Great question. I just turned 50 and convinced my doctor to set me up with a calcium score screen. After a positive test result score he told me I was good and not to worry but left me with questioning when to get further blood work EKG etc as I age.

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TEAM ZOOT 2020

I had a-fib and an ablation in 2013, age 43. Made a 100% recovery, Kq 4x since then, with training and lifestyle adjustments.
I could tell you all the stuff I did that he suggested, but by FAR the best thing I did was get a doctor who I trusted and who runs himself. Most docs will simply tell you to back off dramatically as there is no upside in them not saying that, almost like lawyer cya advice.
Also, there is contradictory evidence out there, let your doctor tell you what to do. Have to trust that guy. Don’t hold back when you tell him/her how much training/competing means to you.

Good luck.

Typed from iPad and not spell/grammar checking until Jan 2021. Excuse typos.

That is a great question... A buddy of mine training with Kona aspirations had a family history of clogged arteries. His wife persuaded him to get some mega cardio scan looking for that. He got a clean bill of health on the clogs, but the docs found a massive aneurysm next to his heart waiting to pop. He had open heart a couple months later. If not for the mega scan (whatever it was), the aneurysm likely would have killed him, and they would only have discovered the cause in the autopsy.

Stuff like my friend's is generally rare, and Tom's diagnosis is probably rare in trained athletes. I am curious what kinds of tests are sufficient to find the unexpected stuff.

- coronary calcium scan- How often is often enough? //

I had just heard about this test about 4 years ago, and like any other tests, I think you need a baseline, then occasional checks against that line..I think most docs would tell you to get one, if it is ok, then tell you not to bother for 5 years, like a colonoscopy. But I got my first one, then about 14 months later got another, and it had gone up a bit, too much for my liking. So I. got a 3rd one about 3 1/2 years since the first one, and it had come down from the last one, kind of split the difference of the two. Of course my fear was that it would continue to go up(bad) on a yearly basis, and eventually put me in a high risk category.


So moral for me as usual, I believe there is some +/- in this test, as one doesnt usually go down in a year. As I'm told, once your arteries are clogged, they stay that way unless you take drastic measures, like stents or other roto rooter procedures. I think this is what is missed in Tom's story, he had some bad stretches in his lifestyle where it was accumulating, and it just stayed after he changed his life. Probably what he did was save his life, but it didnt reverse his blockage, and probably was added to, but at a much slower rate. This is what allowed him to be so active all these past years, but it was catching up and a ticking time bomb..


But even if the test is not 100% accurate, as my doc says, it does point you in a direction. If it is a good score, you can relax, if not, then you can go further down the testing rabbit hole. But at least you know what ball park you are in, it is cheap out of pocket, so why the hell not if you care about this stuff??

I'm 46 and getting ready to have a CAC scan done to get my baseline number.

There is a relationship between proper levels of Magnesium, D3, K2 and coronary calcium. Some people are showing a stop to the progression of calcification and even a reversal.

Some people are showing a stop to the progression of calcification and even a reversal.//


Of course I believe you can stop the progress, well most people who dont have some horrible genetic predisposition for buildup. It would also make sense in a few, that perhaps maybe you can reverse it somewhat?? That seems to be the big question, without hard rooting. My guess that some drugs with living the perfect lifestyle(with diet) could help reverse the clog. My last test showed an appearance of a reverse, but I'm chalking that up to the variance in tests, but hopefully? I had been intermittent fasting the entire year, everyday, so maybe it did something.

One of my local hospitals offers an Advanced Heart Check service. You go to the gift shop in the hospital, pick up what looks like a gift card, pay them $99, then call the number on the back and give them the gift card ID number. The actual scan for me took a couple of months to get on their calendar, but no other money, no co-pay, just $99. And you get the Calcium score as well.

"The $99 Advanced Heart Check begins with a 64-slice CT scan that provides enhanced 3-D views of the inner workings of your heart. The exceptional image quality and capability to view inside your heart provides our expert cardiologists and radiologists with the best means to diagnose any areas of concern."


