I often tell my patients that these sorts of processes are really like a journey and you are just at the beginning of this one at the moment and there are numerous things that will follow from here, but the end of that journey will hopefully have you in a better place than if you had not embarked on it at all.
In terms of the dizziness versus vertigo, it is too early to tell from the information you have provided whether this could be secondary to any cardiac issues and at the moment I would not give it much additional thought, the tests you will go through will provide more clarity on whether this may have been secondary to something cardiac related.
I hope all the tests etc go well from here.

My calcium scan showed mine to be in my LAD and right coronary artery. The LAD is my biggest concern (though they both are concerning). I do have a stress test coming up soon, along with an echo.

Bad part, on my end, is I’ve usually scrolled right past any posts here on Slowtwitch about heart issues because I (naively) thought “nah, that’ll never happen to me”. Now, I’ve been going back and reading past posts about this (and other) heart related issues. I’m now in a statin and aspirin. More testing is coming up.

Thanks for posting that video. I’d seen it previously when desperately searching YouTube trying to find something to help with my vertigo. So far, I cannot find anything to make mine go away except time and lying in bed. When the vertigo hits, it can last 2 hours to 24 hours, and I look like a drunk person if I try to walk. Have been on a few different meds as well, but no relief. The only treatment that helped, so far, was a steroid injection into my ear. I went from having 1-2 vertigo attacks per week to one vertigo attack over a 4 week period.

Yes, the search function and DTOCE have been great resources.

This has certainly been an eye opener. It may sound strange to say but I was a bit embarrassed by my score. No one in my family is physically fit, they are smokers or obese, and most like to tease me with “why do you do all of that running/cycling?” After I received my calcium score, I told my wife “great, I’m the only person in my family who works at being healthy and now I may be the one with coronary disease”. But, more testing is to come and I’ll find out if it’s the changes seen by some endurance athletes, or more ominous.

As you know, since I've PM'd you earlier, you are doing the right things to check things out from a cardiac risk standpoint and you will work with your providers to do the right things to mitigate long term risk.

There have been lots of threads that I've commented on after several athletes in the community had cardiac issues and posed so I'm not going to pull them all up. But here are a few threads that may be worth a read.


Here's a link to an article I wrote for ST a while back
What Endurance Athletes Need to Know about Heart Health
https://www.slowtwitch.com/...art_Health_7911.html

'Statins and training'
https://forum.slowtwitch.com/...st=last-6643505#last

'Worried about my heart'
https://forum.slowtwitch.com/...tring=dtoce#p6619853

'Heart health screening thread'
https://forum.slowtwitch.com/...st=last-7150717#last

plus, Tom's thread
I'm 51, and just had a 5x coronary artery bypass graft (cabg) surgery with no prior symptoms : Triathlon Forum: Slowtwitch Forums

Also, since this always comes up and people want to know what the real risk is about competing in triathlon once diagnosed with heart disease...so to be complete, I'll throw in this one
'Sudden death in triathlon'
https://forum.slowtwitch.com/...riathlon_P6427784-2/

Information about coronary artery calcium scoring
https://www.acc.org/...-cardiovascular-risk


You might like the article that Aaron wrote regarding athletes.
https://www.ahajournals.org/...LATIONAHA.117.028750

Good luck with your upcoming tests.

you are likely the only one who has yet bothered to get themselves checked out and others in your family certainly likely have CAD but do not know it....

as stated by monty: 'Knowledge is power'

Thank you so much for sharing these.

You are certainly correct. I believe a lot of them do have coronary disease (as well as the other maladies associated with poor life choices).

Because of my fitness level, I felt "immortal" for the longest time. Well, life has a way of humbling us and it has definitely done that to me.

Following this thread and have followed most of the recent threads on cardiac issues. I have a CCS scheduled for October although I have no issues (that I am aware of) and my GP hasn’t mentioned it because my lab values have been great. I turn 50 in September so figured it would be a good time to get a baseline score. My health system does a screening that includes CT scan of heart, EKG, glucose and cholesterol panel for 100 bucks. Pretty much a no brainer as far as I am concerned.

---

Let food be thy medicine...

EyeRunMD wrote:

"I am paranoid about being the "fit looking" guy with hidden heart disease"

Me too! Unfortunately, I'm right there with you. I scored a 429 last month. Not happy with it at all as I always "assumed" my arteries were clear because I've always been around 180 cholesterol and have followed a fairly healthy diet the last 20 years.


Things started unraveling for me back in June when I got a lower lumbar x-ray for back pain. Not surprisingly the x-ray showed some mild degenerative discs but what was surprising was the finding of severe aortic atherosclerosis. That was a WTF moment. I didn't even know they could diagnose that with a back x-ray. So that got me to schedule the CT coronary calcium score. After getting those results my primary care doctor put me on a statin and baby aspirin and ordered an echo stress test. The statin lowered my cholesterol to 150.


I do believe I felt some of the side effects from the statin of muscle soreness and started taking COQ10 as has been discussed here. It seemed to help but verdict is still out on that. I did ask my primary care if I had any restrictions and she said no so I did Nationals in Milwaukee earlier this month. I had a panic attack about 200 yds into the swim and stopped because I felt the normal, out of breath, chest tightness, that I've felt for 20 years in wetsuit cold water swims but this time I had something concrete to worry about :) After what seemed like several minutes I didn't die and started swimming again and completed the Olympic distance biking and running at max heart rate.

I finally got my stress test completed last week and initially I was told I passed it but then they later updated the results to say there was a suggestion (?) of stress induced ischemia. My primary care said to see a cardiologist (which I had already scheduled) and now she said to try to keep heart rate below max while exercising. So now I'm waiting for that appointment which isn't for another month.

I did a 110 mile gravel race this past weekend up in Iowa which just about destroyed me but I did try to keep the heart rate down. I also plan on doing another OLY this weekend (keeping the heart rate down).

I wonder if I would have had the calcium score 10 years ago if it would have been the same or near as I don't believe this just started this year. I'm anxious to see what the cardiologist says about my condition.


Oh yeah, concerning genetics, I told my older brother about my score and he scheduled a CT test. He scored a big fat 0. WTF? We both grew up on the same diet. He is moderately active and maintains a good BMI. Go figure!

"I am paranoid about being the "fit looking" guy with hidden heart disease"

Me three. These threads, with the expertise and experiences shared have been extraordinarily valuable.


I had the CACS test done earlier this year - 57yo. My score was very low, but not zero. It was well worth it the understand if my actual risk classification was higher than expected, or in line.

I'm with you Math Drifter. I've been very active most of my life, currently 62. I'm 6-2 158, so I'm not carrying much fat. I moved into endurance training in the late 90's and ran my first marathon in 2000. I am a regular at the Dr's office and have had my cholesterol checked many times and it has always been low. I'm not going to say I have great diet and a great lifestyle, but I will say it is better than most. My Dr, who is a beast of a Triathlete recommended getting a calcium scan score in May. I got a call from the Dr's office a week later saying the Dr wanted to see me about my score. Ooops! It was 280, which after I have done some research is not terrible, but it is not great. I guess the bad thing is 275 of that score is in my widow maker artery, LAD. I was shocked and the Dr. definitely was surprised, but he says it happens. I was really worried at first but have since, tightened up my diet and just being very aware of any symptoms. I'm trying not to worry about it. The glamorous life of an aging athlete.

Here are some interesting videos. My sister is same parents and has high LDL. But 0 CCS! CCS will not tell you the extent of soft plaques. Which I intend to quantify this year once my family’s out of pocket deductibles are reached.



And for PCSK9

For both of us, I hope we fall into the category of endurance athletes who have high calcium scores secondary to our years of running/cycling rather than the same cardiac risk as a non-active individual with a score over 400. I'm no expert but I read a paper saying something like 11% of endurance athletes have CAC scores greater than 300 (and without the same cardiac risks as sedentary individuals). Like you, I am anxiously awaiting further evaluation with my cardiologist and am hoping I don't need aggressive interventional treatment. But, I'll do whatever I have to do to stay alive.

Yeah I am surprised talking to other people who have low CAC scores. It's also interesting to read the histories of others (FB group called Cardiac Athletes....IIRC) who had CAC scores of zero and then were surprised to have an MI and need stents/CABG. It's a screening tool to help us evaluate our risks, and take the appropriate steps.

Thank you for sharing these videos.

At what age should one start to check calcium score? I have no significant family Hx of CAD. Just a couple parents with obesity and DM and HTN.

At what age should one start to check calcium score? I have no significant family Hx of CAD. Just a couple parents with obesity and DM and HTN.//

Usually insurance tells you when you are eligible for certain tests, mammograms, colonoscopy, etc, but since they dont actually pay for this one, it is our choice. Like I said before, I have had many friends die in workouts, the youngest 39 and 44, both high level athletes. One running and one in the pool. I wish I had started my testing in my early 30's, if nothing else, just to see that 0 score and put it out of my mind(but probably not 0 in my case). I sure bet my friends had known their scores in their mid 30's too, but of course that was the last thing on their minds, and no doubt had never even heard of this test.


So since you have to pay anyways(about $100 to $200 bucks most places) just go ahead and get it done. I see a lot of guys in these latest threads in their 40's/early 50's with scores from 400 to over a 1000, so no doubt it would have been picked up in their 30's as something to look out for. IF nothing, then you can relax and wait for 5 or 10 years before another one. That is my non medical/non doctor advice as a long term heart patient who had his near fatal accident at 46...But mine was not related to a high CAD score, but same logic applies..

x2 That first video provided me with a much better understanding of statins that what my doctor did. I thought they just lowered cholesterol. I didn't realize that they could modify the plaque. Good stuff!

Apologies for the question and to the OP. I have just done a cholesterol test and my ldl is 3.2 (120) and the doc isn’t happy. Has given me 3 months to improve this number, otherwise I rekon he will be waiving statins in my face.

My questions is rather simple - those on statins and don’t get any sides of muscle soreness etc , I read that paper and it mentions reduction of mitochondria ? Does this means as a triathlete, we would find improvements in our peformance to swim bike run is diminished ?
Surely people have gotten faster even on statins ?

AchillesHeal wrote:

At what age should one start to check calcium score? I have no significant family Hx of CAD. Just a couple parents with obesity and DM and HTN.

Timing of cardiac screening is an individual thing. I never send my patients for ischemic testing of any sort at age 35 or less. I have, on occasion, done CACS on some patients in their 30's to show their risk is truly low and that they have time *(as I expect it will be normal/0) to take better care of themselves.

I often say to patients that this is the only body you get, so take good care of it.

