Heart Health: Elevated Coronary Calcium Test Score

Hi Team,

I’ve been away from training but still riding when I can, also running now more than ever. That said, I had some mild symptoms last year, shortness of breath, heart palpitations and got all the “healthy guy” tests done, everything came back normal, cholesterol a bit elevated 135 LDL. But, I pushed the Dr for imaging testing, and he recommended a Coronary Calcium Test - I was bummed when mine came back, 156, or in the 80% percentile of men my age (only 20% my age have a higher score). I’m 46 and have been riding pretty seriously for over 20 years.

I’m still processing this, really, but I’ve gone full vegan and currently taking a statin (Simvastatin 20mg) but the side effects are pretty severe, lots of stomach pain and severe heart burn. When I stop taking it, the symptoms improve dramatically. So… I’ve been researching standard vegan diets which led me to the Forks over Knives philosophy (no oil, no, not even olive oil!) and found the book Prevent and Reverse Heart Disease by Caldwell B. Esselstyn, Jr., MD

I know there have got to be others out there experiencing something similar, and I trust a lot of the information I’ve gotten here over the years, so any help is appreciated. I’m interested in your opinions on plant based diets (seems like there’s nothing but merit to them) and taking it a step further with the No oil dogma presented in the Forks Over Knives magazines and the book I referenced above.

Thank you!

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Did you maybe consider mentioning your side effects to your doctor, and seeing if there was an easy alternative? Different dose or different agent? Diet changes are great, but you have established coronary artery disease.

As an aside, long term, long distance runners tend to have unusually high coronary artery calcification for reasons that are not completely understood. It’s one of the potential reasons to explain why mortality tends to increase in people doing more than ~8h or so of endurance exercise per week (though not above sedentary levels).

Ex: Assessment of Coronary Atherosclerosis Using Calcium Scores in Short- and Long-Distance Runners - PMC

I have not seen similar data in cyclists and am not sure if it is true in this population as well.

Anecdotally at least, while MIs are more common than you’d think they’d be in runners because of this, don’t see it with cyclists - afib seems to be what we disproportionately get.

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Talk to dr about side effects and likely try a different statin. There are a bunch and they work. I had ti swap because of leg soreness.

Some people are born with bad heart genetics.

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135 total cholesterol is definitely not high, if anything it’s on the low side. If you mean LDL, then sure that’s slightly elevated. Did you also test for LP(a)? If so, what was that number?

Re: calcium score, this may or may not be an issue. A lot of older endurance athletes have high scores, but they can generally be considered “safe” because they are generally harder and there is less risk of causing a major event. I think there is some debate on this but it doesn’t appear to increase risk in healthy populations.

I do question why you were put on a statin. Did you start having issues before or after you started taking a statin? Did you ever get a calcium score before the statin?

Also: I’m not your doctor, just saying…

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Here is an article of interest. You can get it on PubMed.

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I have been on this journey. Perhaps you should consider a Lipoprotein (a) test. You may have genetic markers that will change your view of your next steps. My results were very high. Most of the living people in my family have had stents, etc. They have been tested and are just like me—high scores. Diet may not be as helpful as you would hope if your score is high.

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I did mention my side effects to the Dr. he recommended taking a week off, seeing if symptoms (severe GERD) improved, then re-assessing. I’ve also been effected by the Hurricane Helene, so anxiety symptoms were triggered by that event (we’re all ok). I tried going back on the Simvastatin but the GERD came back almost instantly.

Interesting. I do have a very basic understanding of what this score means - you can have some calcium deposits but, if they are stable, they are less dangerous (from what I’ve read). It’s also common for your calcium score to actually increase after statin use as statins have been shown to stabilize softer plague build up.

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Good stuff. But make sure you get 2-2.5g / kg of protein somehow.

Try tiny Rosuvastatin (2.5-5) + Zetia :ok_hand:t3:

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135 was the LDL score, not total. He did not test for LP(a). I’m starting to understand the CAC score isn’t the “be all to end all”, and it’s just one indicator of CAD. Thanks for the potential reassurance.

I actually asked about the statin, my doctor really doesn’t seen that concerned about it, in fact I had to advocate for the CAC screening in the first place, the statin, and the follow up with a cardiologist (I’m still a month away from seeing a cardio).

I’ve dealt with GERD almost my entire adult life, it comes and goes and has never been extreme enough to take anything other than over the counter meds, usually, famotidine is enough to help me, more recently I’ve been put on a PPI and famotidine and neither was doing much.

Then I research and learn that GERD that doesn’t respond to medication can be a symptom of CAD, so it’s been an anxiety loop between real symptoms and my over-active mind.

I had such a bad anxiety attack yesterday, I actually went to the ER. The staff was wonderful and thankfully we crossed off any chance of symptoms (dizzyness, naseau, and chest pain) being related to a heart attack. and now I’m working on getting a referral to a GI specialist and a sooner cardio referral.

I either need to communicate better to my Dr. (I’m now using a daily health journal) or find a different Dr.

I’m very open to being on a statin, perhaps I need to find the right one. In the meantime, I’ll advocate for a Lp(a) test. Thanks for the input!

Indeed. I’m still in the beginning stages of going vegan, just a couple of months, so it’s been an adjustment. Lots of beans in all forms seems to be the answer.

Yep, totally open to using a statin, did you try others before landing on this?

No, but did a bunch of research and nudged the Doc to prescribe it.

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How do you feel about tofu? I don’t eat vegan now (tried for a short time) but I found a tofu that I like with 24g protein in a 150cal block. That really helps when I’m trying to get 140+g per day.

I wrote about my experience with the coronary calcium score in another thread so I apologize for the repeat info.

My calcium score was 433 and it freaked me out because I’ve always considered myself to be in good shape. The calcium score indicated the majority of my calcium buildup was in my left anterior descending coronary artery (the “Widow Maker”). I told my wife “I don’t want to be one of those fit looking middle aged men who dies in the middle of nowhere”. Because of my calcium score, my cardiologist put me on a statin (my LDL was 165) and ordered more tests (echo, stress test, and CT coronary artery angiogram). I ended up not getting the stress test because of a calf injury prevented me from running on the treadmill.

I did not do well with the two statins I tried. Atorvastatin made my muscles feel like I had been running 120 mile a week and Rosuvastatin gave me terrible GI disturbance. I ended up stopping both, after discussing the side effects with my doc.

The CT angiogram was what gave me the most relief (mentally) as it showed my coronary arteries to have zero blockages. Because of this entire ordeal, I started researching the cardiology literature for information about coronary calcium scores and endurance athletes. Come to find out, a lot of the rules that apply to non-athletes (with high calcium scores) cannot be applied to endurance athletes. Truthfully, it seems a lot of cardiology literature indicates this is an area that needs continued investigation. For now, discuss with your cardiologist on your best step forward to protect yourself.

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