If you want peace of mind for yourself or your spouse, $99 is cheap!

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I'm closer to the feathered end of the spear than the point.

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Indoor Triathlete - I thought I was right, until I realized I was wrong.

All the reading I've been doing agrees with what you're saying - that a fit athlete can "fake" their way through stress testing. In fact, more than one study I read indicates that for asymptomatic low-risk individuals there's little correlation between stress test results and CAD, and the test can generate false positives (and lots of additional testing and worry and expense).

In my mind, the two areas of concern are blockages and arythmias. You can't really "fake" your way through a calcium CT scan, so that seems like a pretty no-brainer way to monitor for blockages. Arythmias are another story. What I've read seems to indicate that a sedentary ECG is nearly useless for detecting potential stress-induced arythmias, so you have to rely on family history and/or prior episodes as the best gauge of whether you're at risk here. From what I'm reading, most home monitoring ECG devices are only going to pick up on something if your'e actually in the middle of an episode, and even then many of them (like the apple watch) can only pick up on afib and not things like long QT or other arythmias.

For STers, getting the CAD test makes all kind of sense. Mine cost me about $200 with no insurance coverage.

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Indoor Triathlete - I thought I was right, until I realized I was wrong.

I am a medical professional but will leave this to DTOCE to chime in, he is one of the few on this forum actually qualified to talk to these issues in depth.
On top of everything else, one thing to keep in mind is personal insurances. My income protection policy is brutal, I was keen on a coronary CT calcium score lately and my friend, a fellow triathlete and cardiologist, warned me of what could happen if it was positive and I did not have all my insurances in place first. We were literally at the point where we were going to do the test under an assumed name in case it shows anything that might need me to get my insurances adjusted first before having anything proper done.

This will be a good thread but the best people to comment are cardiologists.

I'm in the UK and have been going through tests with the NHS for the last 2 years due to ectopic that get worse with exercise. I don't have private insurance, or the money to self finance tests.

I did look into it due to the massive nhs waiting lists, but couldn't find somewhere I could just pay for a calcium scoring or other tests without going through the full on private consultancy route.

Anyway for me initial 24 hour halter monitor showed lots of ectopics, more so when exercising, a while later echocardigram showed no issues other than 'athletes heart' with slightly enlarged ventricle. Some time later exercise stress test was halted due to increasing ventricular ectopics as the test went on.

It was assumed CAD, but another 6 months later that was definitely ruled out with zero calcium score and clear angiogram.

Another 8 months for a cardiac MRI which I will get the results of 2 weeks today! Not sure if I'm expecting some kind of carditis from that or what.

Any how it's been a long stressful time with mixed messages along the way. If you can get the calcium scoring or ct angiogram faster even at a relatively small cost I would go for it peace of mind for you and any family.

I will make a few generic comments but do hope that this doesn’t cause the thread to go astray...I usually only get involved if there is 'misinformation' out there. This is not a Q and A session.


I’ll start, as usual, with The generic disclaimer that everyone should, of course, speak to their own physician more in depth about any questions or concerns that they have regarding their health. The internet is not where you should get/make medical decisions generally. Fortunately, heart disease IS my area of expertise and I have lots of patients who are athletes, the majority (*but not all) adults over 35 years of age.


That said, I think there is a some confusion about the testing that is done, indications, and the information that is gained by doing this kind of testing. And it should always be remembered that test have a certain number of false positives and false negatives. In addition, there are costs involved and all of these things need to be weighed when ordering tests for patients. I won’t go into Bayesian considerations...There are proposed guidelines available for screening of athlete's (both here and in Europe).

After the tender age of 35 years, ischemic heart disease (CAD) is the number one reason for dying in the United States. Additionally, the risk will go up if there is a genetic predisposition for early heart disease- by definition, anyone with a first-degree family member having a heart attack or CAD diagnosed/treated before the age of 55 male or 65 female. I've said it a lot-you can't change your age or your genetics. And to that point, some people have additional risk factors like HTN, DM, inactivity or smoking. Although, far fewer of those latter 2 categories in triathletes.