There are no guidelines for specifically what age to start screening of 'low risk' individuals but I did read an NIH paper saying 42 yo for M and 58 for F. I generally think ~45 yo for men an ~50-55 yo for women *(protected by hormones longer compared to M). You'd like it early enough to intervene meaningfully and not so early to cause anxiety for years.

It is still likely best for clinicians to use the ACC risk estimator and MESA calculators *(using CACS) to help assess risk.
https://tools.acc.org/.../calculate/estimate/

https://www.mesa-nhlbi.org/...Score/RiskScore.aspx

Here's the article on 'hardening of the arteries' in athletes by Dr. Aaron Baggish of MGH.

https://www.ahajournals.org/...LATIONAHA.117.028750

The MESA %ile calculator using the CACS
https://www.mesa-nhlbi.org/Calcium/input.aspx


It is my belief that there will be a shift towards CTA and ultimately CTA with AI *(from coronary artery calcium scoring) to evaluate for soft plaques in the coronary arteries eventually. We'll see. It's been talked about for a long time but much closer to reality now.




This is the downside of Rx with statins-issues with the muscles aka SAMS *(statin associated muscle symptoms)--- pain/achiness/muscle inflammation-myopathy/myalgia/concern about performance... It is real and varies in studies. Probably 5-25% of patients have some issue related to the muscles but it is still risk vs benefit and the discussion about an individual's personal risk and best plan to optimally treat needs to be shared decision making with the patient and the provider. The actual % of patients that have very significant issues may be as low as 1%, but that is not 0. There has never been any paper saying statins truly reduce muscle function but if they hurt, you will not be training appropriately. Some of the statins seem to affect the muscles more than others and there have been papers also suggesting that CoQ offsets this and that is why it is suggested-even though there is no hard clinical data to prove a benefit. Many of these studies are small so hopefully over time there will be better information to make informed choices. *edited to add: the meta analysis of all co Q 10 studies was only about 6 or 8 studies of ~240 participants. That muscle biopsy study you cited only had 48 patients...

It is suggested that diagnosis should be based on the triad of (i) temporal relationship of symptoms and/or CK elevation to initiation of statin therapy; (ii) disappearance of symptoms on withdrawal; and (iii) re-appearance on re-challenge with statin therapy
SAMS can be further classified based on muscle symptoms, the presence and degree of CK elevation. Muscle symptoms with no elevation in CK, often referred to as myalgia, is regarded as the mildest form. The term myositis is sometimes used to describe symptoms associated with significant CK elevation (>10 times upper limit of normal range). Rhabdomyolysis is the most severe form, and may result in myoglobinuria and renal impairment. CK levels in rhabdomyolysis may rise to >40 times upper limit of normal range.
The pathophysiology of and mechanisms leading to SAMS is yet to be fully understood.

Going 'low and slow' and finding a statin that is tolerated can be a challenge and take some time and effort. Multiple with-drawl trials are usually needed and re-challenging to find out if symptoms are truly related and to assess severity. It is still best to do whatever is necessary to optimally treat patients despite how difficult the effort.

It always starts with assessing risk...

While scrolling around, I did see a nice summary from the ACC about Primary Prevention and Reclassification of Risk using CACS so I copied those below.
Top 10 Take-Home Messages for the Primary Prevention of Cardiovascular Disease

1. 
   The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life.
   
2. 
   A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions.
   
3. 
   Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician–patient risk discussion before starting on pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin. The presence or absence of additional risk-enhancing factors can help guide decisions about preventive interventions in select individuals, as can coronary artery calcium scanning.
   
4. 
   All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, red meat and processed red meats, refined carbohydrates, and sweetened beverages. For adults with overweight and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss.
   
5. 
   Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity.
   
6. 
   For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations are crucial. If medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist.
   
7. 
   All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit.
   
8. 
   Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit.
   
9. 
   Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low-density lipoprotein cholesterol levels (≥190 mg/dL), those with diabetes mellitus, who are 40 to 75 years of age, and those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion.
   
10. 
    Nonpharmacological interventions are recommended for all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy, the target blood pressure should generally be <130/80 mm Hg.

Utility of CAC in Reclassifying ASCVD Risk
For individuals with intermediate predicted risk (≥7.5% to <20%) or for select adults with borderline (5% to <7.5%) predicted risk, CAC measurement can be a useful tool in refining risk assessment for preventive interventions (e.g., statin therapy). In these groups, CAC measurement can reclassify risk upward (particularly if CAC score is ≥100 Agatston units or ≥75th age/sex/race percentile) or downward (if CAC is zero) in a significant proportion of individuals.
In adults at intermediate risk, CAC measurement can be effective for meaningfully reclassifying risk in a large proportion of individuals. In such intermediate-risk adults, those with CAC ≥100 Agatston units or CAC ≥75th percentile have ASCVD event rates for which initiation of statin therapy is reasonable. Those with CAC scores of zero appear to have 10-year event rates in a lower range for which statin therapy may be of limited value. Therefore, for patients with CAC scores of 1-99, it is reasonable to repeat the risk discussion. If these patients remain untreated, repeat CAC measurement in 5 years may have some value, but data are limited. It is important to note that the absence of CAC does not rule out noncalcified plaque, and clinical judgment about risk should prevail. Clinicians should not down-classify risk in patients who have CAC scores of zero but who are persistent cigarette smokers, have diabetes, have a family history of ASCVD, or, possibly, have chronic inflammatory conditions. In the presence of these conditions, a CAC score of zero may not rule out risk from noncalcified plaque or increased risk of thrombosis.
CAC might also be considered in refining risk for selected low-risk adults (<5%), such as those with a strong family history of premature coronary heart disease. CAC measurement is not intended as a screening test for all but rather may be used as a decision aid in select adults to facilitate the clinician-patient risk discussion. The following candidates for CAC measurement may benefit from knowing that their CAC score is zero:

• Patients reluctant to initiate statin who wish to understand their risk and potential for benefit more precisely
• Patients concerned about the need to reinstitute statin therapy after discontinuation for statin-associated symptoms
• Older patients (men 55-80 years of age; women 60-80 years of age) with low burden of risk factors who question whether they would benefit from statin therapy
• Middle-aged adults (40-55 years of age) with pooled cohort equations-calculated 10-year risk of ASCVD 5% to <7.5% with factors that increase their ASCVD risk.

I hope this helps...

Absolutely brilliant. I did see reccomendations for statin therapy with ldl greater than 190. I am 120, however my dad had a heart attack at 58 (I’m 43), and was on statins. My two much older brothers (55) are on statins however not active at all, one a heavy drinker and smoker.
My kick in the teeth is I have type 1 diabetes. I am not overweight, am fit, but I have a need to consumer sugar more than I’d like. It’s a nasty co-factor that increases risk for every other fricken disease I swear. Perhaps why doc isn’t happy with 120 ldl reading, it’s not just that number, but family hereditary link and t1. Anyway thanks again for this information, it is very helpful.

Dan has graciously linked this thread to the 'Hot Forum Topics' so people can see the links and comments regarding Coronary Artery Calcium Scoring.

many, thanks dan-

Wow, that’s great. Important topic for all of us athletes to be educated about. Thank you!

Very timely thread, thanks.

After a quite sudden drop of 'form' in April - a week after setting a 20min power record, I decided to get a few things checked out. My mother died from some blockages, and i am on statins as my cholesterol started creeping up a few years ago.
During the following 10 weeks, I did ZERO intensity on the bike, whilst getting some tests done, the last of which was a CT calcium check a couple of weeks ago. To my (and my cardiologist's) shock - my reading was zero.

Like others in this thread, I started to fear becoming the 'fit guy who dropped dead'.

If nothing else, getting yourself checked out gives you peace of mind.

Oh yeah... my issue? Likely over trainiing - a cross between too many hard days & not doing 'easy' days easy enough.

@EyeRunMD I had a score of 364 at age 53 (I'm 55 now). Like you, I was surprised and immersed myself gathering knowledge to understand this issue. For what it's worth, here's the Cliff Notes version of some key learnings:

1. LDL isn't the best metric for identification of heart disease, it's actually the number of LP(a) particles as the primary driver. Amgen has a drug in a clinical trial to reduce LP(a) and thus slow the progression of coronary artery disease (CAD). I don't want to get too technical here, so here's a link about it if you want to read up: https://www.amgen.com/...w-about-lipoproteina

2. PSK9 Inhibitors is the only treatment know to reduce LP(a) concentration, but most insurance won't pay for it, so the best alternative option is a statin that reduces your total LDL number. Interestingly, statins increase the LP(a) concentration; however, this risk is overwhelmed by the benefit of total LDL decrease. For what it's worth, my cardiologist has me on 40mg of Rouvastatin and 10mg of Ezetimibe to keep my LDL under 70. And yes, I take CoQ10 to offset muscle fatigue.

3. People who exercise generally have better plaque composition. There's a ton of research in this area using athletes over age 50, but my takeaway was the process of exercise functions similar to a statin in that it turns soft plaque into a safer denser plaque. It's the dense plaque that gets shown in your calcium score, not the soft plaque, so ironically people with a lower calcium can in some cases be at more risk. Lastly, athletes tend to build collateral pathways to promote blood flow leading to my next finding.

4. Stress test results and METS achieved have prognostic charts similar to calcium score charts. Based on my calcium score, I was in the bottom 5% with the highest risk. Based on my stress test, I'm at the top 5% with the lowest risk.

Overall, I think there's A LOT still being learned about CAD in athletes, but exercise serves as a protective mechanism which could enable us to live to be 100 years old with arteries full of dense calcium. Perhaps even taking a statin is redundant and unnecessary, but we aren't far enough along our learning cycle to say that with confidence. It sucks that you were dealt a bad hand, but realize it's not all gloom and doom. Just keep doing what you enjoy and follow your cardiologist's advice to slow the progression of the disease and calcify the soft plague. Good luck!

There's not much I can add but I had the Calcium Score Test in March and got a 755. I also had it 5 years ago and got a 455. Both times all follow up tests including a angiogram the first time and a cardiac stress test the second time were fine.

I was against going on a statin but agreed to take 10 mg of atorvastatin and a baby aspirin after the first one and doubled the statin after the second one. My first cardiologist's attitude was that since I'm a long term long distance runner with no chest pains, I didn't have anything to worry about. After the second test, my new cardiologist at first told me to keep HR under 142. I did a max HR stress test and I got it up to 161. I think I could have gotten it higher if the test was different but it was designed to get you to failure not to make it easy but that doesn't matter.

I still run 5 or 6 days a week but with a different attitude. I don't push myself and I just keep my HR in my safe zone. It probably ruined my racing career but maybe it will extend my happy life. I just did an 8 mile trail run Upstate, running at my relaxed pace. I got creamed in my age group but I still enjoyed to run. I'm going to run a very hilly 10k on Long Island in a few weeks at my relaxed pace, then hit a few 5k races and see if I can pick it up some still keeping the HR under 161.

