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''!

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''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.

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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

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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 .

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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