Wow TJ56, that is a great story! You have likely helped to save your friend’s life by making him aware of this issue, and then him taking the next steps to be evaluated and treated. Major kudos to you!
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.
If you have no rate-limiting or exertion impairments, especially when you exercise, then your coronary arteries are patent. In which case, almost irrespective of your calcium score, means that no intervention is required beyond modification of typical risk factors - sugar control, cholesterol, blood pressure, smoking cessation.
Even if some of your coronaries are blocked, if you have no symptoms with exercise that means you have strong collateral vessel formation, which again means no intervention is required.
Chest pain, shortness of breath, and exertional limitations are really what guides treatment for coronary disease. Otherwise it’s all about prevention.
Vast majority of sudden cardiac death is related to cardiomyopathies (specifically congenital/genetic ones), not elevated calcium scores.
Hope that makes sense.
With the talk about high blood pressure I thought I would add this
I was at approx 14x/8x. For a year + Dr wanted to put me on meds
I started taking 3 tablespoons of ground flax seed every day 3 weeks later numbers were (and 6 months later still) 120 or lower over 7x
my wife consistently (2 years) high 130s over 8x
Started flax liquid. 1 month later consistently 120/ mid 70s
Doesn’t seem possible to me but I have the logs showing it did happen
Dr has confirmed for both of us
got my calcium score done… NO dye this time or contrast of any kind… I was in and out of there in like 5 min. Not joking
the worst part was tearing off the sticky NODES they put on me.
anyways. calcium score was zero
daved
With the talk about high blood pressure I thought I would add this
I was at approx 14x/8x. For a year + Dr wanted to put me on meds
I started taking 3 tablespoons of ground flax seed every day 3 weeks later numbers were (and 6 months later still) 120 or lower over 7x
my wife consistently (2 years) high 130s over 8x
Started flax liquid. 1 month later consistently 120/ mid 70s
Doesn’t seem possible to me but I have the logs showing it did happen
Dr has confirmed for both of us
That’s an impressive improvement.
For me, my BP was being measured in the 14x/8x range each time I was at my doc’s office. He was concerned…of course, considering my higher cholesterol and the high CAC score…but I told him “I believe I have White Coat Syndrome because I never get BP measurements this high when I randomly check it on my own”. So, he had me start a log for my measurements over the next few weeks. I checked it 2-3 times per day and documented it. It was almost always 11x/6x each time. He was pleased with this,
I’m glad your BP measurements are improved.
got my calcium score done… NO dye this time or contrast of any kind… I was in and out of there in like 5 min. Not joking
the worst part was tearing off the sticky NODES they put on me.
anyways. calcium score was zero
daved
That is excellent.
Yeah, when you are only obtaining the calcium score, it is a quick easy test. If you needed the CT angiography, that would require dye and takes a little longer.
Just remember, the CAC is a screening tool and does not 100% mean you are without risks. After obtaining my score, I started reading up a lot about others who had this done, and there are a number of people who had a CAC score of zero who still reported an MI. Pay attention to your risk factors and/or symptoms.
got my calcium score done… NO dye this time or contrast of any kind… I was in and out of there in like 5 min. Not joking
the worst part was tearing off the sticky NODES they put on me.
anyways. calcium score was zero
daved
That is excellent.
Yeah, when you are only obtaining the calcium score, it is a quick easy test. If you needed the CT angiography, that would require dye and takes a little longer.
Just remember, the CAC is a screening tool and does not 100% mean you are without risks. After obtaining my score, I started reading up a lot about others who had this done, and there are a number of people who had a CAC score of zero who still reported an MI. Pay attention to your risk factors and/or symptoms.
Very well said, but there’s low risk and very low risk.
A 0 is very low risk.
In reality, the data suggests about 0.04%/year risk of an event. In cardiology, we try to get risk down to <1%/year.
The problem is that the cor score does not show vulnerable, soft plaque…that’s what can rupture and cause an event.
How Low-Risk Is a Coronary Calcium Score of Zero? | Circulation (ahajournals.org)
The (not so) joys of living in a small mountain town. Got the referral to a cardiologist. I was told that we have exactly one here in town at the hospital (La Grande, OR), and they are sufficiently overloaded that if you’re not dying (more or less) you don’t get on the schedule. The next-nearest one is in Walla Walla, WA, about 90 minutes away at Providence hospital heart center. It’s a pretty drive so I don’t mind it, although winter here is nasty so I was worried about being able to get over the Blue Mountains in winter. That won’t be a problem, as the earliest appointment they have in the beginning of March 2024 
.
The (not so) joys of living in a small mountain town. Got the referral to a cardiologist. I was told that we have exactly one here in town at the hospital (La Grande, OR), and they are sufficiently overloaded that if you’re not dying (more or less) you don’t get on the schedule. The next-nearest one is in Walla Walla, WA, about 90 minutes away at Providence hospital heart center. It’s a pretty drive so I don’t mind it, although winter here is nasty so I was worried about being able to get over the Blue Mountains in winter. That won’t be a problem, as the earliest appointment they have in the beginning of March 2024 .
