Q: I am a 69-year-old male who is being treated for high blood pressure and high cholesterol; both are well-controlled. My recent cholesterol level was 150 mg/dL with an LDL of 56 mg/dL and an HDL of 42 mg/dL. I’m on 10 mg of rosuvastatin, and I do intensive workouts with a trainer four days a week and hike two to three days a week.
I never get chest pain or unreasonable dyspnea. I have lost 20 pounds in two years. My mother had a cardiac stent put in at 82 and died of aortic stenosis at 86.
Four years ago, my CT calcium score was 920. I had another test done this week, and my score was 1,100. I see a cardiologist annually because of it.
My EKG is normal, and my cardiologist appears unconcerned about these results. He told me to take 81 mg of aspirin a day, but advised against a stress test since I’m asymptomatic. He said that over time, the calcium deposits can “coalesce” and raise the score, but this doesn’t mean I have fatty plaque that could rupture and cause an unexpected heart attack.
He feels that I probably have stable coronary artery disease that could eventually cause warning symptoms, which is when he would do the testing. It was my primary care physician who ordered the test. My cardiologist discouraged doing it.
His advice makes sense to me, but should I get a second opinion? – C.S. A: I agree with your cardiologist about not getting a stress test.
You are already on the appropriate medical treatment for coronary artery disease (blockages in the arteries), so making 100% certain of the diagnosis wouldn’t change that. Even if you had an angiogram, in absence of symptoms, there is pretty good evidence that placing a stent would not prevent a heart attack or make you live longer, since you are on effective medical treatment. There has been much debate about whether a beta blocker would be of benefit in preventing a heart attack in people who have stable coronary artery disease without symptoms.
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