At least I'm still running and enjoying life. The last thing I want to see on my grave stone is ''He died doing what he loved''!

---

---------------------------
''Sweeney - you can both crush your AG *and* cruise in dead last!! 😂 '' Murphy's Law

i have never before been accused of exhibiting grace. i think i said it once.

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Dan Empfield
aka Slowman

Thanks for the info. Good to see others experiencing similar feelings/concerns over this. I’m scheduled for a stress test, and echo, in about three weeks so I’m really hoping/praying for good news. But, I’ll try to take it in stride. If I find out I have significant blockages, I look at it as “well at least I found out so I can do something about it and be able to live a long life (hopefully)”

Wow that’s quite an increase. I think I’d be scared to recheck mine in five years, but it would be interesting to know. I started atorvastatin and an aspirin once I received my CAC score. I
was hoping to get a coronary CT angiogram but my insurance has denied it since I’m asymptomatic during activity. I told them I’d be willing to pay out of pocket for the test because, in addition to the stress test and echo, it will give me more piece of mind knowing…..whether good or bad.

Did your cardiologist explain the reasoning for recommending keeping your heart rate below 142?

Here's the link to the Amgen clinical trial: https://classic.clinicaltrials.gov/ct2/show/NCT04270760

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clm
Nashville, TN
https://twitter.com/ironclm | http://ironclm.typepad.com

I thought the Youtube video posted on the previous page gave a plausible explanation of why the score would go up after starting statins. In my understanding of the video, the statins are turning the soft plaques into calcified hard plaques (a good thing) increasing the score. That video also implied (my understanding) that a 0 score doesn't mean you might not have a soft plaque waiting to break off at some time.

I posted earlier that I had a panic attack in the swim at Nationals due to thinking about my CC score and the cold water, tight wetsuit, going out to fast, out of breath experience. This Sunday I raced another Oly in 82 degree water. I had a much better swim. And that was after my inconclusive stress test and reading and thinking about the three swim deaths posted on here (My bet is they were cardio related).

For me, the warm water swim relaxes me to where I feel much more comfortable (and safer) in the water.

I'm still waiting to see a cardiologist. My appointment is not till the end of September. I tried to keep my heart rate down during the race (as per primary care doc) and for the majority of it I did.

As long as I don't have physical symptoms I'm still training/racing until I talk to the expert or get different advice.

Thanks for the Clif notes on LP(a). I had never heard of it.

I had blood work done last week and a DEXA scan, mostly for thyroid questions, but the doc ordered 27 different tests (8 vials).

Even though I carry too much body fat, all of my cholesterol values (and other blood work) have always been excellent and I'd never had the LP(a) tested but this was one of the 27 tests done last week. No cardiovascular symptoms at all, just to too high body fat percentage.

My LP(a) number came back at 152, so they postponed the VO2 max test that I had scheduled and today I got the Coronary Calcium test done. That came up at 26, so the doc wasn't too concerned, especially as a female who has been without the protective effect of estrogen for nearly 20 years. Time to buckle down on increasing the exercise and watching the diet more closely.

@eyerunmd - Hope everything works out.

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clm
Nashville, TN
https://twitter.com/ironclm | http://ironclm.typepad.com

This thread popping up was perfect timing for me. I’m 47 years old, had my first child 4 months ago, and just went in and got a high coronary calcium score, 77 I think it was.

I’ve been very active my entire life, never been overweight, but I have the hereditary high cholesterol. Sky high last it was checked, 400’s I think. Doc put me on a statin, but I don’t really tolerate it, makes me feel terrible.

Trying to figure out a plan not to die before my kid gets through grade school.

Hi Matt J.
I have posted in other posts on this issue and as a result, I’m very reluctant to engage. I would suggest looking at the following at the science behind heart disease (coronary artery disease) and a whole food, plant-based diet. There are lots of resources out there for lay people (if that’s you) and lots of peer reviewed science if you are savvy with reading the scientific literature (pubmed). Some suggestions for where to start:

Read “prevent and reverse heart disease” by Esselstyn and/or “china study” by Campbell and/or “How not to die” by Greger

Watch “Forks over knives” documentary- streams for free on website

Watch videos/read blog on nutrition facts.org
Listen to any podcast with Kim Williams, MD

Tons more ways to access this information. Your MD should know, but as you can see even from the posts above, it is a blind spot for our society and culture which includes our physicians.

The leading cause of death among cardiologist is heart disease just like everyone else.

Heart disease is universal with a western diet by age 10.

“There are 2 kinds of cardiologists- vegans and those that haven’t read the science”

This topic is triggering and I am not going to engage a debate (again) here. I do feel morally obligated to share.
Take it or leave it- but try to know for yourself.
Best wishes to you!

Thanks for your post, endurer.

Going plant based is one option I’m considering.

Doc already has me off of caffeine and gluten, so most edible joy has already been eliminated.

I really just want to be French. Smoke, eat lots of butter and bacon, and live to be 100.

Count me as a person who learned about calcium screening from a thread on here last year. With both my mom and grandma dying of sudden heart attacks, it was a no brainer to schedule an apt. Of course, that appointment was just a "why yes, I agree you should have the screening done" appointment, so now my screening isn't until late Nov. My doc warned me that if my score is anything over zero, he will be giving me drugs. So, I'm pretty nervous too. I'm 54 and female. I'll be following this thread--you sure aren't alone in all this.

Thank you to all the people who have been so forthcoming about their heart issues, and for giving sound, solid advice. It still amazes me that I had to learn about this process via a forum on a triathlon site, and not my doctor.

--Meg

Hi - Haven't read through comments yet, but if they have not looked for a semicircular canal dehiscence in one or or both ears, they should. That can cause the symptoms your are having. And I too just found out my calcium score is higher than it should be. Waiting for a cardio consult to figure out what that means and what I can do. Hope you feel better.

Haha. I get that. But like so many things in life those feel good for a moment then you kinda feel like shit later. In my experience there has been a lot of pleasure and joy in eating and living this way. It is an adventure. And there’s no hangover. 😊

Wow, never heard of that. Do you know how this is assessed/diagnosed? I don’t have hearing loss (per testing) but I do have a muffled sound whenever the pulsatile tinnitus shows up. Doc thought I had Meniere’s Disease (except for the hearing test being ok)

hi! I believe it is a specialized temporal CT that can diagnose it. It is often misdiagnosed as Menieres too.

Your Dr. Sounds like a tape recording of my doc from 4 years ago.

However. My screening only took a couple of days to get done.

---

I saw this on a white board in a window box at my daughters middle school...
List of what life owes you:
1. __________
2. __________
3. __________

Here in Nashville I called on Friday morning and got in that afternoon. $50

---

clm
Nashville, TN
https://twitter.com/ironclm | http://ironclm.typepad.com

Dale:

Thanks for being such a great resource.

I'm interested in your viewpoint regarding the role of statins in turning soft plaque to hard plaque; from what I've been able to gather, you can expect ~10% increase in your calcium score AFTER starting statins from this phenomenon.

If what we see in masters endurance athletes with elevated scores is a result of the damaged arteries calcifying (Peter Attia's description), then I don't follow the logic in starting a statin to see a further increase in that score.

I've not been able to find any evidence in the literature regarding any treatment that demonstrates a decrease in CAC scores; the only mention is anecdotal in concentration camp survivors who were starved demonstrating a reversal of CAD (of course, they weren't doing CAC scores then). However, once they resumed a normal diet, it returned.

Jeff

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Jeff Shilt
__________________________
www.mdotdoc@blogspot.com
twitter @MdotDoc

I learned about particle repositioning over 30 years ago in medical school. This is a cool video. It allows patients to do what I do in the office at home. I teach people how to do something somewhat different at home but this seems more effective.

When I arrived where I practice now I was local particle repositioning doctor for about 20 years. The local ENT guy was an old codger who didn't seem to have learned anything new in a long time and didn't do it.

The most common type of particle generated vertigo responds to this maneover (sic) but there are a few rarer types that don't and sometimes an ENT can help with a different maneover .

---

They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

Grace is grace despite of all controversy. (Lucio in Shakespeare's Measure for Measure)

---

They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

Once identified, behaviors can modify plaque and statins do exactly that-turn soft plaque *(that can become vulnerable and rupture) into hard plaque that is stable. There is increased risk with more plaque burden of all kinds, but risk actually goes down significantly when there is less soft plaque. It's all about risk management at that point not at all about lowering your calcium score. The disease process really starts early in life and there is cumulative damage to the vessels over time made worse by so many things...

All scores will increase over time. Identifying CAD plaque and quantifying it can allow a patient to try to take better care of themselves going forward-eat better, exercise more *(if needed-although less here in the triathlon world) and for many, but not all-taking a medication to lower long term cardiac risk like a statin.

Dr. Attia is a great champion for heart disease and I enjoy his videos. He does help people learn about the disease and the process.

Talking about heart disease in general.


Talking about CAC


CAC discussion starts ~ 1:11:00

1. 
   All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, red meat and processed red meats, refined carbohydrates, and sweetened beverages. For adults with overweight and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss.

Everyone should absolutely understand that any non- heart healthy diet is very significantly contributory to CAD and soft plaque formation. There is no argument from me that plant based, dash, ornish and mediterranean diets all are much better than most western diets. But diet can only lower risk by about 15%. Statins work adjunctively with diet to lower risk and actually work far better absolutely.

And it is awfully difficult to modify patients behavior-especially eating. People do like to eat...




I think there is always more to learn about CAD. But once risk is identified, there are coronary vessels that have plaque and taking a statin is the BEST known treatment for mitigating risk. Once treated and at lower risk, progression is slowed and plaque becomes more stable. Then you can not only enjoy exercise but also know there is truly lower risk. And I'd say were are certainly far along enough to say that confidently.

Stress tests are done to evaluate whether there is elevated risk from a physiologic standpoint. Is there a significant blockage causing EKG changes suggesting higher risk? You can certainly have higher or lower risk with elevated coronary scores and that's why patients with high numbers get additional testing to re-classify risk.

I also agree that Lp(a) and ApoB are truly important and help identify risk. We are still learning the best way to treat elevated numbers for these. This may be a bit busy, but perhaps helpful to some.

I am no cardiologist but two of our pts have had strokes with catheter angiograms. I would take the non invasive route.

My wife and I always have ate relatively healthy. Red meat used to be once or twice a week. But most meals had some meat.

