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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

#121

Post by Theodores »

gcanyon wrote: post #108
beacon294 wrote: post #100

Earlier quoted context omitted.

I think, politely, this perspective misses the forest for the trees (or maybe the trees for the forest). Out of the approx. 250 million adult americans, a large cross section do manage their health. While average outcome might be better in the UK, it's useless to lump the 60% (150 million) of americans who are not obese in with the 40% (100 million) who are obese. And while this is easily the most major, it is just o…

As an anecdote, I saw just this morning plastic adirondack chairs for sale outside a grocery store, and they had a large sticker on them proclaiming in 4-inch lettering that they are rated for 350 pounds(!). That says something sad about the U.S.

As an aside, I am amazed that chairs can be sold without some redundancy, in case of breakage. 350 pounds is not exceptional these days, that is only 160Kg, which is only 90 Kg more than what I weigh with clothes, cup of tea and plate of food... 80Kg is reasonable for a healthy person and two people should be supportable by the chair.

However, chairs get left outside and they can rot. This can lead to collapse even if a 50Kg person gets on. This can be incredibly dangerous. Hence every chair should have a secondary support structure, in some cases this can be wire under tension, other times it might have to be steel tubing.

There are thousands of chair designs, none of them built for the ultimate eventuality of catastrophic failure.

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

#122

Post by breadwinner »

m_a_g wrote: post #88
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.

And you're offering nothing to back up your claim. Literally everything written in the article is backed up by sources such as New York Times, which in turn quotes experts in the field.

- Is it not true that the existence of a link between high cholesterol and heart disease is only a hypotheses that originated in the 1950s, not a scientifically proven fact?

- Is it not true that the FDA generally has not required drug companies to prove that cholesterol medicines (such as statins) actually reduce heart attacks before approval?

- Is it not true that lowering cholesterol by different means (i.e., other than statins) is not beneficial, and does that not mean cholesterol is not the villain it is made out to be?

- Is it not true that the only large clinical trial funded by the government (rather than drug companies) found no statistically significant benefit at all?

What exactly are you saying is wrong?

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

#123

Post by zzzeek »

Buttons840 wrote: post #38
zzzeek wrote: 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?

i had the elevated liver enzymes on a higher dose (10 mg / day which is not considered a high dose) and jury is out on whether or not I perceive muscle weakness. unsure

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

#124

Post by TechDebtDevin »

It cost <$200 to go pay cash and get a calcium score yourself. Its hard to talk a cardiologist into getting your insurance to pay for it if you're young. As a male who had a grandfather die in his 30's from heart disease it was even hard. If you're worried about this at all just pay for it yourself. I also reccomend getting Lp(a) testing (<$50) if this concerns you, DYOR, but it will give you a better grasp on how your body is handles bad cholesterol (everyone is different).

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

#125

Post by breadwinner »

rsanek wrote: post #52
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...

not sure I'm gonna trust a medium article that lists NYT and Bloomberg as references over what basically every single cardiologist recommends

Cardiologists don't do their own research. Drug companies do the research, and cardiologists are limited to just trusting the drug companies. So then the question is how trustworthy are the drug companies? Pfizer’s Lipitor raked in $125 billion between 1996 to 2012, becoming the world’s best-selling drug of all time. You don't think drug companies are even a little bit motivated by profits?

You are right about one point: You should absolutely not trust a random medium article, anyone can write medium article. Instead you should follow the links, then decide whether the experts quoted in the NYT and Bloomberg articles have a point.

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

#126

Post by breadwinner »

derektank wrote: post #64
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...

Setting aside the fact that the majority of people prescribed them tolerate statins with minimal side effects, there are other therapies besides statins available for treating dyslipidemia such as PCSK9 and ANGPTL3 inhibitors, to say nothing of non-pharmaceutical lifestyle interventions one can make.

Therapy for what, exactly? Cholesterol? A substance the human body naturally produces because it needs it (cholesterol is a key structural component of every cell membrane in the body)? A substance that has not been conclusively proved to be harmful?

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

#127

Post by brandonb »

rsanek wrote: post #50
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…

I'd add in the LDL subcomponent assay as well -- LDL pattern, particle number, peak size, etc. you can get those and all the ones you mentioned for relatively cheap https://www.walkinlab.com/products/view/cardio-iq-advanced-l...

The latest evidence is that if you have ApoB and Lp(a), then particle sizes don't add any more information. This is the most recent research (published July 2025): https://academic.oup.com/eurheartj/article-abstract/46/27/27...

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

#128

Post by brandonb »

OutOfHere wrote: post #43
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…

Unfortunately there is no approved oral medicine to lower Lp(a) that I am aware of. (I mean given a normal LDL.) Statins don't lower it afaik. An oral medicine named muvalaplin is being tested for it.

There's a clinical trial for a new drug, lepodisiran, which lowered Lp(a) by 93.9%.

Outside of that, if your Lp(a) is high, then the first strategy would be to choose a lower ApoB target than you would otherwise. (Every Lp(a) particle is also an ApoB/cholesterol particle, but 6x more atherogenic. So by lowering ApoB, you are compensating for the effect of high Lp(a))

Summary of the current research/evidence is here: https://www.empirical.health/blog/lipoprotein-a-blood-test/#...

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

#129

Post by brandonb »

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?

Eric Topol has a cool post on "machine eyes" -- using deep learning to identify subtle signals in ECGs and medical images that would be invisible to the naked eye: https://erictopol.substack.com/p/the-amazing-power-of-machin...

There are still regulatory/deployment/reimbursement barriers to cross, but this is happening.

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

#130

Post by j_bum »

pugworthy wrote: post #32
crdioptnt wrote: post #26

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.

Glad you’re ok. Stories like this are good to rebase myself and remember how important it is to enjoy life now while I can. No matter how healthy I try to keep myself, luck can change things in an instant.
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