Coronary calcium scan - UPDATED

Today, the result of my coronary calcium scan:  Zero.  Again.  Same as 7.5 yrs ago.

The scan comes with a disclaimer:

TECHNIQUE: Computerized axial tomography of the mediastinum was performed without contrast material. This study is performed without intravenous contrast and its sensitivity for pathology is reduced. This includes the detection of neoplasms, abscess, pulmonary embolism, and aortic dissection.

I asked Dr. Gary about a more detailed scan, but he said this was good enough, without me exhibiting any obvious pathology.  

Researching on this test, I found:

"...guidelines make a large distinction between CAC = 0 and CAC >0. ... Once detected, CAC progresses... Because of the exponential nature of CAC, its relationship with risk is logarithmic, that is, each successive increase in CAC translates into a smaller increment in risk. Thus, quantifying high scores versus very high scores contributes only moderately to improved risk prediction. An important concept is that most of risk stratification occurs with the CAC score range between 0 and 100."

So, it seems that CAC = 0 is way better than CAC = 1, because once established, it progresses.

In terms of mortality, I read that:

Cancer was the leading cause of death for patients with baseline CAC = 0, whereas CVD overtook cancer above a threshold of CAC >300.

OK, so I'm probably more likely to die of cancer than heart disease.  

My scan did show a hepatic cyst on my liver, so maybe that will be my death?  These are somewhat common, usually benign, and in 18% of the population.  Anyway, added a liver cancer test to my Ulta test package.  I'm getting both lipid fractionation tests, standard lipid panel, alipoprotein profile (A&B), and the AFP liver cancer screening...  all these tests for less than $170 with the Halloween discount.  I'll probably do it in Dec sometime.  Afterward, I'll be able to further assess my CVD risk and make a decision about statins.  

Dr. Gary had some encouraging words:  

"Zero means you have incredibly low cardiac risk. We usually don’t repeat this as we don’t have a handle on what progression means in terms of risk. Zero make less of a case for a statin drug. Hepatic cysts are very common. No need to pursue this further. Means nothing. Annual Skin cancer screening with a dermatologist and colonoscopies every 5-10 years are what I would recommend for cancer screening. Also, prostate cancer screening with annual PSA testing IS worthwhile despite historical commentary that it is not. And you do not need a stress echo or ECG. Given your cardiopulmonary fitness and CAC = 0, an ECG and/ or stress test will add nothing to determine your risk."

And... JP said it is immoral and impure to take drugs.

UPDATE:

I spoke with Allan T., orthopedic surgeon, fastest man in the world over age 60 (60m, 100m).  He sent me this form that assesses the 10-year risk of the following ASCVD events: 1) CHD death, 2) Nonfatal MI, 3) Resuscitated cardiac arrest, 4) Coronary revascularization in patient with angina (bypass?).

According to this form, my risk of a 'cardiac event' in the next 10 yrs is not 'incredibly small' but is listed at 6.9%.   

Allan has values similar to mine and worse, has a family history with his father having a heart attack at age 55.  But he eschews statins.  

Although not a cardiologist, he agrees with my theory that 'running the engine hot' or pushing HR to max a couple times a week may have anti-arteriosclerosic benefits.  

150s on turf ... again. CVD studies.

 Low 70's, sunny, light breeze and dry as the exceptional weather continues.  Happy to have the field.  Took down the volume and upped the speed a bit. 

Hoka trainers on

stretches, drills, bands, 100m

Hoka Rocket X2s on

3 x 150m w/ 30 sec rest - 24.71, 26.08, 27.40

2 x 150m w/ 30 sec rest - 22.48, 24.74

150m - 22.01

Only 900m total but a little speed.  It was plenty hard.  HR maxed at 182 1st set, 179 second set, and 167 on the last one.

Staying relatively light, eating more fiber and fruit, and less meat and vegs past few days, mostly because Roya is gone.  

Weight is decent, 140.5 after workout

CV Health

Seeing contradictory findings about LDL and CVD, it seems that the technology is improving beyond the standard lipid panel.  This study, really a commentary on recent research, says...

There are several subclasses of LDL-C, including large floating (lb), intermediate, and small, dense (sd) LDLs. Recent studies have shown that sdLDL is more atherogenic than other LDL subfractions and that sdLDL-C is a higher-accuracy prognostic biomarker for overall CVD than total LDL-C....   Apolipoprotein B (ApoB), containing lipoproteins of less than 70 nanometers in diameter, can traverse the endothelial barrier, particularly when the endothelium is compromised, where they may become ensnared following interactions with extracellular components such as proteoglycans. Subsequently, they are retained within the arterial wall and further begin a very complex process that ultimately leads to an atheromatous plaque.  