We now have converted to Mediterranean diet. Our grocery bill is way less than pre pandemic despite all the food inflation and the food is actually pretty good. I am trying to live like a Sardinian peasant did one hundred years ago. Unfortunately I still get around in my truck.

---

They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

After obtaining my coronary calcium score, and finding out it was high, my cardiologist had suggested an angiogram. I asked for coronary CT angiography but insurance would not pay for it. Since my concern for potential coronary blockages was high, I told the cardiology office I’d pay for the test out of pocket. It’s amazing the difference in prices among the different imaging centers in the area. Some as high as $2400 for this test. I found one for $760 and proceeded to have this done two days ago.

Coronary CT angiography is a quick test but can require you to get there an hour beforehand so they can give you medicine to lower your heart rate. My resting heart rate was 42, so I didn’t need the pre-CT med and was able to proceed straight to the test after an IV. The CT technologist said they have had to cancel people’s scans previously because they were unable to get their heart rates low enough to obtain quality scans

Today, I was supposed to go in for an echo of my heart and a treadmill stress test. I have a tear at the myotendinous junction in my right calf so I was unable to do the stress test. When I first walked in for my echo, the tech asked if I’d seen the results of my angiogram. I had not and she proceeded to tell me it was “abnormal with an 80-90% blockage”. I asked which vessel and she said “your circumflex, but that was the only vessel with blockage”. This was confusing to me because my coronary calcium score broke down the score (or calcium) for each coronary artery and my score was very high for my left anterior descending and a little less for my right coronary artery. All other coronary arteries were scored as “zero”. She was nice enough to ask the cardiologist if he would go ahead and see me today since my angiogram was read as abnormal.

When I saw the cardiologist, he started off by saying “your echo was normal except you have an ‘athlete’s heart’ and this is because you are a runner”. Next, he says “now let’s talk about your angiogram”. At this point, I was sure he was about to explain that I needed a stent placed. Instead, he says “you have no blockages anywhere”. This was a HUGE relief and he proceeded to explain the shape of my circumflex artery made it appear to have a blockage when in fact it was actually not blocked at all. He showed it to me on my angiogram.

So, the coronary calcium score was a good learning lesson and forced me to dig deeper into my cardiac health. Looks like I’m one of those endurance athletes who has a high calcium score but open arteries. I’m thankful for the knowledge and expertise of these heart specialists

That’s great news to hear!
Looks like tonight is a celebration-
:)

Knowledge is powerful

Have any Canadians here travelled to the US to have this done? Any issues with doing that?

Here in Canada, you first have to convince your doc to send you to a heart specialist, and if they agree to that, then wait a year+ to see said specialist, and then try to convince them that you need the test....

Holy SHIT!

So happy for you

When I read 80 - 90% blockage I felt horrible for you


So very glad you were able to speak with the cardiologist right away instead of being worried about it for days or weeks

Huge congratulations

How relieved do you feel?

How did you feel thinking it was 80-90% blocked?

Thank you. To some, this may sound strange but I actually got teary eyed when I got out to my car. I think the idea of having significant coronary disease was weighing on me a lot more than I realized. But, I was certainly overjoyed and very thankful to have the great test result.

I had convinced myself I’d likely need a stent placed (best case scenario) but was scared the testing would find significant enough disease I’d end up needing a CABG (open heart surgery). Whatever was needed, I was going to do it because my ultimate goal is to live as long as possible. So, when she said she read the report and the circumflex was described as 80-90% blocked, I was kind of relieved and thought to myself “ok, it’s only one vessel so maybe this means I’ll just need a stent and will not have to undergo open heart surgery”.

When the cardiologist clarified that I actually had no blockages in any of my vessels, I could’ve hugged every person in that office.

Doesn’t sound strange at all

So happy for you buddy

And I would have give you a great big hug back

Now go out and eat steak every day lol. Just kidding

Enjoy the relief

From someone just recently diagnosed, I wanted to say thanks to all for sharing information here. I also have a question: does anyone have a cardiologist in California that they are happy with? The first cardiologist I saw does not have any knowledge of athletes, and seemed somewhat surprised that I am struggling with statins and training and muscle soreness. (She told me there were no known issues with that.)

Background: 54yo, completely asymptomatic (FTP 350w with no issues at all at high intensity), recently returned CAC score of 467. When I asked for the CAC referral my dr said insurance probably wouldn't pay for it because I had no risk factors, but now I am obviously very glad I did the test. I am just now trying to catch up and learn what all this means, and all the links and videos are very helpful. Thanks especially to dtoce for generously sharing his knowledge.

I’m glad you had the testing done and you are being proactive. Our data points (age, CAC score, FTP) are all very similar, so I felt like I was reading my story to a degree. I started taking Atorvastatin 20mg as soon as I found out my CAC score was above 400. Fortunately, I’ve not really noticed muscle soreness nor fatigue, but I’ve heard of plenty of other athletes who’ve had a similar complaint as you.

Like you, my insurance would not cover further testing (angiography) for my elevated CAC score because I was asymptomatic. It weighed on my mind enough that I finally decided to pay out of pocket for CT angiography of my coronary arteries. I hope all continues to be well with you

so glad you had that done and now know that you can modify risk going forward-

Jae had great advice for people for primary prevention in terms of going low and slow. I've quoted it below from the "statins: experience training and racing on them" thread

This is where we move away from evidence-base medicine. As you are aware, the CV outcomes trials for statins were evaluated with on-label regimens, which were daily administration. However, the totality of evidence strongly supports the LDL hypothesis, and intermittent regimens, so long as LDL is efficaciously reduced, should translate into reduced CV events.
There are so many permutations of intermittent statin regimens, and are in balance with what you can tolerate versus your LDL-C goals. This is why partnering with an experienced lipidologist who specializes in statin intolerance can help. Your case is even more special because your regimen needs to fit an endurance athlete’s lifestyle (I refuse to believe your tibia fracture can permanently set you back! We will cheer you from the sidelines to start running again once recovered!!!). Again, with the usual caveats to take anything a stranger online will say with a grain of salt and to partner with your doc:
1) Since your presentation is primary prevention and not secondary prevention due to ACS, it means you can probably afford to go “low and slow”.
2) Depending upon your level of intolerance: if very intolerant, might start with 2.5 mg or 5 mg rosuvastatin once weekly. If you can tolerate, can start or titrate to twice weekly (eg. Mon/Thurs) or 3 times weekly (eg. Mon/Wed/Fri) 2.5 to 5 mg rosuvastatin. Switching to fluvastatin or pravastain is also on the table if the above does not work. Also, you can further titrate rosuvastatin dose to achieve your goals or add ezetimibe help achieve LDL-C goals if needed. PCSK9 inhibitors are also available, but is much more expensive and not sure if it is cost-effective for you.
3) The elimination half-life of rosuvastatin is ~19 hours. It will take about 3-5 doses on whichever regimen to achieve “steady-state”, to see where you land before making further changes or titrations. Suffice to say, intermittent regimens will result in higher “peak trough fluctuations” in plasma concentration. You can leverage this peak trough fluctuation to your benefit in terms of timing your exercise sessions!
4) I would take the statin at night (ie, before bedtime). While long duration statins like rosuvastatin tend to allow time of administration at any time of day, you are trying to get the most “bang for your buck”—most cholesterol synthesis occurs at night, which means at least on those days you take the statin, the highest concentrations of the nightly-administered statin occurs at the time when it is most needed. Taking the statin at night also gives you a practical way to manage exercise... next bullet
5) Taking the statin at night on an intermittent regimen means the daytimes on the days you take the statin are “trough” or nadir levels of statin in your body and may be the ideal days for your higher intensity exercise sessions. For example, if you are due to take your statin Monday night, Monday morning could be you higher intensity or longer training session day.
6) Preface—this is REALLY anecdotal and NOT evidence-based: but for really big exercise days, eg a triathlon race, you might consider pausing your statin for 3 or more days before (which is >3 elimination half-lives). Big races result in CK releases (or muscle injury pattern) in even healthy people without medical conditions, and people on statins are shown to have even higher CK releases. SInce you are in the primary prevention category, you might consider this since races are few and far in between and should not unduly affect your overall “time under the curve” on LDL-C reduction.

Take care and good luck!





My response in the that thread quotes the studies proving importance of statin Rx.


In answer to the question, most active patients tolerate needed statin medicine just fine. I have quite a lot of patients who have known CAD/with or without revascularization, or risk equivalents like abnormal coronary calcium scores who are on drug therapy and continue to train and race without any issues at all. This list includes: people who do every aerobic sport, including lots of triathletes.

Depending on why you are taking a statin, the path to achieving the desired LDL level can be fast or slow. My patients with ACS (acute coronary syndromes) or AMI (acute MI) have no choice but to begin high intensity statin immediately and we deal with side effects and taper the med as able, when able. Most people placed on a statin take it for primary prevention-not secondary prevention: ie to prevent the first cardiac event. There is often less urgency and additional non-drug Rx can help lower the need for medication. Eating better, exercising regularly (*less of an issue with most, but not all, triathletes) and losing weight helps lower lipid numbers. I usually start low and titrate up to the needed dose to achieve an LDL goal of 40-70 for patients with known CAD or risk equivalents *(this includes any abnormal coronary calcium score or having a CT scan with vascular/coronary calcification). There is no evidence that CoQ10 works via studies, but I do encourage those with myalgia to try it.

Also, since this always comes up and people want to know what the real risk is about competing in triathlon once diagnosed with heart disease...so to be complete, I'll throw in this one
'Sudden death in triathlon'
https://forum.slowtwitch.com/...riathlon_P6427784-2/

I do wish you the best!

Please discuss options and any concerns with your MD, and be honest about side effects. Sometimes there is a perceived association with a med that may or may not be valid. Cardiac health is almost always most important for all, although the better we get at treating heart disease, the longer the patients are living and now getting CA...


edited this thread to add these LDL-C studies:

Bigger, broader and better 'Evidence Based Medicine' clearly shows that lowering LDL-C is associated with risk reduction and statins are a very useful mechanism for achieving this.


