What does this mean: Elevated calcium score 893 predominantly involving LAD and RCA 11/2022

[SViking]

Cardiologist said: "Elevated calcium score of 893 predominantly involving LAD and RCA. His stress nuclear study was unremarkable. His prior angiogram was unremarkable. He will add baby aspirin and statin given the elevated calcium score. Last LDL was 121 mg/dL.

PVCs-he does not have active ischemia. He has not had sustained arrhythmias. There is no specific therapy indicated at this time."

I'm currently on Orgovyx and Zytiga. To maintain bone health I've been eating a cup of full fat along with my 90-day Xgeva shot. Also have trouble with left kidney failing so I have not started the statin yet. Add to that close to being accepted on Eclipse Trial.

Advice?

[tango65]

Start the statin. Elevated calcium score put you at a higher risk for a heart attack

mayoclinic.org/tests-proced....

The LDL should be below 100.

Consult with your nephrologist if you could take statins given your kidney problems. There are other medicines they could use to reduce your LDL.

ncbi.nlm.nih.gov/pmc/articl....

nejm.org/doi/full/10.1056/N...

[SViking in reply to tango65]

Thanks. I’m currently prescribed atorvastatin but I’m thinking to wait until I have a few LU 177 treatments done before I start taking a statin. Given that the Zytiga also can cause liver issues like some statins do I wonder if it’s best to just deal with one treatment at a time.

[tango65 in reply to SViking]

Zytiga and atovarvastatin don't have interactions. Pluvicto may affect the liver enzymes.

You could get one pluvicto treatment and see what happens with the liver enzymes and then add the statin and see if the liver enzymes are affected.

[Purple-Bike in reply to tango65]

There is also ezitimibe, Zetia, lowers ldl and apoB around 20 % as monotherapy.

[tango65 in reply to Purple-Bike]

It is true. My information from my cardiologist is that it does not improve the outcome when it is used alone. I used it along with lipitor and my LDLs are around 50 to 60.

[Purple-Bike in reply to tango65]

Thanks. Did you notice any side effects from it?I do find studies indicating ca 20 % lower LDL with ezetimibe monotherapy.

An additional cá 15 % lowering together with a statin compared to a statin alone.

Safety profile comparable to placebo respectively a statin alone.

Seems like a great drug!

Clinical Cardiology: Efficacy and Safety of Ezetimibe Monotherapy on Lipid Profiles and Quality of Life in Patients with Hypercholesterolemia: A Systematic Review and Meta-Analysis

Journal of Cardiovascular Pharmacology: Efficacy of Ezetimibe Plus Statin in Patients with Primary Hypercholesterolemia: A Meta-Analysis

[SViking]

A related question is, given that I've read how when there is a calcified heart condition it's recommended to reduce dairy like yogurt should I cut that out?

[tango65 in reply to SViking]

Some yogurt have a high amount of saturated fats. You could eat fat free yogurt.

The other problem is the sugar. Most of these yogurts are sweetened with corn syrup fructose which is rapidly absorbed and metabolized to very low LDLs which are the worst for atherosclerosis.

It is very difficult to get yogurt with a low concentration of fat and sugar. I decided to stop consuming yogurt many years ago.

[SViking]

Nonfat and even low fat dairy are horribly processed. Best to eat organic grass fed full fat unsweetened Greek yogurt. But it's the calcium that concerns me.

[VCinTx]

I had elevated calcium levels and they checked my parathyroids. Turn out that one of them was causing my calcium levels to be extremely high. The surgeon took out the bad one of four and my calcium levels are normal.

[Explorer08]

I had a similar calcium score years ago. Rosuvastatin has kept my LDL in the low 50s.

[timotur]

Confirm CVD risk with CIMT coronary artery test. If it’s normal, then you probably have high serum calcium levels. Your LDL doesn’t seem high enough for a CAC of 893. My LDL is 158 and CAC was only 3. I do exercise a lot so that might help.

cancerresearchuk.org/about-...

[shortPSADT]

I've have similar experience, although my coronary artery score was "only" 410 -- which makes the risk of a coronary event 90% within the next 3-5 years. I've had elevated cholesterol most of my life; tried 3 kinds of statin drugs and quit all of them because of liver enzymes over 10 times the upper normal limit.

Recently my doctor put me on Repatha, a relatively new monoclonal drug which works REALLY well. My total cholesterol is now 113, my LDL is 13 and, according to studies, this can reverse non-calcium plaques over 1-2 years and lower coronary risk significantly.

The only downside to Repatha is the cost -- about $6000 per year without insurance. My insurance did cover it so it costs me $147 per month.

Good luck.

[Purple-Bike in reply to shortPSADT]

Wow, you are on Repatha. As I understand it, it's virtually free from side-effects. How much of a hassle do you find the injecton with its routines to be? It's one third cheaper in India which is still exorbitant. Haven't found a generic version yet, maybe it's too new for that.

[shortPSADT in reply to Purple-Bike]

The injections every two weeks are not a problem at all. Pinch a little belly fat and stick it with a very short needle. Some people complain of injection site discomfort, but I have not experienced that. In fact, I have experienced NO side effects!

[Purple-Bike in reply to shortPSADT]

Thanks. You don't even need a nurse to guide you the first time?

[Jalbom49]

Arthur Agatston MD developed the most famous cardiac calcium scoring system with the units named after him. Since he YouTubed with Ivor Cummins he has emphasized the role of insulin resistance in coronary disease, including the Kraft test, which is an extended glucose tolerance test with insulin measurements.

ADT causes metabolic syndrome. The ratio of triglycerides to HDL is a sensitive measure of insulin resistance and correlates better then LDL with coronary disease.

Also statins may lower LDL but they don’t lower small dense ldl but rather lowers the large fluffy LDL that is not atherogenic. Statins also have anti plate activity that may be its main beneficial effect. Unfortunately they also increase insulin resistance.

You may benefit from an endocrine consult to evaluate your level of insulin resistance. If I was in Florida I would get a consult from Dr. Agatston.

Or you could at least watch his YouTube videos.