High calcium score and angiogram

[Healthy Lifestyle]

Please talk to your doctor, preferably a cardiologist. A positive calcium score is a marker of atherosclerosis. While a score of 207 is not as bad as mine (over 600) it is enough to put you pretty firmly in the group of people with atherosclerosis. Usually with a calcium score as high as yours, a cardiologist will want your LDL under 70 so that you won't build more soft plaque. Some people (like me) need an LDL goal under about 50. Your personal LDL goal might be lower than 70 depending on your risk factors.

However, even if your LDL goal is to be under 70 the vast majority of people can not achieve LDL under 70 no matter what they eat. It is generally good to limit saturated fats particularly from red meat, processed meat, butter, cheese, tropical oils, full fat dairy. It is fine to eat non fat dairy. Reducing consumption of red meat if you eat it is particularly important.

However, most people can't get to under 70 without medication. My LDL before medication was 180. Now it is 27. Anyway, if you aren't seeing a cardiologist I highly recommend it for someone with atherosclerosis.

Thank you for reminding me to follow up with a cardiologist.

 

[HenryD]

Please talk to your doctor, preferably a cardiologist. A positive calcium score is a marker of atherosclerosis. While a score of 207 is not as bad as mine (over 600) it is enough to put you pretty firmly in the group of people with atherosclerosis. Usually with a calcium score as high as yours, a cardiologist will want your LDL under 70 so that you won't build more soft plaque. Some people (like me) need an LDL goal under about 50. Your personal LDL goal might be lower than 70 depending on your risk factors.

However, even if your LDL goal is to be under 70 the vast majority of people can not achieve LDL under 70 no matter what they eat. It is generally good to limit saturated fats particularly from red meat, processed meat, butter, cheese, tropical oils, full fat dairy. It is fine to eat non fat dairy. Reducing consumption of red meat if you eat it is particularly important.

However, most people can't get to under 70 without medication. My LDL before medication was 180. Now it is 27. Anyway, if you aren't seeing a cardiologist I highly recommend it for someone with atherosclerosis.

Inability to get LDL under 70 without drugs has been true for me. I averaged 144 on a slightly better than typical diet. Cutting out processed food, meat, dairy, got it to 123. Five years later, a 262 CAC had me cut out olive oil, alcohol, and add a statin. LDL dropped to 55. It's crept back up to 93, which my well-meaning but ill-informed PCP thinks is fine. I have yet to find a cardiologist who didn't just want to up my statin dose. I'll be looking for a new cardiologist next year.

 

[RetiredHappy]

My CAC score came in as 0 last year and on the report it said, statin is not recommended. I have been on low dose statin since 2018 or so because of my border line cholesterol - about 240 and a LDL of 130. With 10mg of Atorvastatin, it got my LDL down to 50 right away and has stayed there since. So while the report said statin is not recommended, it has brought my LDL down significantly and I am happy with it.

 

[grasshopper]

Always interesting to real real results with real information. My CAC is 1 my cholesterol is 196, my LDL is 114. I have a cardiologist who has me do a stress test every year. And none of my doctors have ever suggested a statin.

 

[AllDone]

It's a factor, probably not as much as they used to think it was. I listen to Dr. Peter Attia podcast interviews with cardiologist and other researchers on cholesterol and it's so much more complicated than the 4 numbers (HDL, LDL, Triglycerides, Total) most people monitor. I have a friend with very good numbers who's on a keto diet. He eats eggs, nuts and animal fats freely. In a recent episode Dr. Attia said that we may have been overlooking the major effects of stress on cardiac health and it might outweigh diet as a factor.

Excess weight does add to your risk of heart attack and puts a strain on your heart, your hips, your back....Pick up a 20-lb. child and walk upstairs carrying them and tell me you don't feel anything. Now imagine doing that all day.