The Cholesterol Treatment Trialists Collaboration-CTT (dec LDL-C 22% less CV events --90,056 pts)
Heart Protection Study-HPS (same benefit in each tertile of baseline LDL--20,536 pts)

PROVE IT, TNT, FOURNIER (more intensive treatment=lower LDL, even fewer events)

above from PROVE IT

MIRACL (Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering), PROVE-IT (PRavastatin Or atorVastatin Evaluation and Infection Therapy) and IDEAL-ACS (Acute Coronary Syndromes) studies outline the benefits of high-dosage atorvastatin therapy started within 24-96 hours, 10 days or 2 months, respectively, of an acute coronary syndrome. Relative to placebo, pravastatin and simvastatin, atorvastatin reduced the risk of death or major cardiovascular events by 16-18%

ASCOT-LLA (Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm), revealed that atorvastatin reduced the relative risk of primary coronary heart disease (CHD) events by 36% (p = 0.0005) compared with placebo in patients with hypertension.

followed by NCEP (National Cholesterol Education Program) committee update-new goal for high risk pts=LDL<70

followed by ACC/AHA Guidelines change in 2013 (tried to be fully evidence based)

ALLIANCE (Aggressive Lipid-Lowering Initiation Abates New Cardiac Events) and GREACE (GREek Atorvastatin and Coronary-heart-disease Evaluation) trials highlight the benefits of atorvastatin in the 'real world' setting in patients with stable CHD. Compared with 'usual' care, atorvastatin reduced the risk of nonfatal MI by 47-59%
IMPROVE IT Among 18,144 patients, there were 9,545 total PEP events (56% were first events and 44% subsequent events). Total PEP events were significantly reduced by 9% with ezetimibe/simvastatin vs placebo/simvastatin
IDEAL- TNT (Incremental Decrease in End Points Through Aggressive Lipid Lowering) and TNT (Treating to New Targets) trials demonstrate the preventive efficacy of atorvastatin in patients with stable CHD. Relative to simvastatin (in the IDEAL trial) and low-dosage atorvastatin (in the TNT trial), intensive atorvastatin therapy (80 mg/day) reduced the risk of nonfatal myocardial infarction (MI) by 17-22% (p < or = 0.02).

more statin decreasing stroke data
SPARCL (16% reduction in CVA in group without carotid stenosis and in the group with carotid artery stenosis, treatment with atorvastatin was associated with a 33% reduction in the risk of any stroke)

2018 ACC/AHA Guidelines states "This confirms the general principle that 'lower is better' for LDL-C".
2019 European Sociaty of Cardiology Guidelines states "Throughout the range of LDL-C levels, lower is better".











Table 1
Randomized cardiovascular outcomes study with high intensity LDL-lowering therapy in patients with coronary artery disease.
TrialMean Reduction in LDL Cholesterol; mmol/L (mg/dL)OutcomeRR (95% CI) (per mmol/L)CTT meta-analysis (high-intensity vs. standard statin; subgroup < 2.0 mmol/L) [17]1.71 (66) vs. 1.32 (50)MI, CHD death, stroke, coronary revascularisation0.71 (0.56–0.91)IMPROVE-IT (ezetimibe plus simvastain vs. simvastatin) [12]1.55 (70) vs. 1.40 (54)CV death, MI, stroke, UA, coronary revascularisation0.94 (0.89–0.99)FOURIER (evolocumab plus high-dose statin ± ezetimibe vs. high-dose statin ± ezetimibe) [19]2.37 (92) vs. 0.78 (30)CV death, MI, stroke, UA, coronary revascularisation0.85 (0.79–0.92)ODYSSEY OUTCOMES (alirocumab plus high-dose statin ± ezetimibe vs. high-dose statin ± ezetimibe) [20]2.37 (92) vs. 1.37 (53)MI, CHD death, stroke, UA0.85 (0.78–0.93)
Open in a separate window
CHD, coronary heart disease; CV, cardiovascular; MI, myocardial infarction; UA, unstable angina.



Last edited by: dtoce: Sep 20, 23 9:56



I have PM'd you for your latest question-
Dale

great news of the follow-up. Also, some incredible info from dtoce and the slowtwitch community on these threads.

Looks like we have a similar path. After getting in to see the cardiologist in September we agreed to follow up with the CT angiogram which I had early this month. The results:

CAD-RADS 2 - (25-49%) Mild non-obstructive coronary artery
atherosclerosis.There are no significant luminal stenoses

This was a huge relief and after going through the entire summer being told to avoid max HR my cardiologist told me I was good to go for racing and to continue leading a heart healthy lifestyle and follow up in a year.


So, after "worrying" all summer a heart attack was imminent, it turns out I'm ok. I think I now understand why the medical community doesn't want us all rushing out to test ourselves. The high score from the coronary calcium test led me down the path to a stress test which, according to my cardiologist, produced a false positive, which then warranted a CT angiogram which showed I was "ok" which is what I thought I was until I had the high coronary calcium score. I never presented with any of the typical heart related symptoms.


I'm sure the coronary calcium score has helped a lot of people but in my case, I believe it led to unnecessary testing, a poor summer of racing (<max HR), and a lot of unnecessary worrying. YMMV!

I'm not an expert by any means, but I guess my takeaway would be different. 25-49% atherosclerosis means you do have heart disease -- again I'm not an expert but my guess is this puts you at least in the worst 10% of people, which means you are at very real risk of a future heart attack. And by finding that out now you can both keep an eye on it, and also take actions to prevent it. The coronary calcium score was a fairly cheap way of finding out that you might be at risk, then the CT angiogram was a more expensive way of verifying that you didn't need a more drastic approach *yet*. But even the CT angiogram is very cheap compared to treating you for a heart attack, let alone the associated possible loss of life and quality of life. In my case I kind of wish I'd known I was at higher risk 10-20 years ago, as I might have acted a bit differently had I known.

Lanier

Those are extremely wise words. I couldn’t have said it better myself…

I didn't know what CAD stood for before this summer. Now I know a little bit more and yes, it's not the best thing to have but it also sounds like it is very common for people eating a western diet. At almost 70 I'll take a CAD-RADS 2 score vs something higher. Out of all of this I am now on a statin and baby aspirin so hopefully that and a healthy lifestyle will keep the CAD under control.

I'm still conflicted on the statin because since starting it there have been a few occasions (maybe once a month) where I feel horrible post workout. But on the plus side, lately I feel like I can breathe so much easier during intense workouts. Something with my body has changed.

Now what I really want to know is if I race a guy in my AG who has no CAD does he have a performance advantage :)

I was wondering if anyone responded to you about best way to get these tests done in or travelling from Canada.
I’ve only found a couple private labs in Canada that do as part of expensive overall packages including body scans etc.
My 50-year old brother passed away suddenly last week in BC. The only thing they were able to find on autopsy was 60% blockage in left anterior descending artery. He was deemed cancer free after a colorectal tumour was found earlier this year and was on a last days of very optional precautionary chemo to help prevent anything from coming back.
We have no known heart disease in my family besides my 90 year old dad finally passing of a heart attack (hardened valves). So we are pretty shocked and the rest of us would like to see where we are at.
He was active, thin, good diet.
I don’t know if side effects from chemo can increase any risks of having such a blockage, but I am pretty sure my brother would have opted out of the chemo to concentrate on his heart if he’d known.
So, super massive cautionary tale both on doing earlier cancer screening for colorectal cancer and any testing on heart health. When you are youngish, thin, active and don’t have family history, it seems extremely hard to have things taken seriously. When my brother started passing blood over two years ago, his GP just told him it was likely hemorrhoids and my brother had to advocate strongly for himself to be tested further 18 months later.

Not really, no.
I don't live far from Maine, but even after lots of googling it wasn't clear where/how I could have it done there.
I have a brother who lives in Florida, so may look into it again if I get down there to visit him sometime.

I got my first CAD diagnosis this summer from a simple back x-ray looking for source of lower back pain. I wasn't aware that they could see calcification in your aorta from what seems like such a simple test.

It was a shocker for me that led me down the path of the coronary calcium score, stress test, and then CT angiogram and finally a CAD 2 diagnosis and a lifetime (hopefully longer) on statin and baby aspirin.

I know it won't be popular with the medical community here but why not complain of lower back pain to your primary care, whether you have it or not, to get a picture of the condition of your lower aorta?

Someone with more knowledge of CT scans can correct me if I am wrong but it seems almost any facility with a CT scanner should be able to do this test for you. Call any of the larger medical centers, in Maine, and ask for the radiology department. Someone there should be able to tell you if they do this test or not. I paid $80US for mine but I've heard prices vary from $80US to $160US

Sadly-you need an order from an md

Recently had mine done as part of heart health screening. I paid $99 and it included the scan, ekg, and lipid panel. Wasn’t having any symptoms but had just turned 50 and wanted to get a baseline. Thankfully score came back 0. Only remarks on report were marked bradycardia (which I expected as my rhr is low 30’s) and incidental note of aortic valve calcification, consider bicuspid aortic valve and/or aortic valve stenosis.

---

Let food be thy medicine...

I’m so sorry for your loss-

Thanks.

Yes. My bad for not pointing this out. Thank you

Following up on my score--while I got the test done weeks ago, they did not release my score until today, when I met with my doc. 62.5. I'll be starting aspirin and re-evaluating in five years to see if I need to add a statin.

Again, thank you so much to everyone who has contributed here. There is so much helpful information, and I appreciated it.

Following up on my score--while I got the test done weeks ago, they did not release my score until today, when I met with my doc. 62.5. I'll be starting aspirin and re-evaluating in five years to see if I need to add a statin.//

I'm no doctor, just a couple decade heart patient now with a lot of first hand experience and those of many others who have posted here over the years. I got a fairly low score first time out about 6 years ago(half your score), but I then did one each year to see if I could discern any patterns. Each year it went up a bit until it was around your score, and that is when I got recommended to start my statin. Super low dose and I do it every other day for the lowest possible chance at side effects. So far so good, and last score was only up 3 points. Doc is pushing to up the dose last visit, but I'm resisting and cleaning up my diet to try and get the same result.


I suppose all of this is to ask you why wait? You have heart disease now, I think many would recommend a very light regime like I have been doing. Not sure how old you are, suppose that could make a difference, but just something to think about. If I had waited 5 years for my 2nd test, it would have tripled in that time and I wouldn't have arrested it as quickly. But understand a lot of regular docs just aren't as aggressive with folks, but as athletes we want the most our of our bodies, not the average...

This is a fair question. He gave me two options: aspirin and wait and see, and low-dose statin. He felt comfortable with both as my LDL is under 100. I will have blood panels again in a year and if the LDL is over 100, I would likely go on the statin. He stated the 62 was extremely low risk for heart attack, which was my main concern. If my next CAC is over 100, I would also go on the statin.

Your point is something to think about--although I thought the aspirin would arrest my CAC score, in theory.

Well, geez now I have something to think about--I didn't think scores would go up that quickly. Hmmmm

Well hopefully Dr Dale will see this and chime in. I consider him to be the foremost expert in this area for athletes, a category that most doctors dont consider as any different from their couch potatoes..

Crazy this popped up..

headed to get my calcium score right now and an mri on this shoulder.
two birds one stone.

