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

---

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.