63 here. I have been an avid mountain biker for many years. I had a physical in January of last year and as usual, everything came back great except my LDL as a single line item (113 against a target of less than 100). My GP seemed unconcerned due to everything else looking so good and gave me the usual "eat a little healthier, cut down on red meat, maybe try the Mediterranean Diet" etc... A biker in his mid 50's had just died on my local trail of cardiac arrest however so I asked if there were any other cardiac related tests I could take as a precaution. He sent me for a "National Heart Health Month" Calcium Score exam as they were running a special 99.00 discount. To my surprise my score came back at 525, with most of it on the left side in the Left Anterior and especially the Left Circumflex. The automated results email suggested I see a Cardiologist as soon as possible. I freaked out!
I managed to get scheduled with a highly recommended cardiologist and the first thing he did when I reviewed my lifestyle and high level of physical activity was seeming to roll his eyes when I mentioned the CAC score results. He commented that he sees many people in a needless panic when National Heart Health month comes around and people opt to have this exam. He thoroughly checked me out and was completely unconcerned. I also reviewed my heart monitor logs with him from a typical trail ride. My typical average HR is in the 150s with peaks in the mid to upper 170s. My one minute recovery runs around 35-40 BPM while my two minute recovery approaches 60+BPM.
He was quite reassuring and told me I had no reason at all to expect a heart attack anytime soon. He said to ride as hard, long and fast as I could tolerate. He did offer me a statin if I wanted to get my LDL under 100, but said I could do it easily with diet adjustments. I followed up with a Functional Medicine Doctor who immediately ordered an NMR Lipoprofile. This is a cholesterol deep dive test which actually analyzes the particle size and compositional makeup of your LDL. LDL as a single line item is a useless number. Mine turned out to be primarily the large fluffy type which simply bounce around in your arteries as they go on their merry way performing the functions of the body cholesterol is actually needed for (many). I had a very small amount of the small particle type which are the ones that can oxidize and stick to artery walls and cause harm and blockages. My Triglycerides are quite low while my HDL is very high making "Total Cholesterol" also a useless number.
I also did some research and there is some thinking in the medical community that endurance/high intensity sport athletes will typically have higher calcium scores, but that their calcium is stable and quite unlikely to cause any problems.
Here are some links that may be of interest:
Good thread here on the heart topic:
https://www.bikeforums.net/fifty-plu...our-heart.html
From that thread:
https://www.runnersworld.com/health-...your-arteries/
Also check the two documents attached which I received from my Functional Medicine Doc. You can't really know how good/bad your LDL is without the LipoProfile test.
I am still riding full out 3-4 times a week and have had zero issues. May or may not have another CAC score some day just to see what has changed over the years.