Guidelines suggest that masters athletes/triathletes (anyone over 35) should be screened for pre-participation if there is increased risk based on: personal history/family history/symptoms or abnormalities on PE (*murmur/abn BP or certain vascular issues). Most people do not need to be screened. Certain people may be at increased risk and probably should see a cardiologist to determine if additional testing is needed on an individual basis. I am not going to do that here.

Tests that are available include:
EKG, echocardiography, exercise treadmill stress test (with/without echo imaging), pharmacologic stress test w nuclear imaging, cardiac MRI, coronary CT scan/calcium score, cardiac cath

Screening EKG's are of limited help in most people who are asymptomatic. We do EKG's to assess the conduction/electrical system and look for ischemia/infarct-signs of trouble with the blood supply or a heart attack actually happening and it will usually show changes after one has happened. Stress tests in general are 'ok' for diagnosing CAD but are better in assessing risk. Adding imaging increases the sensitivity of the test for diagnosing CAD and is an additional check of risk as you see how much heart muscle 'appears to have trouble' with it's blood/oxygen supply. Echo tests look at the heart function/valves etc. Calcium scores and CT of the chest looks to see if plaque has already formed in the coronary arteries and is an anatomic test looking at amount/density/severity of plaque. Risk goes up-especially when the number is greater than 400 and those patients usually get additional tests. Cath is the gold standard for assessing amount of plaque/stenosis and is the means of opening up clogged up arteries urgently with a stent, if able.

None of the tests are perfect and there are reasons that they can look abnormal but patients can have normal coronary arteries.

I will say, that one thing that I'm reading here is erroneous and should be understood-if you have any score above 0 on a calcium score, you likely have CAD. It may be minimal, but you have it. I don't usually do multiple 'screening' tests once you have a real number. We look for symptoms that might need testing at that point and always treat lipids aggressively.

I'm not going to debate the importance of statins or the importance of checking/knowing your numbers (lipids/bp/weight/blood sugar)...you should all talk to your own MD's about that. I've already said my piece about statins here:
https://forum.slowtwitch.com/...st=last-6643505#last

I've already talked enough about SCD in triathlon also.
https://forum.slowtwitch.com/...riathlon_P6427784-2/


I'm a believer that you will be at lower risk if you have a coronary calcium score >0 and take baby aspirin and a statin. I have a personal history premature CAD and have had moderately elevated LDL my entire life (130-140). I got my calcium score done this year and knew that I might subject myself to needing meds x life, but I want to be there for my kids weddings.

Hope this helps.

Put out a poll on Slack for our family and out of 7 siblings:

1 (eldest) not taking anything, tests are OK
3 are on statins
2 with recent test results, 2nd tests to be evaluated.

I'm 60 yrs, last test 6 years ago, was in upper or over the normal range for LDL. I feel I could be at risk, but hard to say. I don't recall the other numbers but my doctor said using a statin would only better my situation by a few %. I am not sure he's reading that right!

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I believe any CT scan of the chest, including the suggested coronary CT scan/calcium score, will also identify an aneurysm. It would be great if a doc could confirm.

I had an ascending aortic aneurysm that has been fixed. It was found incidentally during a CT of my lungs for cancer diagnosis. I had absolutely no symptoms and would have otherwise never known about the aneurysm.

I'd done 25+ triathlons, many years of masters swimming, and countless running races and had no clue the big pipe coming out of my heart might burst. Cancer and the resulting CT scan probably saved my life.

I think a couple of hundred bucks for a scan is probably worth it!

Yes.

Comments will be made if there are ‘incidental’ findings of lung nodules/mass or aortic aneurysm.

I have picked up several lung cancers that way and a few thoracic aortic aneurysms.

Edited to add: cost of the scan here in CT is ~$100 out of pocket. Been advising patients to get them for many years...but the cost is lower now.