5 years ago my score was 0

daved

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http://www.theundergroundcoach.com

current guidelines sort of have it the other way around, IMO...
best use of cor scoring should be with the MESA calculator, 10 year risk calculator and a reasonable discussion about choices and risk

using coronary calcium scoring only--what I recommend:
0-repeat cor score in 3-5 years-no need for asa or statin
1-99--is best treated with statin to goal LDL~<100, no asa needed
100-400-baby asa and goal LDL <70
over 400-above with surveillance stress test

the rec from the 2019 ACC paper said any CACS>0 was associated with a net benefit from statin Rx by 10%

using mesa data in non-diabetics, there is a net benefit of asa Rx when CACS is >100
also a net benefit of asa for primary prevention when the 10 year risk is >10%

Discuss with your own MD...good luck

Thank you— and Monty too for the push. This is exactly why I wanted my score before my appointment, but they refused to release it. Now I actually have questions, but my appointment is over.

Partly based on reading this thread, and partly on learning more about family history of heart disease that's way more significant than I knew, I got a calcium score test done a few weeks ago. Among other things, my mother had a situation when she was my age - moves to a new town in her 60s, goes in for some routine tests and is admitted to the hospital right away after test results showed significant blockage in 3 coronary arteries - triple bypass done the next day after the results came back. Her doctor put it to her this way, as she told it: You can have the surgery to fix this before the heart attack that's coming your way, or after it if you survive. Some of the language in my results are unfamiliar to me but if I read between the lines correctly, something needs to be done and sooner is probably better.

FINDINGS:
CORONARY ARTERY CALCIFICATION
Left Main Coronary Artery: 0
Left Anterior Descending Artery: 250
Left Circumflex Artery: 135
Right Coronary Artery: 26
PDA: 0
Other: 0
Total Calcium Score: 411
No pulmonary parenchymal, hilar, cardiac, pericardiac, chest wall, or
osseous abnormalities are seen.

IMPRESSION:
1. Total calcium score is 411, which is between the 50th-75th
percentile for males between the ages of 60 and 64.
2. No significant extracoronary pathology.

Comment
A score over 400 indicates an extensive plaque burden with a high likelihood of significant coronary stenosis (Rumberger, Mayo Clinic Proceedings 1999; 74; 243).

Your score, and mine (433), are very close. My CAC breakdown was significant in my left anterior descending and my right coronary. All the others received a zero.

My doc wanted me to start a statin and aspirin, and he also suggested more cardiac testing.

Definitely get in touch with your doc about the next steps needed to protect your health (and further evaluation).

Keep us updated.

Just had mine done recently as I’ve had historically high cholesterol as does my family. Doc wanted me on a statin, but I said I wanted a calcium score first.

39 years old and about 25 lbs to comfortably lose. Lots of low hanging fruit with diet. Still racing long course tri but not competitively, more just to finish and enjoy myself.

Score was 0.46 in LAD only.

I’m not going on meds yet. Although I am curious about soft plaque and would be tempted to pay for that out of pocket.

It simply warms my heart that this thread has had such a meaningful impact on the triathlon community.

♥️🏊‍♀️🚴‍♂️🏃‍♂️😃

Cheers to you EyeRunMD!

Yea Id say this is a thread that carries a lot of value and should continue to help those in the future. I appreciate your contributions as well as the other links you provided. I've read them through a couple times each. And massive thanks to EyeRun for his candor and starting this. I will say this thread was the push for me to go get this done.

I do have very high cholesterol but I dont fall into one of the four groups you alluded to for statin rx. Been a stressful couple of years and I've put on a decent amount of weight and have completely tanked my diet. I'm eating like a petulant child avoiding veggies and binging on carbs. I've also lost a lot of my lean muscle.

I was happy to get the low score although in my head even though 0.46 starts with a zero, its not a double zero. I just need to get my diet under control and start some more resistance training then keep an eye on my blood panel. Thankfully no family history of heart disease. Fingers crossed.

Thanks again for your contributions.

i'm glad you've gotten some insight and 0.46 is awfully close to 0 but not quite...
don't get confused with CAD/plaque risk and diet-

you should eat healthy for life and that is really best with a plant based diet, lower carbs, not a lot of fat and enough protein
it is more about best risk behavior and my last post using the risk calculators and mesa and CACS are now in the spotlight-which could change as the data evolves

I'm pretty sure if I had that score at 39 and had a low 10 year risk that I would not go on statin, but I'd likely pay for a CTA out of pocket to look for soft plaques, which might change my mind...it's a new world and I'd like to be alive for my kids weddings

I do appreciate the feedback-thanks
and yes, mad props to EyeRunMD-

Thanks y'all.

Others have written about coronary calcium scoring as well but I am glad this thread has been an avenue of discussion, awareness, and education (big thank you to dtoce for this). Cardiac issues can be scary, especially when you read about other athletes dropping dead during an event. or looking like the "perfect" physical specimen and then requiring triple bypass. It can also be somewhat depressing to believe you are doing everything in your power to have a "healthy heart" and then realize you can control some factors but you cannot control everything. Hopefully others can continue to chime in with their own results/stories.

Thank you EyeRunMD for starting this thread, dtoce for your contributions, and the rest of the posters for the much-needed information.

I just turned 35 and am regularly exercising like most here, but with a problematic family history of heart disease. My father and grandfather both died from a heart attack before turning 59. I have two or three uncles who got angioplasties before they turned 60. They were all lifelong smokers. The rest of the paternal side of my family has naturally high cholesterol levels. I knew early on that it was hard to escape genetics, which is why I've never ever smoked and got into endurance sports since high school.

Early this month, I did my annual physical exam with the usual lipid panel, blood count, ECG, treadmill stress test among others. My cholesterol levels have averaged at the low 200s since doing annual tests back in 2013. LDL was at 164 mg/dL which is close to the average over the past 5 years. Obviously, my diet can be better.

However, they found probable signs ischemia during peak exercise during the stress test which hasn’t happened in the past. I got a referral to consult a cardio and found someone specializing in adult/interventional cardiology with further experience in sports cardiology. Like EyeRunMD, I was asked to do a cardiac CT scan and a stress echo. He also prescribed 10g of rosuvastatin for 2 months. I’m trying to take note of any side effects. For now, I feel some numbness in my left glute and leg, but I’m not really sure if that’s from the statin.

Currently waiting for the result of my scan and scheduled for the stress echo next week. Will get back with the cardiologist by the second week of December and am hoping for good results. Like many here, I’m afraid of being the fit guy who suddenly drops dead especially at my age. Anyway, this thread has been very helpful in understanding CAD and things to mitigate the risks involved.

Had the talk with my local doctor about the results. The actions to take at this point are:

10 mg rosuvastatin / day. My cholesterol is too high (total is about 220) but it's been stable for many years. Blood pressure has always been good.
1 baby aspirin / day
increase fiber via supplement or other means (we already eat quite a bit of various leafy greens).
reduce animal fat load (smaller portions, reduce frequency). We eat very little butter, cheese, bacon, so this winds up meaning that we eat less fatty meat (e.g., lamb) and add in some protein from other sources.

I've got no shortness of breath or chest pain. I'm back to running after having covid in late october / early November. Pay particular attention to the onset of either of these symptoms during runs; increase intensity very slowly.

Consult with a cardiologist about the need for a stress test and assessing the extent of artery blockage.

I somehow missed this--



Obviously, you need to consult with a cardiologist and IMO, get a stress test done to see if your known, extensive plaque is or is not associated with significant blockages.

As I previously noted for another poster:

best use of cor scoring should be with the MESA calculator, 10 year risk calculator and a reasonable discussion about choices and risk

using coronary calcium scoring only--what I recommend:
0-repeat cor score in 3-5 years-no need for asa or statin
1-99--is best treated with statin to goal LDL~<100, no asa needed
100-400-baby asa and goal LDL <70
over 400-above with surveillance stress test

the rec from the 2019 ACC paper said any CACS>0 was associated with a net benefit from statin Rx by 10%

using mesa data in non-diabetics, there is a net benefit of asa Rx when CACS is >100
also a net benefit of asa for primary prevention when the 10 year risk is >10%

My patients with CACS > 400 all get surveillance stress testing and a discussion about types of symptoms which warrant more urgent evaluation. I advise pts to take it easy until the evaluation is complete.

I've found about 1/3 of patients with extensive plaque (CACS>400) have abnormal stress tests which prompt cardiac cath...
ASA for life. Enough statin to achieve an LDL of <70 and lifetime vigilance for symptoms which could be cardiac.

Good luck to you.

Hi Dtoce,

I have yet to hear from my doc via the portal his recommended statin and dosage, is it okay for me to ask you to make a suggestion? I'm keen on having a perspective from a doc with an eye toward endurance.

Thank you,

Meg

So here is a good news/bad news story regarding this thread. I posted my journey to a diagnosis of coronary heart disease this summer and the coronary calcium score test was a big part of it. Besides sharing my story here on ST, I shared it with the masters swim group I've been swimming with for almost twenty years. Most all the members are now good friends.

One of them, a gentleman a few years younger than me and a triathlete had already followed in my footsteps with prostate cancer, and had his prostatectomy earlier this year. I've been sharing recovery milestones with him throughout the summer.

When I told him about my coronary calcium score test, he was interested in how it led to my CAD diagnosis and so he scheduled one himself. He was very surprised when it came back over a 1000. His doctor ordered a coronary angiogram and he got the results today: three major blockages. He is now scheduled for a triple bypass!

I'm so glad he caught it before anything bad happened and I feel that my story led him to pursue his diagnosis. So, a big shout out to ST for promoting the coronary calcium score test as it was a big reason that I got mine and I was able to pass the recommendation along to a friend who as it turned out really needed it!

You are a good friend indeed!

This shows how strange it is Test isn’t paid for by most insurance and not recommended by more doctors

It’s one of the very lowest cost tests there is even out of pocket

As I alluded to in my post-

For my pts with a score of 62,
I’d start low dose statin-low dose 3rd gen statin and slow push to a goal of ldl<100

I usually use Crestor 5 mg qd or qod depending on the starting ldl
Aspirin not needed

Repeat cor score in 3-5 yrs

Recheck lipids in 3-6 months

Thank you for the specifics. I feel much better about this process.

This x1000. My cholesterol was/is very high. Familial history with mother, father, and aunt (my primary also sees my parents and worked alongside my aunt in the same medical group). I was having a very odd and scary thoracic pain earlier in the year. Saw my primary and he wanted to do a calcium score test after bloodwork but my ins co denied it the day before.

Why? Because the risk factors are for people 40+. .....I'm 39!

I fought with them and with my primary who wouldn't do a peer to peer for me. I mean I dind't have a problem shelling out the $99 but it was more about the principle.

