849

There’s a test called a CAC scan.  If you haven’t heard of it, you probably will soon. CAC stands for coronary artery calcium.  I’m not a doctor, but my untrained, overly simplistic understandIng goes something like this: If your coronary arteries are inflamed or damaged, your body responds by coating the damage in layers of plaque.  Plaque is made of fat, cholesterol, calcium, “animal style” french fries, Cheetos, chocolate croissants and maple bacon. The calcium, also an ingredient in your bones, shows up on an x-ray.  If you’re relatively young, a little bit of calcium in your arteries is not good, and may be a signal for you to make some artery-friendly changes to your lifestyle.  Otherwise, if you accumulate enough plaque, it can eventually constrict or block the flow of blood, or chunks can break off and clog things downstream, with potentially devastating consequences like a heart attack. A higher CAC score comes with a greater risk of an “event,” which may include myocardial infarction, death, or coronary bypass surgery.

Peter Attia, a 48 year old Stanford trained surgeon, in his podcast with James O’Keefe, talks about his own personal freak out over a score of 6.  Anything over zero suggests that the process of damage and repair has started, and there’s nothing you can do to make the calcium go away.  Anything from 1 to 99 is considered “mild disease.” 100-399 is “moderate disease,” and 400 or more is “severe.” My wife, who is roughly my age and eats the same food that I do, just had a scan, and her score was 0. My score is 849.

Prior to my valve repair surgery, they did an angiogram.  One of the things noted by my doctor was atherosclerosis.  That was the first time I’d heard that word in the context of my own body.  My surgeon, reviewing the angiogram in our pre-surgery meeting, talked a lot about a “narrowing” in a “small artery.”  Eventually he brushed it off.  If it had been more of a concern, he might have chosen to bypass the partial blockage at the same time he did the valve repair. He ended up leaving it alone.

A couple of years later, while reviewing my medical records with a new primary care physician, that term “atherosclerosis” came up again.  This time I wasn’t preoccupied with an impending open heart surgery, and the word reverberated in my head. After asking the doctor several questions about the nature and consequences of atherosclerosis, he suggested that I have the Coronary Artery Calcium scan. (BTW, the scan is generally not yet covered by insurance.  The cost is around $100.) I followed his suggestion, and got the mind-bending score of 849, putting me around the 90th percentile for my age group, and making me second guess about whether or not I’d have been better off not knowing my score.  This is about when I started taking a statin, despite the fact that my cholesterol profile is, and always has been, remarkably good.  Statins have “anti-inflammatory properties that surpass their cholesterol lowering abilities,” my doctor told me. They also, by the way, tend to increase coronary artery calcification.

In the book Exercised, by Daniel Lieberman, the author writes about Amby Burfoot, the winner of the 1968 Boston Marathon, and longtime editor of Runner’s World magazine. Amby, a few years older than I am, has never stopped running marathons since the 60’s, but when he turned 65 he too had a CAC scan.  His score was 946. Lieberman suggests in his book that the problem may not be with Amby’s calcium, but with our definition of normal.

“...these risk estimates are based on nonathletes and do not take into consideration the size and density of the plaques, the size of the coronary arteries around them, or the likelihood that the plaques will grow, detach, or do anything else that could cause a heart attack.  An alternative, evolutionary perspective suggests that plaque calcification is one of the body’s many normal defense mechanisms, not unlike a fever or nausea…they appear to be protective adaptations--kind of like Band-Aids--to repair the walls of arteries from high stresses caused by hard exercise.”

I emailed Amby Burfoot through Runner’s World about my own calcium story, and he replied promptly: 

You're not alone. I know a fair amount about this subject. Happy to give you a reassuring call at your convenience if you'd like to chat.

Best. Amby

We spoke on the phone for over an hour, trading stories about running, aging, training strategies, cardiology, anxiety and hope.  It turns out that he is part of an extensive community of older runners, all of whom are still at it in some form or another, and all of whom have astronomical CAC scores.  I found him to be gracious, articulate, and indeed, reassuring.

My story isn’t Amby’s story.  During most of the 80’s for example, while he was running marathons, I was living on the “bartender’s diet,” relying primarily on cigarettes, coffee and beer for fuel.  So if there are such things as good plaque and bad plaque, no doubt I’ve accumulated a mixture of both.  

What about you?  Should you get a scan? If you’re young, and you get a non-zero score, your doctor is hoping that you’ll be scared into making some long-term lifestyle changes.  Good luck with that. If you’re older, and you’re not my wife, you probably have some arterial calcification. It tends to go with the territory. If you get an exceptionally high score, you’re eligible to join the Amby Burfoot club. And regardless of your score, if you lead a sedentary lifestyle, you’re overweight, you drink excessively, you smoke cigarettes, or you’re on a diet for which maple bacon is a regular featured item, then you’re likely on the road to an “event.” But you already knew that without a scan, right?