High Coronary Calcium Score

[Yisselda]

I am a slim, generally fit, active and healthy 70 year old. I have a vegetarian diet, don’t smoke and only drink wine occasionally.

I began suffering from breathlessness when running in March 2022 and saw my GP in October 2022. Following a thorough investigation, which included an exercise ECG and calcium measure, I received a stent in June 2023. I am now in cardiac rehab and on medication.

My question concerns my coronary calcium score of almost 7,000. I know that 0 is the preferred level and as we age it can creep into the hundreds, but to be up in the thousands is extreme worrying to me. I wonder if anyone else has this problem and, if so, what they have been advised. Thank you.

[Bluehope81]

What is more important is not the magnitude of the number, but the rate of growth or decay of the number, which will come down to medicines and diet, if the rate of growth is 0, then all the calcium and fibrous fatty layers will firm up and harden and your risk profile plummets. I have heard of very high numbers with patients having no need for intervention, possible scenarios include large coronary arteries where the plaque is "filling in the walls", so I would not fixate on the number, you know your condition and you are learning now what needs to be done.

I will write a long post on this at some point , but very briefly someone whose CAC score is in the thousands by being prescribed statins will bring their 10 year risk into around 10% this is a reasonable risk for the cardiologist, and a one tablet prescription has a high adherence rate, but you can decide if you want to push the risk down further by adding an extra cholesterol medicine e.g. ezetimibe. We can be more aggressive in the pursuit of cholesterol reductions and bring down our risk profile.

mesa-nhlbi.org/MESACHDRisk/...

There is no agreed upon lower limit of cholesterol lowering.

What medications are you taking?

[Yisselda in reply to Bluehope81]

Many thanks for your comprehensive and encouraging reply. I am currently taking:

Lansoprazole 15mg (for 6 months post op)

Clopidogrel 75mg (for 6 months post op)

Bisoprolol 5mg ( recently reduced to 2.5 but I started getting angina when exercising so am back up to 5mg)

Aspirin 75mg

Atorovastatin 40mg

GTN spray

Thank you

[Bluehope81 in reply to Yisselda]

So you can discuss the possibility with your cardiologist about adding an extra cholesterol reducing med, if you feel that's something you would like to pursue, as a vegetarian make sure you drop all seed oils for cooking and anything else they are used to make, think flora, benecol, if you must cook in some oil , extra virgin olive oil, not virgin olive oil, virgin olive oil is a blend with chemically processed oils, or avocado oil, use as little as possible, some people find a spray pump helps.

Let us know in time how you get on.

[Yisselda]

I don’t eat butter or use any spreads or products such as Benecol. I have always had tahini or peanut butter instead. The predominant oil in my diet is organic Italian extra virgin olive oil (EVOO)but I have read that flax seed oil is good for omega 3. I have been thinking about increasing my consumption of EVOO for the heart protecting benefits. Are you saying that’s not a good idea? Could you say a bit more about dropping seed oil please? Does that include nut oil? Thank you

[Bluehope81]

There are different schools of thought, there is no grand unifying theory of nutrition, which is common in science there is no grand unifying theory of physics, different theories are correct seen in different observations , like wave theory and particle theory of light, both are true at the same time but not coherent or congruent, the same is true with nutritional theories

As you are following a vegetarian diet, you should limit animal fats, - you do already, and fats from oils, I wouldn't increase your oils.

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

It would be wise to look into the works of:

1. Caldwell Esselstyn

2. T Colin Campbell

3. John Mcdougall

4. Dean Ornish

5. Nathan Pritikin

The ideas and theories and studies will align well with your vegetarian diet, well maybe not Pritikin he encourages Salmon as I recall. The problem of course is living like a monk isn't the easiest thing to do and I like a piece of cake myself, but the better you can do the better.

I am on Keto, and monitoring bloods every 6 months and CAC scan every 3 years. These are just suggestions for what you might look into and adopt, as per your assessment.

[Yisselda in reply to Bluehope81]

Thank you. I very much appreciate your taking the time to respond in such detail and look forward to working my way through the reading list.

The article about Esselstyn’s research is particularly helpful and has been quoted by others promoting a predominantly plant based diet, such as Dr Michael Gregor. I’m encouraged to concentrate on further reducing my dairy intake and baking whole meal sourdough bread instead of white as a starting point. There are other tweaks which can be made over time.

Many thanks.

[Bluehope81 in reply to Yisselda]

There is an interesting story about Dr Michael Gregor , that you might know, when he was a young boy his grandmother had terrible angina and chest pains and was bedridden and the doctors at the time , possibly the 60's said she didn't have long to live, and a nutritionist visited her and overhauled her diet and she followed it to the letter, and within 2 weeks she was up and walking 2 miles, all chest pains gone, and this left such an impact on him as a 5 yr old boy, that he became a highly recognised nutritionist , and what was this groundbreaking diet, fresh fruit, fresh vegetable, no oil or fats , salmon 3 times a week i.e. the Pritikin diet, and who was the man that visited his grandmother at 5 years old? Well it was Nathan Pritikin.

[Yisselda in reply to Bluehope81]

I did know that…apart from the link to Pritikin! 👍

[Milkfairy Heart Star]

The BHF recommends the Mediterranean diet.bhf.org.uk/informationsuppo...

[Bluehope81]

Has the cause of your high CAC score been found? Blood tests run looking at TC, LDL, TG, Homocysteine levels, familial Hypercholesterolemia, Lipoprotein a , spring to mind Did you smoke when you were younger? It could of course be idiopathic.

[Yisselda in reply to Bluehope81]

Hi again, the results of my blood-tests show low triglycerides ( which I understand to be a sign that my diet is fairly good) and it has been suggested that the problems are hereditary. Familial hypercholesterolemia has been suggested, although not specifically tested for as far as I’m aware. I have always had high cholesterol levels but my HDL levels were thought to be protecting me from the LDL.My mother had 3 heart attacks, her first at 61.

You have mentioned your own CAC levels being monitored. Do you know the cause? Is this a long term issue and have you been able to affect them through dietary changes?

[Bluehope81]

Let me see if I can PM you.