Thanks for sharing your personal info, even the embarrassing part! :) I look forward to hearing how this has informed your day-to-day lifestyle and medication choices, and whether the knowledge has given you more or less equanimity. I'm also curious to hear your take on the article below. Maybe the improved risk prediction will help doctors more accurately pinpoint who best to target for primary prevention. I do wish the CCT would release the data because their failure to do so leads many folks to reasonably conclude they must be hiding something.
Correct me if I am wrong: 'This test is ONLY a predictor for something that can not be stopped, reversed or cured. And while it MAY be useful longitudinally to chart an assumed future demise, the downstream psychological harm to many patients has the POTENTIAL to cause more damage than good or promote any reasonable understanding of the test results.'
Follow up: In what universe would a sane person disclose: "My LDL-C levels weren’t particularly high but I periodically took rosuvastatin after eating particularly unhealthy meals just to be on the safe side (not a recommended protocol.)" ???
I have been covered by insurance by appealing their denial. I am asymptomatic, 75, not intolerant of statins with a treated LDL in the 50's by statins and diet alone. However I have a CAC over 1000, a very elevated LP(a) @300, mild aortic valve disease with mild thicken and mild calcification. I used the subset data data from the FOURIER study on LP(a) to bolster my case.
Nina Teicholtz and Gary Taubes also have a substack following and their most recent post talked about:
Among healthy, lean folks, 80 participants on keto diets versus 80 participants on regular diets. The LDL cholesterols were 273 versus 123 and after 5 years the heart scan plaque amounts in both groups were the same.
Conclusions Among primary prevention-type patients aged 50–89 years without diabetes and not on statin therapy, the lowest risk for long-term mortality appears to exist in the wide LDL-C range of 100–189 mg/dL, which is much higher than current recommendations. For counselling these patients, minimal consideration should be given to LDL-C concentration.
So, have you looked into calcium dysregulation as it is involved in CVD, Alzheimer’s, Parkinson’s, cancer, diabetes?
ALL of these diseases share this - calcium dysregulation. Others, too.
Search it. Please. Search each disease with calcium dysregulation in PubMed or similar sources.
Add in vitamin K2. Lots of newer insights. Statins interfere with vitamin K2 actions. That’s why statins increase CAC. Again, search this. I can show, but actually searching seems to offer better insights.
It’s contrary to the enormous energy/money/careers into which we’ve poured our time and interests, but it’s there, it’s viable and it’s rather strongly supported. The only thing standing in the way of a paradigm change is that we’ve completely bought into cholesterol as ‘dangerous’ and related misguided ideas. Whole careers are based in them and ENORMOUS amounts of money, so who can change?
It’s fatal…To doctors, pharma, hospitals and our current (really, really broken) medical system. Fatal not bc more folks will die, but bc we would have to completely change and no one wants to (nor can…we’re stuck).
Yes, we want to avoid sudden death, but we’ve headed the wrong way!
BTW, there are claims that castration adds 14 years to a man’s life…so who is signing up?
In statin studies, so-called ‘side effects’ are cited as absolute risks while ‘benefits’ utilize relative risks. This is complete BS. And so few know! See:
We’re fat, sick, malnourished, and poisoned and modern medicine is either a direct guilty participant or indirectly responsible by way of bias.
Let’s use AI to sort out these various hypotheses. But to avoid garbage in, garbage out, ALL data must be included. See article above about statistical manipulations. See what really leads to healthy longevity. And it’s NOT statins, which actually cause calcium dysregulation.
Is there a difference from observer to observer in interpretation ? This sounds very exciting and a non invasive way to see coronaries , the test I’m told is about 1.500$ compared to invasive angiography , seems to be the future . Thank you sir
Unfortunately, lots of seemingly healthy individuals with no symptoms die suddenly from coronary artery disease. Death is their first symptom. You don't get second chances unless you are fortunate enough to have bystanders do CPR, utilized an AED and get you to a Cath lab.
Not sure what "detailed reductionist information is". The CCTA tells us exactly what amount of the disease of concern (CAD) we have. We need unbiased, enlightened MDs to help individuals do the best thing with that information, therein lies the problem.
I appreciate the prompt insightful response. My point is that as we look harder we find more. Not uncommonly I care for elderly frail patients admitted with serious bleeding issues on dual antiplatelet therapy after percutaneous intervention due to extrapolated study findings. Yes of course we are worried about in stent thrombosis. I welcome efforts to inform the clinician in these situations. I also hope that new AI generated information can not only persuade but also dissuade the practitioner when nuanced judgement is required.
This information is exciting to be sure. Cautionary tales abound however. A few basic truths should be kept in mind. First, it’s hard to make a healthy person feel better and attempts to intervene on this population should be viewed with great caution. Second, coronary artery anatomy blockages when approached as a plumbing problem is a simplistic naive world view fraught with unintended consequences. More detailed reductionist information is not necessarily a good thing(if we have learned anything from our cancer screening misadventures).