I'm 70 and I've also got shortness of breath and do everything "right"- BMI under 20, over an hour of low-impact cardio every day, rarely eat meat, low BP (no effort in my part- it just is). I passed a treadmill test with flying colors and my calcium score was 1. I have mitral valve regurgitation and my cardiologist tells me it's a Stuff Happens thing- nothing I did.

You really need to change the things you can, and keep an eye on the whole picture.

Dr. Attia has pivoted on saturated fats fairy recently although he is more in favor of pharmaceutical treatment for high ApoB (LDL is a marker for ApoB and when one is high, they're usually both high).

 

[Dash man]

With my recent cardiac event, my Atorvastatin was increased from 40mg to 80mg. I also now take 75mg of Plavix. The good news is they took me off two of my four blood pressure meds and off a potassium supplement.

 

[Katsmeow]

Inability to get LDL under 70 without drugs has been true for me. I averaged 144 on a slightly better than typical diet. Cutting out processed food, meat, dairy, got it to 123. Five years later, a 262 CAC had me cut out olive oil, alcohol, and add a statin. LDL dropped to 55. It's crept back up to 93, which my well-meaning but ill-informed PCP thinks is fine. I have yet to find a cardiologist who didn't just want to up my statin dose. I'll be looking for a new cardiologist next year.

Agree about the cardiologist. When I got my over 600 CAC, my cardiologist said that sometimes people don't understand that with a calcium score getting under 100 is no longer good enough. Unfortunately some PCPs are not very up to date.

I recently was reading the research on how reducing statin but adding ezetemibe can have a better effect than just increasing statin. My LDL was 48 on 80 mg atorvastatin (it had been lower 40s with rosuvastatin). I wanted to be under 50 so it was OK. But I had some mild foot cramps with the atorvastatin and didn't want to take max dose rosuvastatin. I talked to the cardiologist about it and he switched me 40 mg rosuvastatin and added 10 mg ezetemibe. I had previously tried 20 mg rosuvastatin and it only got me to 59. Anyway, I switched to the combo and 4 weeks later my LDL was 27! Very pleased with the combo.

 

[Dash man]

The primary benefits of a statin I was told by my cardiologist is to reduce inflammation in the arteries. This reduces the chance of soft plaque breaking off and causing a stroke or heart attack. It’s not all about cholesterol levels.

 

[ls99]

Just as a bit of general info, a study done in 2001 published in Circulation. For older individuals rom age 65 to 99.

https://www.ahajournals.org/doi/10.1161/hc4601.099464

"Methods and Results Electron beam tomography was performed to assess coronary artery calcium (CAC) in 614 older adults aged, on average, 80 years (range, 67 to 99 years); 367 (60%) were women, and 143 (23%) were black. Calcium scores ranged from 0 to 5459. Median scores were 622 for men and 205 for women. Scores increased by age and were lower in blacks than in whites. Nine percent of subjects (n=57) had no CAC, and 31% (n=190) had a score lower than 100. A history of CVD was associated with calcium score. Age, male sex, white race, CVD, triglyceride level, pack-years of smoking, and asthma, emphysema, or bronchitis (chronic obstructive pulmonary disease) were independently associated with CAC score in the fourth quartile."

"The value of screening the elderly is in question because autopsy3 and clinical4 studies suggest that coronary artery atherosclerosis and calcification are almost universal in those with advanced old age. No study has yet defined the “typical” levels of CAC found in unreferred populations of older adults, whether a sex difference persists into old age, or whether CAC would predict a higher risk of CVD events or mortality in this age group."

More recent info:

Navigating Cardiovascular Risk Assessment in Older Patients: Insights From Coronary Artery Calcium Scoring - American College of Cardiology

www.acc.org

"Although the CAC score is a promising tool for patients ≥75 years of age, its practical application in guiding treatment decisions is yet to be defined. Ongoing research efforts, including the CAC PREVENTABLE (Pragmatic Evaluation of Events And Benefits of Lipid-lowering in Older Adults) ancillary study, may help guide selective use of CAC scoring in this age group"