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Coronary artery calcium testing can reveal plaque in arteries, but is underused

nytimes.com

31–40 of 197 posts

Re: Coronary artery calcium testing can reveal plaque in arteries, but is underused

#31
post #29

Earlier quoted context omitted.

> EKG showed no sign of heart attack What about troponin? I was told by a Dr that it's more accurate than an EKG. Edit: I had the word tryptophan before.

Did you mean Troponin? Troponin shows up in the blood when there's been damage to heart muscle.

Yes I meant that! I spelled it wrong on Google, then copy/pasted the wrong word from the suggested replacement.

Re: Coronary artery calcium testing can reveal plaque in arteries, but is underused

#32

The first sign of trouble was chest pains while playing tennis. The pain subsided after a couple of minutes and I was fine. EKG showed no sign of heart attack or major blockage. Prior to that I had no symptoms whatsoever, exercised regularly, never smoked, 57yo male, 6 ft, 175lbs. A CAC scan revealed a calcium score of 411 and a stress test indicated a major lack blood flow to the front of the heart. A cardiac cathet…

63, no history of heart disease, all my numbers in the "normal" range, fit, don't smoke, not overweight, good diet, etc. I was building a greenhouse in the back yard and went from feeling kind of "shitty" to classic left chest and back of arm pain.

It's amazing how fast you get into the ER when you come in like that. I got an angiogram within 45 minutes and also had 2 stents in the LAD with 90-95% blockage.

Re: Coronary artery calcium testing can reveal plaque in arteries, but is underused

#33
post #25

This article is so anathema to me. My experience is, your total cholesterol is over 200 (with some more specifics about LDL I can't recall, like 130 or something), all doctors everywhere will then hound you incessantly to get on Crestor, immediately. Diet and exercise don't matter (they cite research showing it doesn't make a difference). Whether you have plaque or not isn't considered, you need to be on Crestor righ…

[deleted]

Re: Coronary artery calcium testing can reveal plaque in arteries, but is underused

#34
post #29

The first sign of trouble was chest pains while playing tennis. The pain subsided after a couple of minutes and I was fine. EKG showed no sign of heart attack or major blockage. Prior to that I had no symptoms whatsoever, exercised regularly, never smoked, 57yo male, 6 ft, 175lbs. A CAC scan revealed a calcium score of 411 and a stress test indicated a major lack blood flow to the front of the heart. A cardiac cathet…

> EKG showed no sign of heart attack What about troponin? I was told by a Dr that it's more accurate than an EKG. Edit: I had the word tryptophan before.

What I was told in the ER is that troponin basically only shows up when there's been heart muscle damage so is a pretty clear sign. It doesn't show up immediately though - typically a rise within a few hours of the heart attack.

RE: EKGs. There are clear signs in the more detailed 12 lead EKG that can show irregularities in the electrical patterns and specifically help pinpoint the location of the active problem.

Re: Coronary artery calcium testing can reveal plaque in arteries, but is underused

#35

Earlier quoted context omitted.

Is this a keto diet that's mainly leafy greens with healthy protein like salmon? Or is this the "keto" diet of bacon and steak and as much fast as one can shove in the food-hole?

I don’t understand why some prople claim that diet does not impact cholesterol. I did ‘keto’ with bacon/steak/chicken/etc for 3 months, got bloodwork done before and after and my LDL went through the roof.

In contrast, I had a high LDL of 190, largely genetic, and panicked and switched to a vegan diet. I had my LDL tested again 10 days later and it was 120. I couldn't keep up with the strict diet, but learned some good habits and to avoid saturated fat. My doctor hasn't recommended statins... yet.

Re: Coronary artery calcium testing can reveal plaque in arteries, but is underused

#36
post #5
post #3

Before getting a CAC scan, I'd probably do these tests first: * ApoB - about 20% of people with normal cholesterol results will have abnormal ApoB, and be at risk of heart disease. * Lp(a) - the strongest hereditary risk factor for heart disease. * hs-CRP - inflammation roughly doubles your risk of heart disease * HbA1c - insulin resistance is a risk factor for just about everything. * eGFR - estimates the volume of…

CAC is the right test for people who already have identified that they have major risk factors such as metabolic syndrome/T2D, high cholesterol, etc. It identifies whether heart disease has already advanced enough that the risk factor has become a risk. Some of the tests you list (like A1C) are baseline things everyone should get checked every year. Agreed that the others could provide value for those who want to kno…

Lp(a) is a once in your lifetime test and also not very expensive.

