dogwalker

First post here...I'm not expecting medical advice, but I'd appreciate input from anyone with similar/parallel circumstances and/or experiences. I really enjoy riding on the road about 40 miles three times a week with my club. I am 63, have a coronary calcium score of about 1000 (>90% of others my age, i.e., high risk), and HDL of around 42 (40 is the minimal target level). My internist has told me that pushing myself on my rides is good for my heart and blood pressure and I should continue just as I am. My new, excellent cardiologist is telling me to cut way back on those rides...that I should instead ride at a moderate pace for about 10-15 miles 5 days a week or so. My cardiologist points to a bevy of recent studies that show intense exercise should be limited to a very small portion of exercise time over any kind of extended period, especially for those over age 45, let alone those having coronary artery disease. I knew about this idea, but basically hoped that my internist wasn't too far off the mark. I asked my cardiologist if I could wear a heart rate monitor during my rides and to ease off when I'm pushing into, e.g., zone 4, but she said regardless any 40-mile rides should be limited to about twice a month at most.

I haven't discussed this with anyone else (my wife and kids are already worried about the danger of distracted drivers where I currently bike with my club). Whether to follow the new recommendation from my cardiologist is obviously an individual risk-reward decision for me to make about my own riding but I would appreciate relevant input/comments.

grizzly59

All I can say- your cardiologist is the heart specialist, I would take her advice. You did say she was excellent.

pdlamb

I don't give out medical advice. But perhaps it would be worth getting a second opinion.

My wife works with about a dozen cardiologists, and I've talked with perhaps half of them over the years. Their responses to my cycling range from "You bike on the road? You're going to die!" through "I'm afraid of traffic, so all my biking is mountain biking. That's why I have pins in one leg and an artificial knee on the other." to "Neat! I'm a cyclist too, and I ride to work a few times every week!" The one with the last response is the one I deal with regularly. It's working well for me, I haven't had any more problems since he put my stent in.

Have any of your doctors prescribed anything since you got your calcium score? My HDL jumped 50% (40 to 60) after I started on a statin.

dogwalker

Thanks for the responses.



I have been on Simvastatin for 15 years. I just changed to Rosuvastatin, which is more appropriate for me. You're very fortunate to have a statin increase, let alone jump, your HDL.

Marylander

I intentionally found a sports cardiologist when I was initially working out how to deal with the numbers my regular doc was telling me. You might have someone like that not too far from you. It'd be worth a look.

Iride01 

Maybe your cardiologist knows something you don't. Maybe you need to do some more discussion with your heart doctor. You had more than just a calcium score done didn't you? Surely an echo cardiogram and the usual hair pulling EKG that they do every time you visit them.

Calcium score itself doesn't tell you everything. Personally I consider it just a scare tactic to make us straighten up and take notice of why the doctor is giving such bad news about the other tests. But as high as yours is, you probably should listen closely to the advice. Even so, I'd be inclined to check with another cardiologist or even more.

I'd make certain they fully understand what your normal riding habits have been for the last few years. Also determine if it's the mileage itself they are opposed to or the intensity of your rides. I'd think intensity of your ride will be the issue and even a very short ride can be intense at a high effort. So which is it they don't want?

You might have to give up riding with the group or maybe find a slow group, but find out if riding and keeping your HR below a certain number for as long as you care to ride is okay.

Wildwood 

2nd @Marylander - Hugely. If you want the most specifically informed opinion. (assuming they are any good)

As for me at age 70. When my longer and/or more intense rides required more than 1 night to recover from I reassessed my riding plan. When I evaluated 'what I was training for' - and chose Feeling Good Everyday over Ancient Athlete, I reassessed my riding plan. For 2021 I hope for 125mi/wk Apr - Oct, less in off-months when I supplement with regular hikes. All my centuries are metric. Triples give me gears for the big hills/mts. I no longer ride with computer or HRM or apps - i just ride, sometimes fast sometimes less than fast and with stops for pics. When I was riding with groups (up until about 2 years ago), I could keep up with all the 50+ riders for about 30 miles whereupon I begin to flag. [OK there are a few 50+ guys I couldn't match]

Just keep smilin all ride long.





Free your handlebars and your mind will follow!

dogwalker

Thank you for the thoughtful responses.

Marylander, could you PM me? I tried to initiate a PM earlier but the site won't permit me to send one because I'm a newbie with only a few posts.