There are now tests that are reasonably priced and available called Lipoprotein Fractionation NMR test that utilizes Nuclear Magnetic Resonance (NMR) spectroscopy to give values of these subclasses of LDL.  However, the study warns:  "further studies are needed to establish a series of standardized methods and guidelines in order to evaluate sdLDL subfractions and properly adjust the current clinical practice."

Affirming this link of sdLDL with CVD in this study discussion:

 - The Quebec Cardiovascular Study showed that small LDL subfraction levels were independently correlated with coronary heart disease (CHD) risk in 2072 men over a 13-year follow-up period. Contrariwise, large LDL particles were proven to have no predictive value in this matter. 

- Atherosclerosis Risk in Communities (ARIC) and the Multi-Ethnic Study of Atherosclerosis (MESA), proved a directly proportional relationship between small, dense LDL-C levels and the risk for ischemic heart disease. 

- Quebec Cardiovascular Study, no relationship with large LDL particles was found. 

- The Stanford Five Cities Project and the Physician’s Health Study also proved that a small LDL-C diameter is an important univariate predictor for coronary artery disease (CAD).

Within this study review, some other interesting results:

- We have multiple pieces of evidence to show that lowering the LDL-C beyond the recommended goals can further reduce the number of ASCVD events (heart attacks).

- The Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) study compared the effects of two different doses of simvastatin (20 mg and 80 mg) on 12,064 people who had previously suffered a heart attack in a double-blind trial. After two months, the 80 mg group had a 0.51 mmol/L (19.7 mg/dL) lower LDL cholesterol level than the 20 mg group, but this difference was reduced to 0.29 mmol/L (11.2 mg/dL) after five years. There was a nominal reduction in nonfatal myocardial infarctions in the 80 mg group, but the primary endpoint of major vascular events was reduced by only 6%

- A study published in 2020 by C.D.L. Johannesen et al. prospectively evaluated 108,243 subjects with a median follow-up period of 9.4 years in order to evaluate the correlation between the serum levels of LDL-C and all-cause mortality, and concluded that the association between LDL-C and the risk for all-cause mortality was U-shaped, with both low and high levels associated with an increased risk of mortality the lowest overall risk being observed at an LDL-C concentration of about 140 mg/dL–3.6 mmol/L. (so maybe LDL 150 isn't terrible? But which type!)

- Another prospective study based on a cohort of 14,035 adults aged 18 years and older, with a median follow-up period of 23.2 years (with a mean age of 41.5 years, 51.9% women), noted that both very low and very high LDL-C levels were associated with increased risk of CVD mortality. In particular, very low LDL-C levels were associated with a higher risk of stroke and all-cause mortality

- Other study suggested a link between low LDL-C and stroke, but not clinically confirmed as caused by statin therapies.  

Cleveland Clinic posts some values that are helpful in assessing risk from the test result:

https://www.clevelandheartlab.com/tests/lipoprotein-fractionation-nmr-with-lipids/

 

However... there are other methodologies for measuring lipid fractionation.  Ulta lab offers both.  The other is called "Ion Mobility Lipoprotein fractionation"

This study says it's better:  "Ion mobility appears to provide greater resolution of the pro-atherogenic effects of VLDL than other methodologies"

More on Ion Mobility test here from Quest: 

This LDL fractionation isn't the endall, as Quest states:

"  ... based on large population studies showing that people without coronary heart disease tend to have an abundance of large, buoyant LDL particles (pattern A), and people with coronary heart disease tend to have an abundance of smaller, dense LDL particles (pattern B). However, the literature suggests that CVD risk is conferred by a trio of factors that define the atherogenic lipoprotein profile (ALP). The ALP includes elevated small LDL particles (pattern B), low levels of HDL-cholesterol, and often an elevated fasting triglyceride concentration."

UPDATE:  I asked Gary about this (heart surgeon), his response:

"I have been aware of small particle LDL as possibly a stronger prognostic indicator of overall cardiovascular risk. I would encourage you to pursue the measurement of the subclasses of LDL. While I suspect there is indeed some merit in the notion that the small particle LDL is a more potent instigator of atherosclerotic disease, I am much less sure that diet, exercise and even any of the medications we currently have available can impact (lower) the level of this subclass. There is ample data, however, to show that getting your LDL-C below 100 (and if you are a diabetic, closer to 70) will lower cardiovascular event risk (heart, stroke). As a cardiac surgeon, I do believe this and have seen positive results in my patients who lower LDL-C...usually with medication as diet and exercise can only do so much when the liver is genetically programmed to churn our LDL-C."