I apologize for not remembering if you posted it or not but have you already had your calcium score done? And now need to see a cardiologist? Or are you wanting to see a cardiologist to get the test ordered/done? dtoce can correct me, if I am wrong, but I assume your local primary care doc should be able to order the coronary calcium test as well (and it should be able to be done at a local facility with CT scan capabilities)
see post #93
He had it done-it’s over 400.
He’s on asa and statin
needs stress test and discussion of plan with a cardiologist
I’d aim for an LDL goal of <70.
get the consult (and hopefully stress test) done as soon as possible…
edited to add:
I’ve seen at least 3 of my recent patients at the hospital for follow of their elevated cor score
leading to a stress test-which was abnormal>leading to a cath showing severe coronary disease>leading to a stent in 2 of them and CABG in the other
(*and this is just in the last week)
as I’ve said-in my practice, about 1/4-1/3 patients with markedly elevated cor scores needs further evaluation and wind up getting PCI-stent or CABG
No worries; it was a bit context free. I was mostly grumbling about how far out the appointments are here. I had the calcium score done:
Left Anterior Descending Artery: 250
Left Circumflex Artery: 135
Right Coronary Artery: 26
IMPRESSION:
- Total calcium score is 411, which is between the 50th-75th percentile for males between the ages of 60 and 64.
- No significant extracoronary pathology.
Comment
A score over 400 indicates an extensive plaque burden with a high likelihood of significant coronary stenosis.
The more I ask about family history, the worse sounding it gets - both parents had high cholesterol & high BP; between my mother and 2 uncles they have a double, triple and quadruple bypass (+ stents) among them, and their father died of congestive heart failure. I have a lifetime getting more exercise than the rest of my family put together, so I’m hoping that helps to offset whatever level of genetic risk I’ve got. I don’t know how much weight to give to any genetic factors.
From what I can figure out about the without-contrast test I had, the numbers are not directly translatable into amounts of blockage due to the contribution made by soft plaque this test doesn’t detect. My primary care doctor is thinking I may need a stent, but thinks that’s a question for the cardiologist; I’m starting to put together a list of questions to ask them:
- what’s my actual/individual level of risk here?
- what additional tests / measurements would help in answering #1?
- Beyond a statin, aspirin, diet changes and continuing to get some exercise, is there anything else that could or should be done?
- I’ve avoided high intensity exercise since learning of all of this but I still walk the dog or walk with my wife every day. What duration / intensity of exercise is acceptable or off-limits?
I’m not sure if there’s anything else I should ask.
Figure 1. Unadjusted Kaplan–Meier Cumulative-Event Curves for Coronary Events among Participants with Coronary-Artery Calcium Scores of 0, 1 to 100, 101 to 300, and More Than 300.
Panel A shows the rates for major coronary events (myocardial infarction and death from coronary heart disease), and Panel B shows the rates for any coronary event. The differences among all curves are statistically significant (P<0.001).
The bottom graph is in every one of my patient exam room…to help explain risk related to coronary artery calcium scores.
There is certainly more to it, but seeing the data just with a focus on the score helps explain some things to patients.
Thanks; this helps. Now that I look at them more closely, the plots for the higher score ranges all have a visible flat section at the right at the 4-5 year mark. Do cumulative incident percentages really not rise after this time, or this an artifact of the study data & design (e.g., maybe they didn’t look out past 5 years)?
The reason I ask is I found some of the other threads you posted links to (and things they linked to) and ran across the MESA calculator. I plugged in my additional numbers and got risk rate for 10 years that were higher. Some of the notes at the bottom explicitly mentioned that this was due to the other risk factors entered and even separated out the marginal increase due to calcium score. I’m assuming here that the longer time horizon played a role as well.
No worries; it was a bit context free. I was mostly grumbling about how far out the appointments are here. I had the calcium score done:
Left Anterior Descending Artery: 250
Left Circumflex Artery: 135
Right Coronary Artery: 26
IMPRESSION:
- Total calcium score is 411, which is between the 50th-75th percentile for males between the ages of 60 and 64.
- No significant extracoronary pathology.
Comment
A score over 400 indicates an extensive plaque burden with a high likelihood of significant coronary stenosis.
The more I ask about family history, the worse sounding it gets - both parents had high cholesterol & high BP; between my mother and 2 uncles they have a double, triple and quadruple bypass (+ stents) among them, and their father died of congestive heart failure. I have a lifetime getting more exercise than the rest of my family put together, so I’m hoping that helps to offset whatever level of genetic risk I’ve got. I don’t know how much weight to give to any genetic factors.
From what I can figure out about the without-contrast test I had, the numbers are not directly translatable into amounts of blockage due to the contribution made by soft plaque this test doesn’t detect. My primary care doctor is thinking I may need a stent, but thinks that’s a question for the cardiologist; I’m starting to put together a list of questions to ask them:
- what’s my actual/individual level of risk here?
- what additional tests / measurements would help in answering #1?