Carbonfiberboy 

I have a score of about 700. I looked into it, and research says that many long-term endurance athletes have high calcium scores, but that these high scores don't correlate with myocardial infarctions (heart attacks). A theory is that this calcium is tougher and less likely to fragment or come loose. The cardiologist put me on a statin. I tries a couple different ones at different dosages, but they all made me weak as a kitten, so I quit them. I figured that a long happy life would be more likely if I stayed strong. I ride about like I always did, just slower because of age. I'm a numbers geek so I ride with HRM and power, take my morning resting and standing HR as well as HRV. I seem to be just fine. 75 y.o. My only advice would be to ride with an HRM and start taking your morning resting and resting standing HRs, just to see what's going on. More information is better.

As above, talk it over with a sports cardiologist.

Marylander

dogwalker, I think you just need a few more forum messages and you'll be able to PM. Here's the doc I saw, way over in Baltimore: https://www.medstarunionmemorial.org...le/1023312576/

His mentor is Dr. Aaron Baggish, mentioned in this article: https://www.runnersworld.com/health-...your-arteries/.

Rather than a standard stress test like you get at a normal cardiologist Dr. Shah puts you through the sports versions of the tests and gives you your VO2max, LT, and such (not particularly useful info from a health perspective but neat nonetheless).

Besides the calcium score (where I scored higher than anyone else thus far in this thread ) I've also had a CT coronary angiography. This shows a lot of calcium and very little other crap, e.g., cholesterol, in there. It's the other crap that tends to break loose and cause heart attacks. As I understand it the calcium score uses the calcium as a proxy for measuring all the calcium plus the other crap. They assume you have something like a 1:9 ratio of calcium:crap (anyone who wants actual precision on these numbers will need to look them up rather than trusting my poor memory). My ratio is backwards, more like 9:1. I've been doing aerobic exercise (cycling, then running, and now back to cycling) most of my adult life so I suspect I fall into the athletic camp who builds up calcium. I've also had a poor diet most of my life so there's that too.

dogwalker

Thanks, carbonfiberboy. Sounds as if your vigilance is really paying off.

Marylander, I really appreciate you taking the time to respond with more information that is helpful to me now and will be in the days ahead. I'll do more research re: the CT coronary angiography. Wishing you continued good health.

Richard Cranium

Worth repeating - Iride01 says
Keep investigating, but try to balance your current focus with the understanding that there multiple competing factors in the aging process. Myocardial and vascular issues are seldom exclusive.

Thinking that altering exercise intensity is the critical component to extending your healthful part of your life is short sighted.

dogwalker

Yes, I need to get more information. Recommendations from my new cardiologist aside, I started thinking a lot more about exercise intensity after hearing Dr. Peter Attia's Oct. 26, 2020 podcast (#134) with renowned cardiologist Dr. James O’Keefe re: preventing cardiovascular disease and the risk of too much exercise. “If exercise were a drug, it would be the best drug we have for preventing heart disease . . .. But like with any drug, you've got to get the dose right.” — Dr. O’Keefe. As a newbie, I can't post URLs to other sites but I'd highly recommend episode #134 at peterattiamddotcom/jamesokeefe/ (insert .com where I have dotcom) to anyone interested in the subject.

big john

I don't know anything about all these numbers you guys are talking about but I've found many doctors aren't familiar with cyclists/athletes and are used to dealing with sedentary people. I go to a doc and say I don't feel like myself and the doc says "you look good for your age" or some variation of that. I tell the doc I ride 50 or 60 miles and the doc says "What??? 50 miles???"

I had a doctor tell me most of his patients just sit at home and smoke.

I guess my point is to try and find a doctor who has had athletic patients or is at least open minded about it. If a doctor told me to limit 40 mile rides to twice a month he better have a good explanation or I'm looking for a second opinion.
There is climbing on my rides but I could do a flat 40 mile ride without raising my heart rate very much or red line it on a 40 mile ride with 4000 feet of climbing. It's time and intensity, not just miles.

Marylander

Cardiology waiting rooms are kind of depressing. It seems like there are a lot of people like that in those waiting rooms and others in similar boats. When I first went to one I was running 40-50 miles a week. The cardiologist was overjoyed to have a patient who was doing something positive.

Flip Flop Rider

from my experience this guy is pretty smart

Ptcycles

I can't give you exact numbers, but I have mucho sodium in my blood. Never got advice from the cardiologist but my urologist says this is causing my severe kidney stones. I am on some thing and need to drink a minimum of one gallon of water a day to keep my kidneys from overworking during the filtering process. Also on a near zero salt diet, which is not easy.

