Coronary Calcium Score (update)

Triathlon Forum
1

Just had this done and was shocked to receive a 433. Now my cardiologist wants to do either a CT angiogram of my coronary arteries or cardiac catheterization (with angiogram).

Back in May 2023, I had sudden onset of terrible vertigo and pulsatile tinnitus (sounded like ocean waves in my ear that corresponded with my heart beat). It was definite vertigo, and not dizziness. I mentioned I did have occasional dizziness but it would come about with rest or activity and seemed to be more related to work related anxiety/stress than anything else. I mentioned I thought the vertigo could be instigated by my anxiety as well…one episode hit me when I was sitting in my car waiting to return to work after lunch. Because of all of this, the cardiologist/ENT requested multiple different scans (hearing test, MRI brain, CT angiography of brain, EKG, holter monitor, and the coronary calcium scan). They believe I may have Meniere’s Disease (except I don’t have hearing loss yet) but wanted to be safe on the cardiac part.

I ride with a group of 20-30 year old guys (I am 53yo) so my heart rate is maxed out on multiple occasions (and without any chest pain or new excess fatigue or any other adverse cardiac signs). Now that I have this calcium score, and after reading about other’s heart “misadventures” on here, I am paranoid about being the “fit looking” guy with hidden heart disease. Genetics may have doomed me as everyone on my father’s side has had stents placed and/or open heart surgery (none of them were healthy eaters or active).

I’ve read papers that endurance athletes can have calcium scores over 300 without the associated cardiac risk percentages as inactive adults but I am not going to put weight to that until I get further testing.

Sorry, I am rambling here and just concerned.

2

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.

3

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…

4

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

https://youtu.be/mQR6b7CAiqk?si=lgy7oFkD4V5SFLEe

Best of luck with all of it

5

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.

6

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.

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.

7

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…

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.

8

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.

9

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 rest 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.

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.

10

Just had this done and was shocked to receive a 433. Now my cardiologist wants to do either a CT angiogram of my coronary arteries or cardiac catheterization (with angiogram).

I ride with a group of 20-30 year old guys (I am 53yo) so my heart rate is maxed out on multiple occasions (and without any chest pain or new excess fatigue or any other adverse cardiac signs). Now that I have this calcium score, and after reading about other’s heart “misadventures” on here, I am paranoid about being the “fit looking” guy with hidden heart disease. Genetics may have doomed me as everyone on my father’s side has had stents placed and/or open heart surgery (none of them were healthy eaters or active).

I’ve read papers that endurance athletes can have calcium scores over 300 without the associated cardiac risk percentages as inactive adults but I am not going to put weight to that until I get further testing.

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/doi/10.1161/CIRCULATIONAHA.117.028750

Good luck with your upcoming tests.

11

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”. .

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’

12

Just had this done and was shocked to receive a 433. Now my cardiologist wants to do either a CT angiogram of my coronary arteries or cardiac catheterization (with angiogram).

I ride with a group of 20-30 year old guys (I am 53yo) so my heart rate is maxed out on multiple occasions (and without any chest pain or new excess fatigue or any other adverse cardiac signs). Now that I have this calcium score, and after reading about other’s heart “misadventures” on here, I am paranoid about being the “fit looking” guy with hidden heart disease. Genetics may have doomed me as everyone on my father’s side has had stents placed and/or open heart surgery (none of them were healthy eaters or active).

I’ve read papers that endurance athletes can have calcium scores over 300 without the associated cardiac risk percentages as inactive adults but I am not going to put weight to that until I get further testing.

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.

Thank you so much for sharing these.

13

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”. .

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’

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.

14

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.

15

“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 :slight_smile: 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!

16

“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.

17

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.

18

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.

https://youtu.be/…?si=qv4hBeFa2DTBu3vK

And for PCSK9

https://youtu.be/…?si=Dld_Nl_Ams9lWGR7

19

“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 :slight_smile: 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!

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.

20

Thank you for sharing these videos.