Re: Coronary artery calcium testing can reveal plaque in arteries, but is underused

#37
post #7

I had a calcium score of zero, is that good? Hereditary high-cholesterol.

It is expected to be 0 if you're under 45 years old or so, I think. When I did a CAC test, the results came with charts showing where I was compared to the expected value for my age.

Also, taking a statin can increase the CAC score because statins cause fat build ups to calcify faster which makes them less likely to break free and cause big problems.

Re: Coronary artery calcium testing can reveal plaque in arteries, but is underused

#38
post #25

This article is so anathema to me. My experience is, your total cholesterol is over 200 (with some more specifics about LDL I can't recall, like 130 or something), all doctors everywhere will then hound you incessantly to get on Crestor, immediately. Diet and exercise don't matter (they cite research showing it doesn't make a difference). Whether you have plaque or not isn't considered, you need to be on Crestor righ…

Do you have side effects from the statin?

Re: Coronary artery calcium testing can reveal plaque in arteries, but is underused

#39
I got pitched (along with a bunch of other people at an investment conference) on an insanely expensive concierge medicine service and they trotted out some super impressive doctor who was fascinating. Anyway the thing that stuck was that he said it takes 10-20 years for meaningful advances in medicine to show up in general use, which was a little depressing

Re: Coronary artery calcium testing can reveal plaque in arteries, but is underused

#40

Earlier quoted context omitted.

Yes.

... more info please..

So, the simple explanation is this: Cholesterol is a necessary and important chemical, specifically, it is a sterol, and a precursor for Vitamin D, cortisol, estrogen, testosterone, and the substance that makes up the myelin sheath is. Cholesterol is not, and never will be, "the bad guy". Your body produces almost a gram of it a day, but dietary amounts are only about a third of that.

It it also the backbone of apolipoprotein, which is the actual thing your Doctor is talking about when they say "good cholesterol" and "bad cholesterol". Apo combined with other things (triglycerides and phospholipids) make HDL, LDL, and other familiar "cholesterol particles".

Since they shuttle fatty acids around, these fatty acids can be oxidized. When there are too many lipoprotein particles than your cells can safely clear, macrophages end up being targeted by the particles. Macrophages that take on too many damaged particles (damaged by the fatty acid oxidizing) can ram into arterial walls, which summons platelets to try to fix it.

The platelets use a calcium-based substance to fix the damage. Its sorta like organic concrete. Over a lifetime, your arteries become clogged with the concrete.

So.

The western diet and lifestyle lacks many important things required for healthy living. One of these is sufficient sun. Although Vitamin D supplementation is absolutely required for many people (most science is indicating that 2000 IU isn't even enough but is a bare minimum), we also have extremely little K2 in our diet compared to our ancestors, since it comes from certain fermented foods, and we largely no longer eat the correct fermented in sufficient amounts foods, even though it has been a staple of our diet at least 20 or 30 thousand years; long enough that it has changed our gut bacteria to basically necessitate it for many reasons.

K2 is required for signaling of arterial plaque removal, among other things. That organic concrete? It's not meant to be permanent, its meant to merely to stop you from potentially hemorrhaging.

Also, fun fact, anticoagulants that act as K2 antagonists (Warfarin, etc) lead to vastly increased arterial calcification (since, as an antagonist, it blocks K2 signaling). Those anticoagulants also can lead to brittle bones, because K2 is also used for signaling in a few biological processes that want to deposit the calcium in the right place.

So, I could just say "eat healthily", but nobody knows what the fuck that means. Beef liver and hard cheeses are good sources of K2, so is Sauerkraut and Kimchi. Supplement companies also sell good Vitamin K-focused multivitamins, many of which are a oil-filled gelcap with K1, K2 MK4, K2 MK7, and a meaningful D dosage (so its a drop in replacement for your daily D gelcap) (ex: Jarrow K-Right, but all the major good ones have a product like that).

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