Artmo 

About 10 years ago, when I was about 70, I had a nuclear stress test prior to having an ablation for afib. The electrocardiologist told me my calcium number was in the 90th percentile. When I asked what that meant, he said "One day you will feel a sharp pain."
I mentioned this to my cardiologist, a triathlete, who told me he doesn't pay much attention the calcium numbers as they only give some indication of hardening of arterial walls, not blockages. I chose a different electrocardiologist, since had two ablations and a pacemaker ( to correct resting HR of 34 with pauses) and am still riding at 80, albeit a bit slower than 10 years ago, but still managing 20-30 miles or so three times per week with 50W e-assist at times and max HR about 130!

dogwalker

Thanks for the responses.

Artmo, you have an inspiring story. I'm definitely going to discuss my situation with a sports cardiologist. We've got a lot of evidence in this thread that calcium scores are important markers, but are not necessarily the be-all and end-all.

Classtime 

These numbers are bewildering to me. My wife makes me get them updated now and then. I just checked and one of my cholesterol numbers is just over the line: 104 when it is supposed to be <100. She would like me to eat more like her. The only animal products I eat are some goat cheese or occasionally fresh mozzerela on a pizza 2 out of three fridays. Before you start decreasing duration or intensity of your rides, try moving to a Whole Foods Plant Based Diet. Aside from some gas as your body adjusts, there are no negative side effects of following a Whole Foods Plant Based Diet. However, there are plenty of negative side effects that accompany statins. This thread got me looking at the CCS and it turns out that while it is a number derived from a test, getting that test, and knowing that number, does not improve outcomes. And I also read that knowing this number can increase stress which might lead one to conclude you should ride more as a way to relieve that stress.

dogwalker

Thanks. Good advice in general; however, as for me, I have exhausted lifestyle modification years ago. E.g., my diet was Mediterranean from the 1990s to 2012 and the extreme Esselstyn version of a plant-based diet during 2013-2018 (it didn't seem to improve my coronary markers), and now I'm back to a lean version of the pescatarian Mediterranean diet. I have always exercised vigorously and I now love to ride.

So I'm left with trying to evaluate the risks and rewards of continuing to push myself on my 40-mile/3 times a week rides or to ease off or cut back in some form. As discussed above, that evaluation is complicated because "conventional" cardiologists who don't deal regularly with athletes may not be the best source of advice while cardiologists who treat athletes seem to differ somewhat on the benefits and damage caused by fairly intense exercise for those over age 45.

Steelman54 

No surprise, input all over the place. I say keep riding, don't kill yourself trying to go fast, but get a good ride and decent workout. No cardiologist will recommend you over do it, if you died you might sue them. Carbonfiberboy and Wildwood seem to have good input here.

GlennR

I'd see a sports medicine specialist.

My son was a triathlete as a teenager and had foot issues, so my wife took him to his doctor... the pediatrician that's seen him since he was a baby. My son was 17 and 6'3", taller than the doctor so I found a sports medicine podiatrist who helped him with insoles.

My internist recently did a EKG and told me I should see a cardiologist, which i did. He did a EKG and compared it to the one the internist did and the one from the year before and said there is nothing wrong and that non-specialists don't know enough. But since my cholesterol was at 205 I should get a coronary calcium test. My score was "4", he said it's not zero and said I should take medication. I told him thanks but no thanks.

Doctors don't know everything.

But i can tell you that 1000 is high and you should follow up with a specialist. Too often you hear about a marathoner dropping dead, don't let that happen to you.

Steelman54 

GlennR said, But since my cholesterol was at 205 I should get a coronary calcium test. My score was "4", he said it's not zero and said I should take medication. I told him thanks but no thanks.

I went thru same thing, off and on statins, just couldn't tolerate them, got to point where i could not get off couch or move. Doc said go off statins, then 2 months later he called and said you need to be on them, my cholesterol has always been 250. At that point I started doing some research and after digging a bit learned that those without heart conditions don't live longer by taking statins. I was talked into doing the calcium test by a cardio guy, my number was 12. He then said I should take an injectable cholesterol lowering drug that on my plan then would cost me $1500/month. I said see you later.

As GlennR said, doctors don't know everything, I'll say some are in business to make $$$.

This is not a comment on what poster with a number of 1000 should do, just general comment.

shelbyfv

I had one a couple of years ago at age 70. My score was 0.86. Doc said "well it's not zero...." Must be some other reason I am not a cycling god.