This study concluded that patients at all initial CAC scores showed dramatically more heart attacks if they did not hold their CAC increase to 15% per year.
My initial CAC was 2300. Clearly it had been moving rapidly. After 2 years of keto my CAC increase was 12.5% per year. (Also pre-diabetic markers disappeared, raw cholesterol numbers degraded but cholesterol ratios improved dramatically .)
That study was small, retrospective, observational with poor lipid control and published in 2004. Needs confirmation from at least one larger study from a different center. Nothing that I am aware of since then supports that conclusion.
Also, I suspect there were very few subjects who had CAC >2K
I will remember your compliment on my "remarkable online presence" the next time I feel more like playing music than writing posts!
My Dad had the invasive scan (not because he was having a heart attack, although he was getting angina pains. I don’t know whether he also had a non-invasive CT scan. I don’t know whether the NHS has Cleerly AI software for further coronary artery analysis. It sounds like very useful equipment though, and it would be brilliant if it was accessible across the globe via internet!
I just checked where Cleerly is available and am surprised at how limited it is. I live in Oregon, where there are 2 locations. None in California. Also, most of the offices listed are NDs - none were cardiologists. Is it that new, or are cardiologists inherently late adopters?
With a CAC of 2536 I read a CCTA is not very accurate >1000 CAC. Are there advances in this area I have not read about? If CCTA isn’t accurate I would imagine the Cleerly analysis would not be either. Is CCTA /Cleerly viable for me to understand degree of blockages?
Thanks for sharing your personal info, even the embarrassing part! :) I look forward to hearing how this has informed your day-to-day lifestyle and medication choices, and whether the knowledge has given you more or less equanimity. I'm also curious to hear your take on the article below. Maybe the improved risk prediction will help doctors more accurately pinpoint who best to target for primary prevention. I do wish the CCT would release the data because their failure to do so leads many folks to reasonably conclude they must be hiding something.
https://www.medpagetoday.com/opinion/second-opinions/110734?xid=nl_secondopinion_2024-06-23&eun=g2093479d0r
Correct me if I am wrong: 'This test is ONLY a predictor for something that can not be stopped, reversed or cured. And while it MAY be useful longitudinally to chart an assumed future demise, the downstream psychological harm to many patients has the POTENTIAL to cause more damage than good or promote any reasonable understanding of the test results.'
Follow up: In what universe would a sane person disclose: "My LDL-C levels weren’t particularly high but I periodically took rosuvastatin after eating particularly unhealthy meals just to be on the safe side (not a recommended protocol.)" ???
(opinion) 6-2-and even you will not answer!
I have been covered by insurance by appealing their denial. I am asymptomatic, 75, not intolerant of statins with a treated LDL in the 50's by statins and diet alone. However I have a CAC over 1000, a very elevated LP(a) @300, mild aortic valve disease with mild thicken and mild calcification. I used the subset data data from the FOURIER study on LP(a) to bolster my case.
PS see:
https://www.ahajournals.org/doi/10.1161/01.RES.0000181431.04290.bd?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
Thyroid Hormone Targets Matrix Gla Protein Gene Associated With Vascular Smooth Muscle Calcification
There is so much to learn about calcification!
VSMCs are vulnerable.
And endocrinology misunderstands the conversion of T4 to T3.
Another specialty involved in cardiovascular risk that tends to misguided.
Nina Teicholtz and Gary Taubes also have a substack following and their most recent post talked about:
Among healthy, lean folks, 80 participants on keto diets versus 80 participants on regular diets. The LDL cholesterols were 273 versus 123 and after 5 years the heart scan plaque amounts in both groups were the same.
Also, see this:
https://bmjopen.bmj.com/content/bmjopen/14/3/e077949.full.pdf
Conclusions Among primary prevention-type patients aged 50–89 years without diabetes and not on statin therapy, the lowest risk for long-term mortality appears to exist in the wide LDL-C range of 100–189 mg/dL, which is much higher than current recommendations. For counselling these patients, minimal consideration should be given to LDL-C concentration.
So, have you looked into calcium dysregulation as it is involved in CVD, Alzheimer’s, Parkinson’s, cancer, diabetes?
ALL of these diseases share this - calcium dysregulation. Others, too.
Search it. Please. Search each disease with calcium dysregulation in PubMed or similar sources.
Add in vitamin K2. Lots of newer insights. Statins interfere with vitamin K2 actions. That’s why statins increase CAC. Again, search this. I can show, but actually searching seems to offer better insights.
It’s contrary to the enormous energy/money/careers into which we’ve poured our time and interests, but it’s there, it’s viable and it’s rather strongly supported. The only thing standing in the way of a paradigm change is that we’ve completely bought into cholesterol as ‘dangerous’ and related misguided ideas. Whole careers are based in them and ENORMOUS amounts of money, so who can change?
It’s fatal…To doctors, pharma, hospitals and our current (really, really broken) medical system. Fatal not bc more folks will die, but bc we would have to completely change and no one wants to (nor can…we’re stuck).