Ins cos make me furious.

Thats a great outcome! Very happy to hear you were able to help steer him in the right direction that was without a doubt life-saving.

Talk about a thread that delivers.

Wow TJ56, that is a great story! You have likely helped to save your friend’s life by making him aware of this issue, and then him taking the next steps to be evaluated and treated. Major kudos to you!

If you have no rate-limiting or exertion impairments, especially when you exercise, then your coronary arteries are patent. In which case, almost irrespective of your calcium score, means that no intervention is required beyond modification of typical risk factors - sugar control, cholesterol, blood pressure, smoking cessation.

Even if some of your coronaries are blocked, if you have no symptoms with exercise that means you have strong collateral vessel formation, which again means no intervention is required.

Chest pain, shortness of breath, and exertional limitations are really what guides treatment for coronary disease. Otherwise it's all about prevention.

Vast majority of sudden cardiac death is related to cardiomyopathies (specifically congenital/genetic ones), not elevated calcium scores.

Hope that makes sense.

With the talk about high blood pressure I thought I would add this

I was at approx 14x/8x. For a year + Dr wanted to put me on meds

I started taking 3 tablespoons of ground flax seed every day 3 weeks later numbers were (and 6 months later still) 120 or lower over 7x

my wife consistently (2 years) high 130s over 8x

Started flax liquid. 1 month later consistently 120/ mid 70s

Doesn’t seem possible to me but I have the logs showing it did happen

Dr has confirmed for both of us

got my calcium score done.. NO dye this time or contrast of any kind.. I was in and out of there in like 5 min. Not joking
the worst part was tearing off the sticky NODES they put on me.

anyways. calcium score was zero

daved

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http://www.theundergroundcoach.com

That's an impressive improvement.

For me, my BP was being measured in the 14x/8x range each time I was at my doc's office. He was concerned....of course, considering my higher cholesterol and the high CAC score.....but I told him "I believe I have White Coat Syndrome because I never get BP measurements this high when I randomly check it on my own". So, he had me start a log for my measurements over the next few weeks. I checked it 2-3 times per day and documented it. It was almost always 11x/6x each time. He was pleased with this,

I'm glad your BP measurements are improved.

That is excellent.

Yeah, when you are only obtaining the calcium score, it is a quick easy test. If you needed the CT angiography, that would require dye and takes a little longer.

Just remember, the CAC is a screening tool and does not 100% mean you are without risks. After obtaining my score, I started reading up a lot about others who had this done, and there are a number of people who had a CAC score of zero who still reported an MI. Pay attention to your risk factors and/or symptoms.

Very well said, but there's low risk and very low risk.

A 0 is very low risk.

In reality, the data suggests about 0.04%/year risk of an event. In cardiology, we try to get risk down to <1%/year.
The problem is that the cor score does not show vulnerable, soft plaque...that's what can rupture and cause an event.

How Low-Risk Is a Coronary Calcium Score of Zero? | Circulation (ahajournals.org)

The (not so) joys of living in a small mountain town. Got the referral to a cardiologist. I was told that we have exactly one here in town at the hospital (La Grande, OR), and they are sufficiently overloaded that if you're not dying (more or less) you don't get on the schedule. The next-nearest one is in Walla Walla, WA, about 90 minutes away at Providence hospital heart center. It's a pretty drive so I don't mind it, although winter here is nasty so I was worried about being able to get over the Blue Mountains in winter. That won't be a problem, as the earliest appointment they have in the beginning of March 2024 :-( .

I apologize for not remembering if you posted it or not but have you already had your calcium score done? And now need to see a cardiologist? Or are you wanting to see a cardiologist to get the test ordered/done? dtoce can correct me, if I am wrong, but I assume your local primary care doc should be able to order the coronary calcium test as well (and it should be able to be done at a local facility with CT scan capabilities)

see post #93

He had it done-it's over 400.
He's on asa and statin

needs stress test and discussion of plan with a cardiologist

I'd aim for an LDL goal of <70.

get the consult (and hopefully stress test) done as soon as possible...

edited to add:
I've seen at least 3 of my recent patients at the hospital for follow of their elevated cor score
>leading to a stress test-which was abnormal>leading to a cath showing severe coronary disease>leading to a stent in 2 of them and CABG in the other

(*and this is just in the last week)

as I've said-in my practice, about 1/4-1/3 patients with markedly elevated cor scores needs further evaluation and wind up getting PCI-stent or CABG

No worries; it was a bit context free. I was mostly grumbling about how far out the appointments are here. I had the calcium score done:
------
Left Anterior Descending Artery: 250
Left Circumflex Artery: 135
Right Coronary Artery: 26
IMPRESSION:
1. Total calcium score is 411, which is between the 50th-75th percentile for males between the ages of 60 and 64.
2. No significant extracoronary pathology.

Comment
A score over 400 indicates an extensive plaque burden with a high likelihood of significant coronary stenosis.
------
The more I ask about family history, the worse sounding it gets - both parents had high cholesterol & high BP; between my mother and 2 uncles they have a double, triple and quadruple bypass (+ stents) among them, and their father died of congestive heart failure. I have a lifetime getting more exercise than the rest of my family put together, so I'm hoping that helps to offset whatever level of genetic risk I've got. I don't know how much weight to give to any genetic factors.

From what I can figure out about the without-contrast test I had, the numbers are not directly translatable into amounts of blockage due to the contribution made by soft plaque this test doesn't detect. My primary care doctor is thinking I may need a stent, but thinks that's a question for the cardiologist; I'm starting to put together a list of questions to ask them:

1) what's my actual/individual level of risk here?
2) what additional tests / measurements would help in answering #1?
3) Beyond a statin, aspirin, diet changes and continuing to get some exercise, is there anything else that could or should be done?
4) I've avoided high intensity exercise since learning of all of this but I still walk the dog or walk with my wife every day. What duration / intensity of exercise is acceptable or off-limits?

I'm not sure if there's anything else I should ask.

Figure 1. Unadjusted Kaplan–Meier Cumulative-Event Curves for Coronary Events among Participants with Coronary-Artery Calcium Scores of 0, 1 to 100, 101 to 300, and More Than 300.
Panel A shows the rates for major coronary events (myocardial infarction and death from coronary heart disease), and Panel B shows the rates for any coronary event. The differences among all curves are statistically significant (P<0.001).


The bottom graph is in every one of my patient exam room...to help explain risk related to coronary artery calcium scores.
There is certainly more to it, but seeing the data just with a focus on the score helps explain some things to patients.

Thanks; this helps. Now that I look at them more closely, the plots for the higher score ranges all have a visible flat section at the right at the 4-5 year mark. Do cumulative incident percentages really not rise after this time, or this an artifact of the study data & design (e.g., maybe they didn't look out past 5 years)?

The reason I ask is I found some of the other threads you posted links to (and things they linked to) and ran across the MESA calculator. I plugged in my additional numbers and got risk rate for 10 years that were higher. Some of the notes at the bottom explicitly mentioned that this was due to the other risk factors entered and even separated out the marginal increase due to calcium score. I'm assuming here that the longer time horizon played a role as well.

Thank you, to you and dtoce, for the reminder.

You're #4 above was me too. Until I had my angiography done, I was super paranoid. I just knew at any moment I was going to be out on a group ride and my score of >400 was going to catch up to me. I was actually doing the SBT GRVL race, in August, and decided to turn and finish the 100 miler, instead of the 141 miler, because I thought "that's probably too much for my heart, and I am out in the middle of no where". Of course, looking back, those were all silly thoughts but it is what went through my head. I saw that score over 400 and felt like I was a ticking time bomb.......yes, over dramatic :)

This post almost gave me a heart attack. Went to the MESA calculator, put in my values, and it gave me a ten year risk of 51.3%! WTF? Dropping the cholesterol and systolic values way down only lowered it to like 40%. I'm going to die, I thought. Texted with a cardiologist (cycling friend) who had previously said my 65-year old score of 20 was great. Rechecked my values...and realized I had put my systolic mmHg value in the kPa box (so got like 500+ instead of 120). Doing it correctly got me down to 4.9%.

Never mind.

---

----------------------------------
"Go yell at an M&M"

Once again units really do matter;)

---

Genetics load the gun, lifestyle pulls the trigger.

You'd think think that from a app design point of view there would be some level of sanity checking / data validation for user inputs. Maybe 500 is possible; maybe it's like a front-tire blowout at 50 MPH. I don't know nearly enough medicine to have an informed opinion. In a quick scan of the javascript for the app I can see where the blood pressure value is converted from one unit to the other, but there doesn't appear to be any front-end validation. The actual calculations are done in some backend that isn't visible.

Out of curiosity, I did find this on extremes of blood pressure measurements.

https://pubmed.ncbi.nlm.nih.gov/7741618/ - The highest pressure recorded in an individual was 370/360.

So this is good?

The estimated 10-year risk of a CHD event for a person with this risk factor profile including coronary calcium is 2.9%. The estimated 10-year risk of a CHD event for a person with this risk factor profile if we did not factor in their coronary calcium score would be 2.0%.

---

clm
Nashville, TN
https://twitter.com/ironclm | http://ironclm.typepad.com

It's pretty darned fantastic. Being female really shows a huge advantage on the calculator. Try your exact numbers with the male box checked to see your XX advantage.

---

Genetics load the gun, lifestyle pulls the trigger.

 
Heart scan cost $99.00 Insurance doesn't cover it unless you've already had a heart attack. Gotta love our health care system. i went because my friend said it was on sale.

I'm a runner and never expected a problem. My score was 800. Three arteries were clear but 4th one the anterior descending was 800. Turns out it's on the outside of my artery??? But it could restrict blood flow if it gets worse. My stress test was great and blood pressure is too. I asked about not taking the statin but they said there's nothing out right now that could do the same job except an injection once every 6 months, but you need to fail 2 different statin attempts to get the insurance company to pay for it.

I started taking the statin Dec. 1 First medication I've had to take steady. it sucks but I like not having a stroke. Gonna be 70 in 3 weeks.

Changing to male upped it to 4.3%.

I do wonder if there have been any studies done on females who have gone through surgical menopause and if there are any differences in risk?

---

clm
Nashville, TN
https://twitter.com/ironclm | http://ironclm.typepad.com

I suspect the numbers aren't out there of your situation to have had warranted a study. The fact that women seem to begin to "catch up" with men in regards to heart disease after they reach menopause would cause me to guess that your risk may well be more male like especially if you procedure was done well before normal menopause age. That said, even if it was more similar to the male number, 4.3% is pretty darned favorable.

---

Genetics load the gun, lifestyle pulls the trigger.