- Beyond a statin, aspirin, diet changes and continuing to get some exercise, is there anything else that could or should be done?
- I’ve avoided high intensity exercise since learning of all of this but I still walk the dog or walk with my wife every day. What duration / intensity of exercise is acceptable or off-limits?
I’m not sure if there’s anything else I should ask.
Thank you, to you and dtoce, for the reminder.
You’re #4 above was me too. Until I had my angiography done, I was super paranoid. I just knew at any moment I was going to be out on a group ride and my score of >400 was going to catch up to me. I was actually doing the SBT GRVL race, in August, and decided to turn and finish the 100 miler, instead of the 141 miler, because I thought “that’s probably too much for my heart, and I am out in the middle of no where”. Of course, looking back, those were all silly thoughts but it is what went through my head. I saw that score over 400 and felt like I was a ticking time bomb…yes, over dramatic 
Thanks; this helps. Now that I look at them more closely, the plots for the higher score ranges all have a visible flat section at the right at the 4-5 year mark. Do cumulative incident percentages really not rise after this time, or this an artifact of the study data & design (e.g., maybe they didn’t look out past 5 years)?
The reason I ask is I found some of the other threads you posted links to (and things they linked to) and ran across the MESA calculator. I plugged in my additional numbers and got risk rate for 10 years that were higher. Some of the notes at the bottom explicitly mentioned that this was due to the other risk factors entered and even separated out the marginal increase due to calcium score. I’m assuming here that the longer time horizon played a role as well.
This post almost gave me a heart attack. Went to the MESA calculator, put in my values, and it gave me a ten year risk of 51.3%! WTF? Dropping the cholesterol and systolic values way down only lowered it to like 40%. I’m going to die, I thought. Texted with a cardiologist (cycling friend) who had previously said my 65-year old score of 20 was great. Rechecked my values…and realized I had put my systolic mmHg value in the kPa box (so got like 500+ instead of 120). Doing it correctly got me down to 4.9%.
Never mind.
Once again units really do matter;)
.
Thanks; this helps. Now that I look at them more closely, the plots for the higher score ranges all have a visible flat section at the right at the 4-5 year mark. Do cumulative incident percentages really not rise after this time, or this an artifact of the study data & design (e.g., maybe they didn’t look out past 5 years)?
The reason I ask is I found some of the other threads you posted links to (and things they linked to) and ran across the MESA calculator. I plugged in my additional numbers and got risk rate for 10 years that were higher. Some of the notes at the bottom explicitly mentioned that this was due to the other risk factors entered and even separated out the marginal increase due to calcium score. I’m assuming here that the longer time horizon played a role as well.
This post almost gave me a heart attack. Went to the MESA calculator, put in my values, and it gave me a ten year risk of 51.3%! WTF? Dropping the cholesterol and systolic values way down only lowered it to like 40%. I’m going to die, I thought. Texted with a cardiologist (cycling friend) who had previously said my 65-year old score of 20 was great. Rechecked my values…and realized I had put my systolic mmHg value in the kPa box (so got like 500+ instead of 120). Doing it correctly got me down to 4.9%.
Never mind.
You’d think think that from a app design point of view there would be some level of sanity checking / data validation for user inputs. Maybe 500 is possible; maybe it’s like a front-tire blowout at 50 MPH. I don’t know nearly enough medicine to have an informed opinion. In a quick scan of the javascript for the app I can see where the blood pressure value is converted from one unit to the other, but there doesn’t appear to be any front-end validation. The actual calculations are done in some backend that isn’t visible.
Out of curiosity, I did find this on extremes of blood pressure measurements.
https://pubmed.ncbi.nlm.nih.gov/7741618/ - The highest pressure recorded in an individual was 370/360.
So this is good?
The estimated 10-year risk of a CHD event for a person with this risk factor profile including coronary calcium is 2.9%. The estimated 10-year risk of a CHD event for a person with this risk factor profile if we did not factor in their coronary calcium score would be 2.0%.
So this is good?
The estimated 10-year risk of a CHD event for a person with this risk factor profile including coronary calcium is 2.9%. The estimated 10-year risk of a CHD event for a person with this risk factor profile if we did not factor in their coronary calcium score would be 2.0%.
It’s pretty darned fantastic. Being female really shows a huge advantage on the calculator. Try your exact numbers with the male box checked to see your XX advantage.
Heart scan cost $99.00 Insurance doesn’t cover it unless you’ve already had a heart attack. Gotta love our health care system. i went because my friend said it was on sale.
I’m a runner and never expected a problem. My score was 800. Three arteries were clear but 4th one the anterior descending was 800. Turns out it’s on the outside of my artery??? But it could restrict blood flow if it gets worse. My stress test was great and blood pressure is too. I asked about not taking the statin but they said there’s nothing out right now that could do the same job except an injection once every 6 months, but you need to fail 2 different statin attempts to get the insurance company to pay for it.
I started taking the statin Dec. 1 First medication I’ve had to take steady. it sucks but I like not having a stroke. Gonna be 70 in 3 weeks.