Yes, we want to avoid sudden death, but we’ve headed the wrong way!
BTW, there are claims that castration adds 14 years to a man’s life…so who is signing up?
In statin studies, so-called ‘side effects’ are cited as absolute risks while ‘benefits’ utilize relative risks. This is complete BS. And so few know! See:
https://www.cureus.com/articles/141648-historical-review-of-the-use-of-relative-risk-statistics-in-the-portrayal-of-the-purported-hazards-of-high-ldl-cholesterol-and-the-benefits-of-lipid-lowering-therapy
We’re fat, sick, malnourished, and poisoned and modern medicine is either a direct guilty participant or indirectly responsible by way of bias.
Let’s use AI to sort out these various hypotheses. But to avoid garbage in, garbage out, ALL data must be included. See article above about statistical manipulations. See what really leads to healthy longevity. And it’s NOT statins, which actually cause calcium dysregulation.
Is there a difference from observer to observer in interpretation ? This sounds very exciting and a non invasive way to see coronaries , the test I’m told is about 1.500$ compared to invasive angiography , seems to be the future . Thank you sir
Unfortunately, lots of seemingly healthy individuals with no symptoms die suddenly from coronary artery disease. Death is their first symptom. You don't get second chances unless you are fortunate enough to have bystanders do CPR, utilized an AED and get you to a Cath lab.
I've written a lot about the problem with plumbing paradigm of coronary disease (https://theskepticalcardiologist.com/2021/01/24/is-coronary-heart-disease-a-plumbing-problem-or-a-pimple-problem/) which is a disaster of unintended consequences.
Not sure what "detailed reductionist information is". The CCTA tells us exactly what amount of the disease of concern (CAD) we have. We need unbiased, enlightened MDs to help individuals do the best thing with that information, therein lies the problem.
dr. P
I appreciate the prompt insightful response. My point is that as we look harder we find more. Not uncommonly I care for elderly frail patients admitted with serious bleeding issues on dual antiplatelet therapy after percutaneous intervention due to extrapolated study findings. Yes of course we are worried about in stent thrombosis. I welcome efforts to inform the clinician in these situations. I also hope that new AI generated information can not only persuade but also dissuade the practitioner when nuanced judgement is required.
This information is exciting to be sure. Cautionary tales abound however. A few basic truths should be kept in mind. First, it’s hard to make a healthy person feel better and attempts to intervene on this population should be viewed with great caution. Second, coronary artery anatomy blockages when approached as a plumbing problem is a simplistic naive world view fraught with unintended consequences. More detailed reductionist information is not necessarily a good thing(if we have learned anything from our cancer screening misadventures).
I'm sorry for your music but happy for your readers.
Re: The CAC cannot be repeated to gain insights into how effective therapy has been.
Have you considered and rejected the conclusions of https://www.ahajournals.org/doi/10.1161/01.ATV.0000127024.40516.ef
This study concluded that patients at all initial CAC scores showed dramatically more heart attacks if they did not hold their CAC increase to 15% per year.
My initial CAC was 2300. Clearly it had been moving rapidly. After 2 years of keto my CAC increase was 12.5% per year. (Also pre-diabetic markers disappeared, raw cholesterol numbers degraded but cholesterol ratios improved dramatically .)
Should I rethink things?
Thanks for a remarkable online presence.
That study was small, retrospective, observational with poor lipid control and published in 2004. Needs confirmation from at least one larger study from a different center. Nothing that I am aware of since then supports that conclusion.
Also, I suspect there were very few subjects who had CAC >2K
I will remember your compliment on my "remarkable online presence" the next time I feel more like playing music than writing posts!
Dr. P
My Dad had the invasive scan (not because he was having a heart attack, although he was getting angina pains. I don’t know whether he also had a non-invasive CT scan. I don’t know whether the NHS has Cleerly AI software for further coronary artery analysis. It sounds like very useful equipment though, and it would be brilliant if it was accessible across the globe via internet!
Cleerly analysis can be done on any CCTA done anywhere.
Their website lists several sites in SoCal including mine (United Medical Doctors Encinitas)
SimonMed Imaging which is right next to my office has a VPN connection with Cleerly so that studies can be uploaded to the cloud for analysis.
Dr. P
Well, keep an eye on yourself, because no one else writes this stuff.
Question for you: how can something have FDA "Breakthrough Status" (where there is no grade inflation) and yet still be considered investigational?
I just checked where Cleerly is available and am surprised at how limited it is. I live in Oregon, where there are 2 locations. None in California. Also, most of the offices listed are NDs - none were cardiologists. Is it that new, or are cardiologists inherently late adopters?
With a CAC of 2536 I read a CCTA is not very accurate >1000 CAC. Are there advances in this area I have not read about? If CCTA isn’t accurate I would imagine the Cleerly analysis would not be either. Is CCTA /Cleerly viable for me to understand degree of blockages?
And Texas is the only state where coronary calcium scans are mandated to be covered by insurance!