bentus wrote:
This is exactly why sometimes diagnostic tests are not that good of an idea. Now you are scared and feel like you got to act on it. When your stress test is fine and you have no symptoms, I see no reason to go for a CT or a coronary angiography other than your doctors wallet. Do you have any other risk factors?
This is exactly why you should not get medical advice from the internet...asymptomatic people die from undiagnosed CAD every day.
trinerd1 wrote:
No other risk factors other than my age. I feel good, no symptoms. He recommended the test because of my cholesterol. We had a discussion whether total cholesterol is the bad number or if the ratio of HDL is the number to look at. My HDL is out the roof, triglycerides very low, about 130 ldl which isn't great. He was honest and said there is a big debate over the most important numbers so here comes the CT scan. As said previously, I don't know what to say. I think this indicates preliminary heart disease, yet I'm doing marathons, long trail runs, ironmans, etc. Don't know how to progress from here.
Age is all you need. Consider getting a second opinion if there is 'debate' over the meaning/importance of your numbers or what to do with your results. You should go over this with your doctor and make sure your questions are answered and you understand risks and benefits.
That said, I often have my patients pay for a coronary CT scan out of their pocket (with no kickback or violation of any 'Fraud/Waste and Abuse'...) in order to find out if it is likely that they have CAD or not. It is a diagnostic test very specific for coronary artery calcification. The numbers are important as you can identify patients who would not otherwise be treated aggressively, perhaps avoiding a cardiac event. It's an anatomic test, not a physiologic test. It simply identifies plaque, or not. (*I've been able to stop statins in people with calcium scores of 0 too).
A calcium 'score' > 100 is highly associated with plaque in the coronary vessel=CAD. The best treatment option is almost always aspirin and a statin to a goal LDL of ~40-70.
It doesn't mean you can't live life fully and remain active. It means you need to be more vigilant (than previously) for symptoms that could be the
first sign of significant CAD. Discuss it with your cardiolgist.