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

nytimes.com

151–160 of 197 posts

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

#151

“20% risk means we need to without a doubt medicate people for the rest of their life!” This really says something to me about American medicine. Something is going to get you at some point. Is something that has a 80% risk of not happening really justify medication which comes with it own cost and risk? Another article on this topic was posted a few weeks ago and prompted the same reaction in me.

This is a recommendation done globally though. 20% risk = statins. This is true in Japan, Europe, China, Oceania, etc.

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

#152
post #62

Earlier quoted context omitted.

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 apoli…

Since you appear to be quite knowledgeable on the matter, I wonder what’s your opinion on Cholesterol Code and Dave Feldman? Thank you.

I have not seen it yet, however I have heard favorable responses about it. The responses have largely been that Dave's theory is basically a near-complete summary of science that doesn't include roughly the past 5ish years of scientific advancement, so it isn't entirely right, but a good deal of the way there. He's been shaping this theory for like a decade now. People who are more familiar with this (such as career research endocrinologists) have given favorable commentary about it, but it isn't perfect and has small gaps.

I have seen him speak about his theory on a few well known medical/science podcasts, so I am a little familiar with his work so far. I find it interesting that he isn't a career biologist in any way, but a software engineer. So, I imagine he'd fit in with the HN crowd quite well.

The major part of his theory I think that is interesting is people who have weird insulin responses (ie, have been or are insulin resistant; so, have, had, or will have Diabetes) have largely shaped what we consider normal cholesterol numbers. Also, people who are lean and eat low carb may just naturally have different ratios of cholesterol numbers; iirc part of his argument involves the LDL-P(articles) to LDL-C(holesterol in the particles) ratio or LDL-C to TG ratios, and how it may be that they have "bad" ratios that most doctors would try to treat with statins, but there is actually nothing wrong with them, as other biomarkers and CAC scans indicate there is no increase in arterial damage even though they have "bad" ratios.

So yeah, I'd consider it worth watching, but don't take it as gospel. If it shows up on a streaming service I have, I'll consider giving it a watch.

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

#153
post #6

This test is also being heavily misused and misinterpreted in some online communities. There are a lot of people posting CAC scan results after something like a year of keto dieting in their 20s or 30s and using that to conclude that the saturated fat connection to atherosclerosis is a myth or that high cholesterol is fine. These tests don’t have perfect accuracy and resolution, so low or zero results don’t mean that…

Also age is huge so people shouldn't be reading much into a reading of 0 unless you're over 65. https://dirjournal.org/articles/coronary-artery-calcium-scor... (see table 2)

Imagine claiming "my diet is great, i got 0% on my calcium score" when that just means you have the same score as 95%+ of people at age 40.

By 55, 25% of people start showing some % of calcium and at 65, 75% of people have a reading on calcium score.

So anyone under 45 being proud of a zero score is just silly.

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

#154
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…

Since typical blood tests start at under $10, can you codify the value that the company at that link provides that makes their list price $1,490?

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

#155
post #90

Earlier quoted context omitted.

>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.

They are better. Life expectancy at birth in the US is dragged down by myriad societal issues but if you survive to middle age, life expectancy begins climbing to the highest in the world.

Really you just need to look at it by state to see the huge difference. There is almost a 10 year difference between the best and worst states.

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

#156
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…

Since typical blood tests start at under $10, can you codify the value that the company at that link provides that makes their list price $1,490?

That panel costs $190 (and includes 85 biomarkers).

FWIW, similar bundles I've seen online are priced at $400-$500.

All 85 biomarkers, if purchased separately, would cost a total of $1,490. ApoB, for example, usually costs $60 if done in isolation, Lp(a) is $45, hs-CRP is $65 at Quest, etc. The bundles end up having lower pricing due to volume discounts and being able to amortize some of the cost across biomarkers.

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

#157

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…

For me, it was different.

A cardiologist told me (after a calcium test showed 95th percentile for calcium) that what I was looking for was a rapid drop in ability. Not over a decade, but over a couple weeks or a month. Well, I play ultimate, and one day I realized "I didn't get this winded a month ago". So I got a stress test, and it showed "abnormal motion of the heart wall under stress" (that is, not enough oxygen getting to all the heart muscles). They did a catheterization, and I wound up with two stents.

I mean, look, if you get the chest pains, don't ignore that. But it doesn't have to be that way. If you lose athletic ability, or wind, or endurance, in a short amount of time, get a stress test.

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

#158
post #135

Earlier quoted context omitted.

Its not impossible to get diagnostic tests done outside the scope of a GP. It's generally very expensive.

My impression (might be wrong) is that one can get this for some subset of blood tests but not say an MRI or x ray, let alone more complex tests. Are these just insurance company rules? If I found a way to make it profitable can I open a diagnostic lab independent of insurance companies?

Diagnostic labs are just for-profit companies. They’re happy to do tests as long as they get paid by somebody. The only practical restrictions are if you want to convince insurance to pay for it. If you’re paying cash, you can get anything from a simple blood test up to a full-body MRI scan [0].

I got a CT angiogram from a cardiologist here who started her own business specifically to do them. (It’s just her, a nurse, and a CT machine, in a trailer in a parking lot!) Insurance doesn’t pay for imaging like this until things have already gone very wrong, and she feels it should be used much earlier for people who have risk factors.

[0] https://prenuvo.com/

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

#159
post #144

Earlier quoted context omitted.

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

Sometimes free as well. Certain CROs offer free screening: https://cardiometabolicscreening.careaccess.com/en?_gl=1*1du...

The test cost me $35.20 and I found out that I have sky high Lp(a), 218 nmol/L. I already take a statin and my cholesterol is well under control (LDL 83). But as has been pointed out, Lp(a) doesn't respond to statins. I'm getting a calcium score done (probably won't be covered but we'll see).

I'm prescribed a baby aspirin for the Lp(a). The AHA no longer recommends baby aspirin to the general population but 218 takes me out of the general population. The thinking is that Lp(a) clots and baby aspirin counteracts that.

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

#160
post #144

Earlier quoted context omitted.

Sometimes free as well. Certain CROs offer free screening: https://cardiometabolicscreening.careaccess.com/en?_gl=1*1du...

The test cost me $35.20 and I found out that I have sky high Lp(a), 218 nmol/L. I already take a statin and my cholesterol is well under control (LDL 83). But as has been pointed out, Lp(a) doesn't respond to statins. I'm getting a calcium score done (probably won't be covered but we'll see). I'm prescribed a baby aspirin for the Lp(a). The AHA no longer recommends baby aspirin to the general population but 218 takes…

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