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

nytimes.com

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

#81

Post by Theodores »

brandonb wrote: 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…

Fascinating how these tests are something that is an option in America with people getting them.

In the UK we have the NHS and, although private healthcare is available, the NHS are gatekeepers with long waiting lists to see the doctor.

In UK culture you are just not going to 'waste NHS time' by asking for the tests that could inform you on what lifestyle choices you might need to make in order to head off chronic non-communicable diseases. You have to get a chronic disease, then the doctor will interpret the test results and not let you know what the numbers are, just what medication to take, optionally with lifestyle changes.

As a consequence, nobody in the UK knows what their cholesterol levels and whatnot are, yet, in the USA, plenty of people know these numbers.

Do healthcare providers actively upsell testing in the USA?

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

#82

Post by david-gpu »

jrvarela56 wrote: post #17
Telemakhos wrote: post #11

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.

Years ago I also experienced very high LDL after a few months of low carb. A doctor was convinced it was genetic (familial hypercholesterolemia) even though multiple earlier tests over the years had been in the normal range. He had never heard of low carb cholesterol hyper responders and dismissed that diet could have to do with it.

Nowadays I am convinced that what happened was completely explainable by the Lipid Energy Model [0]. Five days a week I was doing 60~90 minutes of cardio in the morning after skipping breakfast. Exercising in a fasted state while on a low carb diet meant that I had very low glycogen in my muscles and liver, which meant that the muscles had to mobilize fat as an alternative source of energy. Since fat is not water soluble, transporting fat through the blood stream requires packaging it inside a micelle wrapped in phospholipids -- a lipoprotein. Hence the elevated LDL & apoB.

The solution is simple: consume some carbs before and/or during exercise, and learn about the translocation of GLUT4 receptors if you are concerned about hyperinsulinemia.

[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC9147253/

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

#83

Post by quantumwoke »

andy_ppp wrote: post #67
agumonkey wrote: post #66

Earlier quoted context omitted.

I wish cardiovascular monitoring was better. It's not uncommon for cardiologist to discharge you saying 'all fine, EKG ok' even though reality says otherwise. Happy you got stents at the right time.

EKGs should be extremely easy for AI to identify every disease with a range of probabilities and even some humans can’t identify from EKGs. Do we have the labelled dataset for this?

EKG changes are a late sign. You need structural imaging like CAC or CCTA or echo.

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

#84

Post by quantumwoke »

wrs wrote: post #14

My cardiologist pointed out that hard calcified plaques are unlikely to come loose, so unless there’s significant narrowing, they’re not a big problem. However, that situation correlates with a high calcium score. So the calcium score is not always correlated to risk. A CT angiogram distinguishes soft vs. hard plaques (and shows narrowing), so that’s the ultimate way to clarify the situation. (Bearing in mind radiati…

Better characterisation on CAC is key. This is a software problem - AI will help.

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

#85

Post by Theodores »

klipklop wrote: post #9

What I always wondered is if I get this test done, what would I even do with the results? If my arteries are already clogged, etc. Can this plaque be reversed?

I hope so!

There are many different schools of thought regarding diet and nutrition. No topic is more controversial since everyone with a stomach has an opinion.

There is science but that has to be believed in. Depending on your favourite foods and your values, you have to dismiss one half of the science as paid for by big beef or the other half as vegan propaganda.

A change in my environment led me to re-evaluate my food choices and I was open minded to completely changing everything. However, I did not go down the butter and bacon route. I became strictly whole food, plant based. This means always cooking from scratch with no processed foods or animal products. It is just an ongoing experiment with a study size of just one.

I did my research and upped my kitchen game. I was surprised at how much I used to enjoy no longer interests me and how easy it has been to stick to a diet rich in vegetables, beans, pulses and much else that I previously never cared for.

So, why am I telling you this?

Well, some believe that a whole food, plant based diet is best for your arteries. Having given it a spin to have a body that I am happy with, I am hoping they are right.

Do your own research with scepticism. Remember that nutrition is highly controversial and, just out of intellectual curiosity, see how it goes on a whole food, plant based diet. Originally I was only going to try and go without processed food for a month, but, with that target met, I kept going and learned more about nutrition just in case there was anything I was missing out on. The only thing turned out to be vitamin B12, which I supplement, with that being the only supplement.

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

#86

Post by quantumwoke »

klipklop wrote: post #9

What I always wondered is if I get this test done, what would I even do with the results? If my arteries are already clogged, etc. Can this plaque be reversed?

AIUI per my doctor wife, plaque cannot currently be reversed with a medication. It's about minimising future risk rather than reversing damage. Remodelling the plaque with medications does happen to a limited extent as commented elsewhere in this thread.

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

#87

Post by quantumwoke »

IAmGraydon wrote: post #46

CAC is pretty common, but I prefer Coronary CT Angiography, which is much more detailed CT of the heart and coronary arteries using IV contrast. It's a bit more radiation, but it shows soft plaque and arterial narrowing, which CAC does not.

It's better, but the contrast and much higher radiation dose compared to CAC carry their own risks. Individuals can evaluate their own risk but I wouldn't get this test under the age of 40 or 45 or so unless I had diabetes.

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

#88

Post by m_a_g »

breadwinner wrote: post #42

The point of this test is to decide whether to take statins. But statins are a problematic drug, see here: https://medium.com/@petilon/cholesterol-and-statins-e7d9d8ee...

That’s a horrible article to share as a source. Literally almost everything written there is wrong. What you’re doing is dangerous.

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

#89

Post by andy_ppp »

justlikereddit wrote: post #76
andy_ppp wrote: post #67

Earlier quoted context omitted.

EKGs should be extremely easy for AI to identify every disease with a range of probabilities and even some humans can’t identify from EKGs. Do we have the labelled dataset for this?

"It should be very easy for an AI to look at an x-ray, CT, ultrasound or MRI image and tell what disease a human got, even some that humans don't know of. Are there any labeled datasets " -Some Software dude, every month since 1971

No the examples you give are extremely difficult compared to the 2D graphs of an EKG. The Apple Watch is clearly doing some fairly accurate inference with a single lead around arrhythmias, for example. I’m really sorry for being enthusiastic about machine learning, I just finished doing an intensive ML bootcamp and it was fun getting results. I also actually have some heart issues so I’d love to see if I could get a result. Thanks for your constructive comment though, I’ve never seen ones like this here before!

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

#90

Post by djeastm »

Theodores wrote: post #81
brandonb wrote: 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…

Fascinating how these tests are something that is an option in America with people getting them. In the UK we have the NHS and, although private healthcare is available, the NHS are gatekeepers with long waiting lists to see the doctor. In UK culture you are just not going to 'waste NHS time' by asking for the tests that could inform you on what lifestyle choices you might need to make in order to head off chronic no…

>Do healthcare providers actively upsell testing in the USA?

In my experience, normal doctors do not, but there are a lot of private businesses that make their living selling testing.

Also, consider that despite a lot of people knowing their levels in the US through testing availability, health outcomes are not better. So, we know more, but don't do anything about it. I don't know what's worse.

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