Bike climb - Raccoon Mtn

Joined Bill M. for a big bike climb up Raccoon Mtn.   To the first overlook in a respectable 35 min or so.  Quite a workout, almost 13 miles, 1624' total climb.  

I attacked the climb pretty hard and died at the end where my HR was at or above 179 for nearly 8 min (179-184).  Overall, above 170 for 17:09, 153-164 for 19:57. 

In regard to CV health, Bill agrees ... good to 'burn the engine hot' a couple times a week.

Bill M.'s HR by contrast (via watch) peaked at 158.   My average was 148, including breaks sitting around.  

I was biking comfortably, not out of breath with HR over 160. 

We got the photo below from a guy with a drone.  

Decided it was time to start wearing my helmet

About 2 weeks from peak color.  I may possibly come out a few more times before Dec.  This is my boating season.   

Will do a running workout tomorrow, I hope, but since I'm here, tempted to do the climb again today, Monday.  

stairs / CV health

Friday at MTSU, I had a busy day.  Ran stadium stairs in the morning, faculty meeting, then moved 3 huge old TVs to recycling (total weight for 3 TVs = 224 lbs), then had to repair a door, door frame and a panel that had rotted out on my porch.  I didn't finish until 8:30pm.  On my feet the whole day, my foot and lower back were hurting.  

Hoka Rocket X2s on

Stretches, drills

12 x Stadium Stairs

The stairs were a bitch because I had eaten late the night before and had acid stomach.  I paused after 3 to go to the mens room.   Although hard, it wasn't that great of a workout since I was resting after every rep past #8.   Heart rate did hit 170+ on those sets of 3.  

Incredible weather continues.   It was 85º in Murfreesboro, TN yesterday.  Planning doing a big bike climb with Bill tomorrow from the boat on Raccoon Mtn.   

Health

My Dr. said if I had an CCTA angiography, it would cost me potentially $1000-2000 out of pocket because insurance wouldn't pay.  So ordered another Coronary Calcium CT scan which is cheap, $50.   That will be this week.

He again suggested to start a low dose statin.  But I told him that I was going to try a few new things to see if I can delay the seemingly inevitable lifelong statin drug dependency.   

I will test again with Ulta lab my lipid panel in early Dec.  These are the steps things I'm going to add to my LDL lowering regimen:

- Limit espresso coffee:  My abuse of coffee as an appetite suppressant is bad.  I've consumed on some days up to several servings in morning cappuccinos and later in the day in iced coffee or protein drinks. Espresso contains cafestol and kahweol, which are diterpenes that can raise LDL cholesterol. But the issue is complex as these compounds also have some positive effects according to studies.  

- Niacin.  Niacin supplements are known to lower TriG and LDL.  

- Citrus Bergamot - flavanoid clinically shown to reduce LDL:  study.

- Oat bran cereal  (not oatmeal) - mostly anecdotal but some evidence proves this can lower LDL.  

My total testosterone was 421, normal, but my free T was low.  Always has been, don't know why.  Maybe a lack of cholesterol or protein in my diet?

We talked about the epidemic of T abuse among men over 50 and he strongly discourages TRT, because it is essentially creates a life-long drug dependency.  I totally agreed and with that, reiterated my opposition to commence statin use until absolutely all alternatives are exhausted.  He seemed to respect my point.  

Weight is good.  141.8 this morning. 

volume tempo 150s on turf

 Conditioning workout on turf again, this time 8x150, 3 sets.   The college is on fall break.  The weather is spectacular.  Sunny, dry, 72º, calm winds.  No rain in the forecast and it's been 22 days without measurable rain, which is not a good thing.  

Hoka trainers om

stretches, drills, bands, 100m

Hoka Rocket X2s on

3x150m w/ 30 sec rest - avg ~ 26.6

3x150m w/ 30 sec rest - avg ~ 26.2

2x150m w/ 30 sec rest - 24.12, 26.14

1200m of sprints today was a high for the season so far.   Still every set got my HR to max. These weren't exceptionally fast but the volume was the point.   Max HRs for each set were 183, 187, 180.

Still haven't run anything more than a 150m and almost entirely on the track.  My foot is coping.  I tried a taping system that seemed to help slightly on my last set.  I took ample rest between each set.  

I'm in real need of speed work and resistance training.  So, I will be doing my Friday workouts either on the stadium stairs, hill, or short sprints (50-100m) on the track.  Just those 2 x 100m sprints I did last Friday made my quads sore so that tells me, my body isn't used to sprinting fast.  That will change.  

