Hermes

Moved to Pills and Ills.

Joe F

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.

dogwalker

Thank you for taking the time to provide so much helpful, detailed information. Seems as if in your case you are as free and clear as anyone can be who has had a bit of a scare.

I'm surprised that your cardiologist was unconcerned about your "typical average HR is in the 150s"...I've been asking around and reading...your feedback just goes to show how differently some sports cardiologists assess situations. Bottom line, you got trusted feedback from someone who is assessing your specific situation, so I'd certainly go with it with confidence.

You mentioned that you may get another coronary calcium test just to see if the high number went down. If it does, you will be very rare...everything I've read says it almost never does no matter what changes the individual makes. However, as we know, that doesn't mean "the damage has been done" because no one is sure if any damage has been done for certain individuals, let alone those of us who are very active and otherwise fit.

Joe F

Actually to clarify I did not say I might get another CAC score someday to see if it went down but just to see if it had changed.

As far as my average HR on the trail. The trail I ride is 14 miles of aggressive single track with some very steep climbs. Alternatively however there are also sections of flat and downhill. My average in the 150s is comprised of a variance between just over 100 to peaks in the 170s on the climbs. I complete the trail in around 1hr 15min which ain’t bad for a Grandpa. It helps push me that my riding partner is in his mid 40s. My resting HR hovers around 60.

Heading out now for a ride as a matter of fact. Cheers!

dogwalker

Got it.

jbrown@bmsj.com

I cycle about 100 miles/week. Cardiologist dumbfounded I was asymptomatic. Did angiogram found nothing actionable. There are recent articles that say don’t worry about it (I cannot post links). Cardiologist demanded I go on a statin and said keep it up.

dogwalker

Given my recent discussions with sports cardiologists and research, if it were me, I wouldn't worry about it. Angiogram revealed nothing actionable. I assume you will continue to be monitored.

My CAC was 1600+ last November. Angiogram revealed moderate blockage in the right coronary artery. Got a stent. I am cycling 40+ miles a week at 17+ mph on terrain with some hills. I try not to attack the hills the way I want to, but I basically do anyway. Oh well.

jbrown@bmsj.com

thanks and good for you. Very inspirational. My problem is I’m really enjoying Zwift and one can push oneself much harder than in the road. At least I can/do.

do you mind my asking did you have any symptoms? Angina or shortness of breath

whtmtn

I just came across this thread as I was researching my calcium score and exercise intensity. My score has doubled in 10 years to 370 (age 61) and has me concerned enough to see my cardiologist. I have been wondering about exercise intensity and the levels of calcium. Have been on a statin for around 25 years due to persistently high cholesterol likely created by a not so good diet from work etc. cycle around 150 miles per week but at high intensity at times.

curious dogwalker if you ever saw the sports cardiologist and what the outcome was.

Carbonfiberboy 

Updating my post 9 from 2-18-21. I had the scan to which I was referring in 2017. I actually don't remember what the exact number was, only that it was in the High realm, which scared me.
What I've learned since:
High calcium scores in endurance athletes are the result of heart inflammation which happens at prolonged high exertion levels. It's a U shaped curve: high levels of exertion are as dangerous as low levels. The CDC has located the sweet spot on the curve: Moderate exercise levels decrease inflammation, high levels increase it. The result of the inflammation caused by high exercise levels are not only atherosclerosis, but also A-fib and electrical blocks in the heart.

So it all depends on what you want out of life, You can't have it all. My choice was to continue riding hard and long. The result so far was 3 stents, one minor heart attack and internal heart blocks so that now I have a pacemaker. I sure had fun though! I am very thankful I live in this age because I'm not dead. So you take your choice and see what happens.

I had my first syncope (passing out) in October '22. It took a year for my 3 cardiologists to figure out what was wrong with me and fix it. While they were working on it, I got my stents and that heart attack. The problem was that very few cardiologists know anything at all about the aging athlete. Almost all of their practice is with folks who've ignored diet, exercise, and their bodies. When I started seeing these doctors they were clueless about what was wrong with my heart, even months into the process. I appeared to them to have the physiology of a mid-40s healthy guy, though I was 77. They said, "Oh you're fine, go home."

The good part, which starts as the bad part: When I couldn't tolerate a statin in '17, my cardiologist said, "Too bad." He was unaware (probably wasn't reading his journals, like many doctors) that a new cholesterol lowering drug was on the market, Repatha. My current cardiologists finally figured out that I had serious coronary blockages only because I insisted on having an angiogram, which turned into an angioplasty in the OR - I got stents. They had been quite resistant. Athlete's heart again, working much better than it should have been able to. Unfortunately the cardiologist missed one and I had a heart attack anyway a few months later, got a third stent. The good part is that I finally got a prescription for Repatha, which could have saved me all this trauma. It not only lowers LDL, it also reduces heart inflammation by reducing the inflation-causing cytokines and IL variations.

Now I'm on a long road to recover fitness and I'm hopeful, like always.

whtmtn

Wow! Maybe there is something to the high calcium score and heart blockage? Most of the literature I have read indicates a correlation between high scores and the likelihood of heart disease (myocardial infarction, etc.). Will see what the cardiologist says next month. My goal is to maintain fitness but also live a reasonably long life without complications May do more zone 2 riding versus zone 4/5.

pdlamb

I've probably told this story before, but apparently not in this thread.

I had a calcium score scheduled on a Thursday. Monday night, I had an MI, SCA and the whole nine yards. It was pure dumb luck a cardiologist was walking down the hall in the ER and saw my wife, with whom he worked. Called in the interventionalist, got a stent, lived to tell about it. The interventionalist cardiologist who put the stent in told me a week later, "You would have passed the calcium score, your arteries were pretty clean except for that one clot that almost killed you."

When I was at home and wife went back to work, it took her a few hours to clean my record at the cardiology practice. I'd been labeled "non-compliant" because I was in the hospital and missed the test. Laying about in the hospital coming out of anesthesia? That was no excuse!

If there's a moral here, it's that calcium scores aren't everything. It's probably worth having a cardiologist do a work-up on you if it's doubled IMHO, but I'm not representing your insurance.

whtmtn

Thanks and sorry to hear about your MI. Friend had a similar arrhythmia incident on an exercise bike in a gym across the street from a hospital. Paddles and MDs working out saved his life of 58 yo. Cardiologist on calendar so will see what he says. Unfortunately many times if you don’t ask or push for things they tend to assume all is fine given the extremis of many patients.

Carbonfiberboy 

That last was my experience. OTOH cardiologists are in the business of saving lives NOW. They tend to triage what they don't understand.