I'm in my early 40s and my calcium score came back 200 with most of it in the LAD. How did this happen?

[Guided_by_Voices]

Wow this is a good book so far! I'm about one third through. Thank you for the recommendation.

I'm in kind of a similar boat as Stoak, with an 18.9 calcium score at age 44, which puts me in the 78th percentile. Of course, my PCP says that's great and didn't recommend I do anything about it.

I had a calcium score done at age 40 and my score was a 3 then, which I thought was great, because it was so close to zero. Now I understand that it should have been zero, and there is a big difference between a little and none. My score then also put me around the 75-80th percentile, so my lifestyle over the intervening years has apparently not done anything positive or negative to influence progression beyond what is typical.

This has led me to start intensely researching CVD. I think regardless of what camp you end up in with regard to your beliefs around cholesterol, you should measure the impact of your interventions with everything available, including carotid IMT, calcium scans, coronary angiograms, etc. Year over year changes in markers of actual plaque will be the most useful way to determine whether you are on the right path.

P.S. don't inhibit aromatase

Kudos to you for actually reading and educating yourself. That book essentially becomes a tool against which almost all actions can be validated against. It's also worth noting that statins are well-known to not reduce plaque and apparently hasten the calcification of soft plaques, which the statinators have tried to argue is a good thing. My issue with the CAC score is that it would be very hard to pin down the impact of one or several interventions, and the overall action is always the same, which to me is to continuously learn and do everything you reasonably can based on what you learn

 

[Stoak]

Also, tadalafil. Tadalafil is being found to reduce CVD events and mortality far better than statins, despite having no effect on cholesterol: Long-term effects of phosphodiesterase-5 inhibitors on cardiovascular outcomes and death: a systematic review and meta-analysis - PubMed

Well I have been taking 2.5 - 5mg per day for 5 years so that's helpful to know.

 

[Stoak]

Wow this is a good book so far! I'm about one third through. Thank you for the recommendation.

I'm in kind of a similar boat as Stoak, with an 18.9 calcium score at age 44, which puts me in the 78th percentile. Of course, my PCP says that's great and didn't recommend I do anything about it.

I had a calcium score done at age 40 and my score was a 3 then, which I thought was great, because it was so close to zero. Now I understand that it should have been zero, and there is a big difference between a little and none. My score then also put me around the 75-80th percentile, so my lifestyle over the intervening years has apparently not done anything positive or negative to influence progression beyond what is typical.

This has led me to start intensely researching CVD. I think regardless of what camp you end up in with regard to your beliefs around cholesterol, you should measure the impact of your interventions with everything available, including carotid IMT, calcium scans, coronary angiograms, etc. Year over year changes in markers of actual plaque will be the most useful way to determine whether you are on the right path.

P.S. don't inhibit aromatase

Do you have a history of AAS use or long term high TRT use?

 

[FunkOdyssey]

Do you have a history of AAS use or long term high TRT use?

Not really - I have just about a year of 140 - 210 mg test weekly. I ate the worst form of processed crap SAD diet from childhood until age 25, and I've had some off-and-on positive autoimmune antibodies like ANA, rheumatoid factor, and anti phospholipid antibodies, which would be expected to increase CVD risk. I think these have been improved with animal-based diet.

In your history, I would guess the seven years of smoking trumps everything else in terms of damage, although the years of 500 mg AAS wouldn't have done any favors. It would also be influenced by what you took specifically: did you go heavy on the non-aromatizing compounds that worsen endothelial function, did you inhibit aromatase, what was your blood pressure, etc.

 

[Stoak]

Not really - I have just about a year of 140 - 210 mg test weekly. I ate the worst form of processed crap SAD diet from childhood until age 25, and I've had some off-and-on positive autoimmune antibodies like ANA, rheumatoid factor, and anti phospholipid antibodies, which would be expected to increase CVD risk. I think these have been improved with animal-based diet.

In your history, I would guess the seven years of smoking trumps everything else in terms of damage, although the years of 500 mg AAS wouldn't have done any favors. It would also be influenced by what you took specifically: did you go heavy on the non-aromatizing compounds that worsen endothelial function, did you inhibit aromatase, what was your blood pressure, etc.

I did a far share of dirty bulking on aromatizing compounds. Mainly Dbol, Test, Deca, EQ. My blood pressure was probably elevated then. I did diet down multiple times and was quite fit then but didn't use any other compounds for that. No arimidex. Nobody was really controlling E2 heavily back outside of nolvadex as a blocker like they do today. Access to bloods wasn't as easy either. I was mostly on 500mg of test weekly for the majority of the time.