Not going to rush it, but I look forward running some longer sprints in a few weeks once I get some speed and strength.  Looking forward to sprinting some 300s, and maybe, if my foot can take it, some longer foundation.  Long ways to go before I attempt a 300m tempo set.  Maybe by Dec - Jan.

Finally, my weight is getting there.  140.3 lbs after workout.  

blood work

Blood work was a total disappointment, as I can't out run my genes.  Despite totally clean eating and exercise, 90% vegan for weeks, low added sugar, and zero animal fat for over a week...

Total cholesterol - 215

LDL - 158

HDL - 42

TriG - 152

Glucose - 91 

Worst LDL - HDL ratio I've recorded at 5.12.  TriG also high.  Oddly, I still get the full state benefit incentive since I just need 3 of 4, the only one I missed was TriG which needed to be under 150, just missed.  Now I need a decent BP reading.  But that is all total BS anyway.

Obviously, the conventional wisdom isn't working.  Mediterranean diet, mostly vegan, low carb.   Can't imagine how bad my values must be when I'm not eating well.  

I've signed up with Quest Diagnostics so I can get tested anytime I want.  I'm going to try some different things that have worked in the past.   Niacin.  High fiber oat bran cereal.  Reduce coffee intake.  Should have done all that before this test.  Damn.   

Nothing else particularly remarkable, but my PSA is up from 1.8, and 1.6 the last tests to 2.6.  Bears watching I suppose.

I did read a meta study involving 12 million people in S Korea that showed the best total cholesterol for longevity was between 200-239, so who knows?  I'm going to still ask my Dr for a CT coronary angiogram scan.  

100s, hills, aging, health

Incredibly gorgeous weather in Sewanee, 63º, dry sunny, calm winds.  I hadn't intended to start 2x/ week running but looks like I am.   I went to the track to warm up, decided to run 2 hard 100s. Then went to the hill and ran 2 more.  A bit discouraging.  

Stretches, drills, bands, 100m

Hoka rocket X2s on

2 x 100m - 13.90, 14.01

2 x 100m hills - 21.90, 21.90

I was hoping to run at least mid 13s in a 100m with a rolling start.  I could probably do it in spikes.   Afterward, I went to the steep on Roarks cove rd. to run 100s.  Wow, they seemed soooo hard.  I have routinely done this hill 5x100 at 19-20, and even 5x200 at 42-44.   I've seem to have lost significant speed.  Probably due to the fact that my stride is shortened and maybe asymmetric due to the fact I can't deliver much force with my R foot.  Only if I could train like I used to.  I'm still going to try.  

Getting lighter and now I need to work on strength and speed.   Thinking I'll keep Mon or Tues for tempo conditioning work, and do a short speed or hill session on Friday.  

I saw an article recently about aging. The Stanford study said that there are two periods of accelerated aging, one in the mid 40s and one in the early 60s. I’ve really seen an unusually high decrease in my speed this fall and I’m thinking I’m in one of those ‘aging spurts.'  Hard to fathom how hard I was able to train just 8 months ago compared with now.  

Will get my bloodwork results in a few days hopefully.  I have my physical next week.  I'm going to ask for another calcium CT scan, it's been 7 yrs since my last one I had (zero score).  I requested a cystatin c test (as recommended by JP), but it was denied by the physician on call as my primary Dr was on vacation this week, he would have to order it.    My mother said she is not on any kidney medication and seems to be ok.  I hope to qualify for the yearly $250 incentive.  It's not a high bar.  I can get most of it through these screenings but I had to take a required call from a insurance co. 'health coach'.  This guy was clueless.  He had never heard of a coronary calcium CT scan.  He offered absolutely zero useful information.   My Dr. is too easy on me and is sometimes reluctant to order tests.  I live in a state where 40% of men my age are obese, 72% are overweight, so compared with most... for example, the women nurses and desk workers at the medical clinic are all obese, 90% at least.  The BMI requirement for the incentive is under 30 (not obese).  Interesting that the incentive program doesn't care about LDL, all they want is HDL over 40, and triglycerides under 130.   Last time tris were just under at 127.  Oddly, on that outlier 3/21 test where I had super high LDL (202), my triglycerides were very low (71).   That was the egg diet experiment.  I would have qualified for the incentive as my HDL was also higher at 59.  

After fasting for about 20 hrs before my blood work, I ate badly yesterday after the test.  Had 2 Panera pastries in the morning, 2 at night, and some chocolate.  Other stuff was fairly ok.  I'm back on track and hope to be down to 139-140 soon.  

140.9 lbs after workout.