Calcium scoring CT scan .. family related history

[LincolnAndy]

Hi all,

New to the forum. I’m sure everyone here would rather not be, but from what I’ve read so far, it’s a great resource of reassurance, understanding and support, from the collective and varied experiences that everyone has had. So this is my story so far.

I’m an above average fitness, healthy 54 year old, who trains regularly, eats healthily, has a BMI of 24, has never smoked and only drinks socially and then in moderation. However, there is a family history of premature death due to ischaemic heart disease - I lost my dad and his dad through heart attacks in their sleep, both in their late 50’s. As such, I recently went for a proactive cardiology MOT … I had no issues or symptoms other than slightly elevated blood pressure, so wasn’t worried too much.

Had a comprehensive range of checks over a few separate appointments, starting with bloods (lipids check), ECG, echocardiogram and then was referred for a CT scan to check my calcium levels and score. Probably all sounds very familiar to many of you at this point ha ! All the checks came back as indicating that I have a healthy heart … they saw all the things they wanted to, it was doing all the things it was supposed to (turns out it’s not made of stone too ! ) and lipids were mostly within healthy range (apart from HDL at 1.0, so could be a touch higher … Triglycerides at 4.0 which should be a little lower … and my cholesterol/HDL ratio was 4.6 - healthy, but could do with coming down a touch).

My calcium score however came back as 83, placing me in the 75th percentile for my age and gender. So there is evidence of some ‘mild proximal plaque in my LAD that was eccentric and not calcified’ and some ‘minimal plaque disease in the mid-LAD that was calcified’. Had a follow up appointment with the cardiologist to discuss the results and then spent the days afterwards going from panic, to frustration, to anger (I’ve deliberately kept myself in good condition all my life BECAUSE of what happened to my Dad, who was also a heavy smoker and drinker), to rational and methodical. I’m a full career ex-soldier (25 years in the Army) - so I went into military mode (don’t judge ha ! It’s my way of dealing with it) .. I’d identified my enemy, I’ve now carried out my intelligence (done my research), formed a plan and now I need to execute it.

A bit of health anxiety has crept in, which I hate because I see myself as a strong person both physically and mentally. My calcium score worries me, because whilst yes I’m technically in the 11-100 ‘mild risk’ bracket, I’m at the wrong end of that. The score can’t of course be reversed (unless someone out there knows different ?), so it’s all about early identification (the whole idea of me getting checked) and then arresting the acceleration and growth of any more calcium. The most common medical advice for people with an elevated calcium score, is immediate lifestyle change - lose weight, get fitter, change your diet, stop smoking, moderate your alcohol intake. I don’t need to do any of those things .. that is my life already, so I can’t improve in that area … plus they are primarily aimed at lowering cholesterol and as I’ve said, my cholesterol levels were overall not of any huge concern. In other words, my cholesterol level has not directly or solely contributed to the build up of calcium.

The one additional measure is that I was immediately put on a low dose statin (Atorvastatin, 20mg), as a ‘worthwhile primary prevention’ measure. Read all the pros/cons/opinions about statins … everyone has a different story or experience, but for me its a no brainer .. it’s literally the only additional thing I can add to my armoury and 3 weeks in, I’m not noticing any side effects. The cardiologist explained that it’s not my cholesterol levels that are the issue, but how/where my body uses it and deposits it .. and the statins are apparently good at fighting that, so I’m hoping he’s right.

If you’ve made it this far, well done haha !! Sorry for the ramble … this has knocked me a bit if I’m being honest, but I’m a bit more relaxed about things now than I was. Relatively speaking, I’m in a good position - I now know it’s there and that means I can do something about it … my Dad and his Dad definitely didn’t have that same foresight and it cost them. My calcium score, whilst not ideal, is in the bigger scheme of things, not that high compared to most of the case studies and examples I’ve read, both on here and also NHS and other cardiology related forums.

I’d be really grateful for any insights, advice, wise words and information that any of you might be able to share, based on my position and numbers.

Wishing you all well in your respective journeys.

Andy

[AlfredV]

Hi Andy,

The good news is it's never too late to make changes.

As you note, your HDL is low and your TG is high. In the US, there is growing use of the TG/HDL ratio as a measure of risk for heart disease and stroke. I wanted to link a UK study but couldn't find one, but you can find plenty of US examples. The problem is that you cannot compare ratios directly as they use different units in the US and the ratios come out skewed, so before comparing I'd recommend converting your readings to US units. This calculator is helpful.

omnicalculator.com/health/c...

Fortunately these numbers tend to move in opposite directions, so the things you do to raise HDL could lower TG and vice versa.

I don't want to give out unqualified medical advice, so hopefully that gives you something to look at and consider when it comes to deciding what lifestyle changes could be made.

[LincolnAndy in reply to AlfredV]

Thanks Alfred - food for thought

[seniorita]

Have you had your blood calcium level tested? I don't know much about calcium CT score, but a bit more about blood calcium levels and to my untrained brain it could be worth asking for that.

[LincolnAndy in reply to seniorita]

I haven’t no .. nor did my cardiologist suggest it. Maybe a question for my GP when I have my next lipids blood test in July. Thanks

[Chinkoflight]

Hi Andy, At the beginning of March I had my 70th birthday and made the rash statement that I felt the fittest I had been for my adult life! Two weeks later I had a severe stroke, full right side paralysis and loss of speech. Quick thrombolising treatment restored most function within 36 hours. This was out of the blue so then all the tests over the subsequent weeks. They all were as you, everything is working well. Apart from being overweight , cholesterol btw 2.8, nothing I could do. I was pretty fed up, especially daily at the witching hour of 9 am, and have reached out for a bit of mental support but to no avail. As the consultant said,' I'm lucky to be alive'. She is right, I was last in to the stroke ward and first out. There is so much unknown about how our bodies work, not least the genetics, and as a statistical outlier, how much time and effort can be spent that will help me right now? Certainly not on the NHS or even privately. So after 9.00am I make the decision to get on with my life!!!! I've added a challenge in the short term by starting Couch to 5k, and have some goals to do some more cycling sportives (more my preferred exercise). Manage what's in your control and feel good about those outcomes. I will keep checking research etc and would/will participate in any research trials. Good luck.

