TL;DR: If you are 50 or older, male or female, get a Cardiac CT Calcium Score Test done. This is a 5-minute non-invasive screening test for evaluating the probability and potential extent of plaque in your heart vessels. Plaque can cause heart attacks. If you are under 50 but have potential risk factors for calcification or cardiovascular disease, you should also consider it.

As some of you may know, on July 23, I competed/participated in Ironman Lake Placid. It was the first “Iron Distance” event I had done after an 11-year hiatus from triathlons. On July 26, I did a Cardiac CT Calcium Score test which is a screening test for potential calcification in your coronary arteries. Following the recommendation of my internist and another doctor, I did it solely as a “why not” test. While I had no history of high cholesterol or familial issues of high lipids, the test takes 5 minutes, is non-invasive, and costs only about $90 out of pocket (some insurers do cover the test). A result showing the absence of calcification for someone in their 50s and 60s provides some peace of mind as far as the probability of the absence of coronary artery disease. $90 seemed like a good investment for peace of mind. So, why not? A “score” of 0 is desirable.

My score came back over 2000.

Yikes!

This precipitated immediately being placed on a statin by the internist who had recommended the test. Some additional tests and a visit to a cardiologist focused on cardiovascular disease. An increase in the statin dosage by the cardiologist. A referral to an interventional cardiologist. A consultation with the interventional cardiologist who then scheduled a catheterization. Six weeks and one day after I completed my 2.4-mile swim and 112-mile bike, I had two stents inserted in two smaller arteries in my heart.

During a catheterization, an interventional cardiologist will do an angioplasty and insert stents if an artery has a 70% or greater narrowing. I had two arteries in this condition. The two narrowed arteries had not caused any symptoms to date. I had trained for and completed two-thirds of an Ironman. I had missed the bike-to-run cut-off, but that is a story for another day. Short digression: the missed cut-off resulted from my being slow – I can’t blame some physical ailment. Before this year’s Ironman training, I had done CrossFit or similar functional fitness training for approximately 10 years. The last 7 years of CrossFit were typically 4 to 5 days per week usually 60 minutes or so in duration with some other activity such as yoga on another day. Prior to that, I had done 12 years of triathlon, including completing two Ironman races and multiple half-iron events. I hiked, I snowshoed, I cross-country skied, and outside of the office, I was generally active.

For my entire life, my total cholesterol has ranged between 170 and 210, typically staying in the 180-195 range. My HDL and triglycerides always stayed in optimal ranges, with HDL always exceeding triglycerides by a 2:1 basis. LDL bounced around between 80 and 110, once hitting 120. Never higher. Glucose numbers are always good and in range. No sign of metabolic disease or otherwise in bloodwork.

I ate a relatively clean omnivore diet – although probably too much red meat. Actually, definitely too much red meat, at least in the period 2005-2015. Minimal processed food. Stayed away from added sugars. I have not had a sugary soft drink in probably over 15 years (not including Olipop). I take a fistful of supplements every day including Omega 3s, Vitamin D, magnesium, zinc, curcumin, CoQ10, and quercetin, among others to limit inflammation in the body. For the last 18 months, I dry sauna 3 to 5 times per week at 175 degrees or higher for 20 minutes a session. I cold plunge multiple times per week.

To my knowledge, no genetic factors indicated that I was at risk for cardiovascular disease.

This is not to say everything was perfect. I did have hypertension due to an overactive adrenal gland, which produced too much aldosterone (a hormone central to the regulation of blood pressure). I had this for 20 years, but this was resolved through surgery in 2022 (also a discussion from another day). I have been overweight. Sometimes more. Sometimes less. But this has also been heading in the right direction for the last several years.

All of this represents a long-winded way of saying, I thought I had limited my risk for ASCVD and otherwise had my health dialed in. NOT! The CT Calcium Test only alerted me to the high probability that I had calcification in my coronary arteries, from which bad things can and will occur if left untreated. From there, I had to follow my instincts and chase down an answer. Be aware, this is not easy in our medical system. Over the course of the 6 weeks I sought an answer, I was denied appointments; told that I did not need certain appointments; or given appointments 2 to 3 months in the future. Told that my insurance company may not cover a certain test unless I did another test first. The takeaway from this is that you need to be your own health advocate. No one else will take on that role for you. Thankfully, through persistence and getting in contact with the right people, I connected with great caregivers who worked within the system to find the answers and get me the necessary treatment before anything adverse occurred. I do not think about the outcome had I been passive.

Where does this leave me? As my cardiologist told me: take my medicine (i.e., statin) and exercise as hard or harder than I did before. Meanwhile, eat more plants. And live my life. All good advice for anyone.

So, I am eating more plants and getting back in the swing of my training regimen. Many hills remain to be conquered. And I have an appointment with a Bike to Run cut-off that I need to make in the future. But there will be a next time.

To anyone who has read this far, do not think that you are immune from cardiovascular disease. You can think you are doing everything correctly. Or at least pretty much correct (the old 80/20 rule), where I thought I had existed. For whatever reason, that may not be the case. So, take this as a public service announcement. Spend the $90. Take the 5 minutes. Get a CT Calcium Score done if you have not. Trust me. It’s worth it.

Peace.