 

[Frank777]

My LDL has been relatively high for years creeping from 130-160 over the past 10 years. My natural HDL is 70-80 and when on TRT it's in the 50-60 level. My LDL basically stays flat on TRT or not. My triglycerides are always always always super low at 50 level. My ApoB recently came back at 119 which is high. I had a Lip(a) test done once and it was quite low at 8 which means I don't have this bad genetic marker.

Every year my PCP was never worried. Said I'm totally fine. This was literally happening for a decade. Then I did a consult with a bodybuilding doctor and he freaked the F out at my ApoB number and basically said I need to assume a diet of near zero saturated fat and get this number down ASAP.

This spooked me so I went to the cardiologist and told her my concerns. She dismissed the "bodybuilding doc" and said my numbers aren't really in the range to be treated but she ordered a calcium score and it would be zero she was certain. Well it came back near 200 and she started me on 10mg of Lipitor and said my LDL needs to be under 100 with this CAC risk.

I abused anabolics for 3 years about 15 years ago (best guess probably averaged 500mg weekly total androgen load for 3 years straight) then went on HRT 5 years ago. I also smoked half a pack a day for 7 years (she said that was basically nothing and wasn't a big contribution).

I'm just wondering if this sounds like any of you here bc I don't know how to continue other than listening to her. She said TRT most likely isn't contributing to my ASCVD based on the most current research but I can help but think running my free T at 30-35 for 5 years is somehow helping.

One forum guy say you'd be nuts to take statins, another guy says you would be nuts not to. I literally don't know what to believe but I'm considering just going back to low T as my best guess is my AAS use 15 years ago is the main cause (I could be wrong sure but that's what my heart of hearts tells me).

I've been fit my whole life. I resistance train 4+ days per week with multiple bouts of cardio for 25+ years straight. I do drink daily 3-4 drinks per day as measured (I can't find any real evidence that alcohol consumption causes ASCVD outside of one study done 20+ years ago.)

Just curious if any of you have a similar story. I just keep thinking I did all of this damage 15 years ago and it isn't progressing and I shouldn't start treating it but maybe I'm wrong.

From what I’ve read and heard from Dr Peter Attia, I’m surprised you were not prescribed a PCSK9 inhibitor instead of a statin for a high ApoB number. Maybe look into them..

 

[Steve78]

From what I’ve read and heard from Dr Peter Attia, I’m surprised you were not prescribed a PCSK9 inhibitor instead of a statin for a high ApoB number. Maybe look into them..

Yes, repatha can reverse calcium scores and reduce lipoprotein A by about 30%

 

[elroy]

I have no answers but here is what I do know about Lipoprotein a. It is hereditary and stays pretty much at the same level throughout your life.
I DEMANDED my wife's doc do a Lp(a) test. I had to cause a lot of trouble before they agreed to do the test. It came back at about 70, normal should be below 30. She then had a CAC test that came back at 1500+. Then had an angiogram that showed 60% blockage.
Her father dropped dead at 69 and her brother had a stroke at 68.

 

[Steve78]

I have no answers but here is what I do know about Lipoprotein a. It is hereditary and stays pretty much at the same level throughout your life.
I DEMANDED my wife's doc do a Lp(a) test. I had to cause a lot of trouble before they agreed to do the test. It came back at about 70, normal should be below 30. She then had a CAC test that came back at 1500+. Then had an angiogram that showed 60% blockage.
Her father dropped dead at 69 and her brother had a stroke at 68.

I don’t understand these doctors, I’m a physician and if a patient asks me for a test I do it mostly (especially a lab), often patients know more about their bodies and history, plus it doesn’t hurt to check a lab value, not invasive etc

 

[Melody68]

I have no answers but here is what I do know about Lipoprotein a. It is hereditary and stays pretty much at the same level throughout your life.
I DEMANDED my wife's doc do a Lp(a) test. I had to cause a lot of trouble before they agreed to do the test. It came back at about 70, normal should be below 30. She then had a CAC test that came back at 1500+. Then had an angiogram that showed 60% blockage.
Her father dropped dead at 69 and her brother had a stroke at 68.

Niacin worked for me. My lp(a) was around 110 and niacin reduced it to 40-50; no it wasn't below the normal 30 level, but much better than 110. If interested read Parsons, Cholesterol Control Without Diet.

 

[Stoak]

My Lp(a) is single digits which is about as low as it gets so this is not from that.