[LincolnAndy in reply to Chinkoflight]

Good luck to you too my friend

[MarmiteB]

Hey Andy

I totally and utterly get where you are coming from. I’m 34 and I have just had double bypass surgery due to my arteries being blocked due to calcification. I’m fit, don’t smoke, I eat well and my BMI is also 24. Why me?! Well, they think my arteries were calcified due to a nasty virus I had when I was 19 but when they did some histology work they saw signs of arteriosclerosis as well. So a double wammy.

My cholesterol was higher than yours (7.5) but my HDL was much higher (5) than my LDL (2.5). I’ve known I’ve had high cholesterol since I was 18 and I had told drs about it previously but because I was young and my ratio was ok they didn’t do anything about it. Grrr.

I had “chest pain” on running and exercising which I eventually stopped because it hurt and I saw a load of different GPs. I was told I had all sorts wrong “but that it definitely wasn’t cardiac”…very long story short I asked for a private referral as I have insurance with work and here I am, post open heart surgery.

But anyway, now for the good news. My cholesterol is down to 3.2 thanks to being on 80mg of atoravastatin a day since October, so about 5 months and I haven’t had any side affects from taking the drug. My cardiologist is delighted and basically reckons I’m fixed now.

So I reckon the drugs will work for you and if you don’t have any side affects with being on 20mg you could potentially increase your dose if needed Keep on keeping on with looking after yourself which is actually much harder than it looks but it seems that you’ve been doing well so far. With your lifestyle and no need for stents or surgery I think your going to be a-ok. Our family histories or freak viral infections are simply hurdles we may just be able to get over with the right mindset and choices.

Good luck Andy x

[LincolnAndy in reply to MarmiteB]

Hi Wow, what a journey you’ve been on ! Thank the stars you persevered - disappointing that you had to go down the private route to get a result though (even though the consultant is the same bloke you’d have probably seen on the NHS if the GP’s had bothered referring you !)3 weeks on Atorvastatin 20mg now and no issues at all so far. I am slightly confused however and will check this with my GP when i have my next lipids check done in July - I’m not on statins to lower my cholesterol … overall that is already pretty ‘normal’. As I said, the cardiologist said that my genetic predisposition was to how my body deposited the cholesterol and where. He said to see how it goes until the next lipids test and then assess if there was a requirement to up the dosage. But if my cholesterol is already normal, how are they going to make that decision ? How will they know if the statins are working or not, without doing another CT calcium score scan ? I’ve already been told that CT’s are not carried out routinely as a monitoring measure - indeed, he even told my doc that I could have another one in 3-5 years time ‘if I was so inclined’. That’s a long time for my current calcium score to stay unchecked for.

For now though, I’m reasonably relaxed about things … I’m as fit as a butchers dog (my Garmin stats say i have the fitness age of a 20 year old … who am I to argue with Garmin ?!! LOL), my diet is now cleansed of all unsaturated fats (well as best I can - I’ve become a food label nerd !!) and I have introduced all the cholesterol busting food recommendations the BHF and Heart UK websites recommend. Apart from Avocado … that stuff is the devil’s work lol 😖

[Tricia7048]

I had calcium score done nearly 6 yrs ago and was 83 too. The cardiologist I saw a month ago told me they dont bother doing that any more! That really surprised me. He said it didnt tell them enough (?) I went on to have some h.a. s in the following years because I couldnt get on with the statins at all, and Im much older anyway! Im glad they are suitable for you and wish you all the best.

[LincolnAndy in reply to Tricia7048]

Thanks Tricia … fingers crossed ! Stay healthy 😊

[Zindolo]

84 sounds great to me! I went for a physical and was referred to a cardiologist as my BP was 200/120. He did a bunch of tests and finally determined that I needed my bicuspid aortic valve replaced because it was too calcified. I did that calcium scan test and scored 504! He gave me the impression that the surgery would fix that, so afterwards I went on my own and did that test again and it was still 478, which was quite disconcerting. I could see the bills coming in on the website of my health insurance and the whole thing amounted to about half a million dollars! I seriously suspect now that their primary motivation was profit, not my well-being. I don't have much stamina at all, but it was getting less before the operation. The one positive change is that I had a very noticeable heart murmur before the surgery and that is gone now. But my BP is still high if I accidentally skip my meds, like 170/100. Sometimes it gets quite low tho, like 120/70, so I'm really not sure what's going on with that. I did call the cardiologist's office after getting back the 478 score but I felt like his aid was just fending off my questions because he knew damn well that yes, of COURSE their primary reason for putting me thru that was financial gain! But who knows... Obviously there's no way to know what would have happened had I chosen not to go thru with it, which I almost did. The cardiologist told me I would be dead by 60 if I didn't... BUT, one thing I do know is that I would literally rather DIE than go thru anything like that again so if they tell me I need another open heart surgery my answer this time will be "Sorry, been there done that!" So my advice to you would be quit worrying, continue with your healthy lifestyle, and I suspect you'll be just fine!

[LincolnAndy in reply to Zindolo]

Wow … that’s terrible to hear ! I’m guessing you are over in the States ? I’ve never understood why the American health system relies on having insurance or paying for it out of your own pocket. So glad we have our fantastic NHS system here in the UK 😊