Yes it would be nice if insurance covered the test, but $99 is a good deal for what you get. That’s what I paid and got the scan, lipid panel, and EKG. Hell, most people blow that on dinner on date night.

As I said earlier in the thread, mine came back 0, but the test noted possible bicuspid valve/calcification of the aorta and they referred me to a cardiologist for check up. Appointment was yesterday and he didn’t seem concerned but scheduled me for an echocardiogram next Wednesday to hopefully see exactly what’s going on.

---

Let food be thy medicine...

It's worth shopping around a bit. The first lab I checked with wanted $149. to do the procedure while the second one which is actually much closer to me only charges $49 including the "read". That's about the lowest cost I've seen posted.

---

Genetics load the gun, lifestyle pulls the trigger.

Just got back from the hospital where I visited my friend who had a triple bypass on Friday. I posted earlier that his very quick journey started with the coronary calcium score (he was >1000). He looks really well considering they just cracked his chest and redid some plumbing. It was very sobering for me seeing him there and really makes me appreciate how I and ST (by getting me to get the test) possibly/probably gave him many more years with his family and friends and he didn't end up on a thread here about someone dying in a swim.

I’m glad your friend is doing well. Thank you for the update

In 2022, I experienced "walk-through phenomenon angina," which was chest pain associated with exercise that went away when I slowed to a walk. I would then be able to continue my runs. I talked to a cardiologist friend, who suggested that I was at the right age (50). The basics of the story is that in 2022, I returned a calcium score of 323, but coupled with an stress test in which I ran 12 minutes (and could have gone longer on the treadmill), I had a small chance of an MI, and I started taking statins and aspirin. In March of this year, I had a perfusion test, which showed a blockage of the LAD, so a catheterization was scheduled. On March 28, I had two stents placed in the LAD. Things have gone pretty well since then, and I am back to running and swimming, though both are a bit slower than where I left off from early 2022 when all this bollocks started.

Last week, I helped perform CPR and external defibrillation on man in his mid-50's who collapsed due to cardiac arrest while exercising. By the time I arrived at the scene, my staff had started CPR and had administered a shock. I stepped in and resumed several cycles of compressions, interrupted only by further analysis by the AED. I resumed compressions on the patient, who by this time had agonal breathing: he was gone. EMS arrived and took over care, recaptured a pulse, and transported. Reports after the fact indicate that the patient survived. The cardiac arrest was caused by severe blockages (up to 98%) in all three major coronary arteries. His feedback mechanism was poor and he, like many other men in his 50's, had no prior symptoms until his sudden collapse. Multiple stents were placed. Had this patient not been in a location with trained personnel, his chance of survival would have been less than 10%. At last report, he was talking and somewhat lucid, but had no memories of the incident.

The intersection of two life stories here is interesting. Because I have been active and healthy for my whole life (competitive swimmer since the age of 7, college swimmer, 9 x marathon and 3 x IM finisher, BMI < 25, low BP, no smoking, infrequent drinking, etc), this was chalked up to genetics, which is the same as with the patient.

I encourage men in their late 40's and early 50's to consider comprehensive tests for heart disease. These may be expensive, but are worth it as diagnostic which can lead to preventative measure. I was able to avoid the MI that I was genetically destined for. I encourage everyone to be trained in CPR, and if available, the use of an AED. The patient was destined for his MI and cardiac arrest, and I am glad that my training and the training of my staff gave this man a chance.

Great story on so many levels. Good for you and your self-care!

Huge thank you, on his behalf.

Bravo to you-for multiple reasons!

The best thing one can do to 'pay it back' to the world is learn CPR and be ready to help others if a situation were to occur where first responders are needed.
Major kudos for not only getting yourself put back together and now into a lower risk group, but also with helping to save that man's life.


The risk of an event from CAD for the general population in the US is ~200/100,000.
Based on athlete data (*Creswell), it's about 2/100,000 for dying in an endurance event.

Far, far less, but still not 0. I often say 'you can't change your age or your genetics'. At least coronary calcium scoring is a mechanism of determining how much risk there actually is.



With time and training, you'll be right back to your fitness level and beyond-140triguy.
Best to you-

What Endurance Athletes Need to Know About Heart Health - Slowtwitch.com

A 630 CCS wasn't what I was hoping for but now that I've seen it, what are my best next steps?


I'm a 70 year old long time endurance exerciser who bikes regularly in the warmer months and cross country skis as well as Concept II ergs throughout the winter. I've turned to marathon canoe racing for the past 5 years. My diet has been near vegan for the past 5 years and annual lipids testing has usually put my total cholesterol at ~160, LDL in the low 80s although the calculated value was 106 on my most recent test and HDL ~ 52. My Apo-B was 66mg/dl last year. My blood pressure is typically ~ 116/78 with no medication needed. I've experienced some disturbing increasingly noticeable paresthesia symptoms especially from the knees down over the past few years. I've never been prescribed a statin but from what you've mentioned previously assume a low dose of rosuvastatin would be appropriate as a starting point.

I don't presently have a cardiologist and perhaps finding one is one of the most appropriate first steps.

Ought I press for an exercise stress test? CT angiogram? Any other thoughts going forwards?

Thanks so much for your generous participation on this thread.

Hugh

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Genetics load the gun, lifestyle pulls the trigger.

It is alarming to see these high numbers pop up. Definitely talk with your pcp and look forward to a likely cardiology referral

dtoce is the expert in these matters but I‘ll tell ya what advice was given to me after my high calcium score was obtained.

My primary care doc immediately put me on atorvastatin and a baby aspirin, and I was scheduled for a stress test and echo by cardiology. Ends up, a week before my treadmill stress test, I developed a calf strain and could not run. So, the cardiology office rescheduled me for a month later and said if I still could not do the treadmill test then they‘d schedule me for the non-treadmill version. Well, after another few weeks my calf was not any better and I was getting more paranoid I was going to have a heart attack any day now, so the cardiologist ordered a CT angiogram. That helped with more clarity for how bad, or not, my coronary arteries were after getting my high calcium score.

This has become a very long thread and it may be best to summarize what to do for those with markedly elevated coronary scores...


Since you need an order to get this test done, the first step is always to discuss the results with the provider who ordered the test.

Guidelines suggest all patients with coronary calcium scores over 400 begin ASA (aspirin) 81 mg daily and start statin to achieve a goal of an LDL<70.
Patients should also get an ischemic evaluation (stress test) to evaluate for critical blockages in the coronary arteries.
This is done because there is significantly elevated risk in the group with marked coronary artery calcification-even in the absence of any symptom of concern.

Risk is also concurrently assessed using the MESA risk calculator and ACC risk estimator.

https://www.mesa-nhlbi.org/...Score/RiskScore.aspx


https://tools.acc.org/.../calulate/estimator/




These are a few graphs showing the risk :







Dr. Aaron Baggish did find that there is a group of endurance athletes that is paradoxically low risk and wrote an article about these patients.
https://www.ahajournals.org/...LATIONAHA.117.028750

This was the definitive article from the ACC regarding Coronary Calcium Scoring and Risk which came out in 2019
https://www.acc.org/...-cardiovascular-risk

Once a high score is obtained, patients should obtain a cardiology consult. It is always prudent to maintain an active lifestyle without pushing it from an activity level until the consult is obtained and treatment and testing is scheduled.

Good luck.
D. Toce MD FACC

Thanks so much for the, as always, reasoned and very helpful reply. My GP and I discussed the results yesterday and he's put me in charge of finding a sports oriented cardiologist. I'm lucky enough to have a good friend in the medical field who is helping me with that.

So I take it that my killer 4 X 8 minute super intense erg intervals ought to go on the back burner until I'm cleared but my long zone 2 bouts are probably reasonable and will keep me sane.

I'll report back to the thread as things progress.

Hugh

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Genetics load the gun, lifestyle pulls the trigger.

Dr. Aaron Baggish did find that there is a group of endurance athletes that is paradoxically low risk and wrote an article about these patients.
https://www.ahajournals.org/...LATIONAHA.117.028750//

That was an interesting study, but as it says, dont take anything conclusive away from it. I have always wondered if the higher #'s of CAC scores in athletes, wasn't from the increased amount of food that an endurance folks eats. I mean food is a big input along with genetics, so someone that eats twice or more food, wouldn't that be a bigger input(if negative)?

I mean diet if often used to help correct scores(cholesterol mainly), so food, what kinds, and perhaps amounts will be inputs when they finally sort out all the studies, and bring new ones online..

Just wanted to drop back in and say thank you to everyone again. I've been on the low dose of Crestor for four months now and had my bloodwork done for a new cardiologist who is more on top of research and who understands athletes.
My LDL dropped from 90 to 55! Pretty stoked with that. He ordered an ANA blood test for inflammation factors and while I do have a "fine, dense speckled pattern" I don't have any rheumatoid factor involved. So, we still have some puzzle pieces to figure out in terms of contributing factors to my heart disease, but I will take the W with the results of the statin.

I very much appreciate everyone who chimed in--looking at you too, Monty--your words matter.

xoxo

Meg

Thanks for the update. I’m glad the testing is moving along and you are responding well to the Crestor

Here's my quick update. I'm a 70 year old, very active cross country skier, cyclist and fairly new marathon canoe racer. My lipid numbers have been very good for at least the past 5 years but in running all my numbers through an ASCVD risk calculator I was surprised to see it recommend a statin. My GP who knows my eating and exercise habits had never brought this up to me but when I asked him for a prescription for a self pay coronary calcium score to help me decide if it actually made sense to go on a statin he said sure. Just before Christmas I had a scan done, figuring it would come in with a nice reassuring low number. The 630 was an expected surprise that caused a good deal of ramped up anxiety. It took a couple of months to see a cardiologist. Based on my CCS we decided a low dose of rosuvastatin was appropriate to harden down any soft plaque that might be lurking and an exercise stress echo was scheduled.

For the stress echo I was a bit surprised when the doctor "calculated" my maximum heart rate based on the old 220-age equation rather then the more modern equation for men that runs something like 207- (.67X age in years) or even higher max I've hit several times in the past year. Long story short, I never broke a sweat and could easily gone one many more minutes. My ECG and echo looked fine with no ST depression. I was told not to worry, call if things went south and come back in a year. To be honest I would really have preferred to competed the treadmill test to exhaustion but do understand they don't want patients keeling over on them. I was also advised to have another lipid panel in a few months to see the effect of the rosuvastatin. I resumed quality intervals on the erg and am now nearly back to last year's fitness after laying of intervals for much of the winter. Zone 2 may lay a nice base but isn't the icing on the cake.

YMMV,

Hugh

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Genetics load the gun, lifestyle pulls the trigger.