Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

nytimes.com

Post reply on HN
Print view View original

161–170 of 197 posts

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

#161

Post by dugmartin »

jgalt212 wrote: post #136
gcanyon wrote: post #106

Earlier quoted context omitted.

Given the low side effect rate and limited overall impact, shouldn't the bar for deciding to take statins be near-zero? Like, the articles say if there's a 5% chance of a heart attack in the next 10 years there's no reason to take a statin, but if the statin changes that 5% to 4% (that's speculation on my part) then given the limited side effects it would likely be worth it, right?

> the low side effect rate The rate of serious side effects is quite low (e.g. brain fog), but the reported rate for muscle weakness is non-trivial.

It caused a lot of muscle weakness in the legs for two members of my family. The weakness went away for one of them when they stopped taking it.

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

#162

Post by breadwinner »

It is surprising that no one has mentioned antioxidants and green tea yet.

Cholesterol is a substance the body naturally produces and requires for many functions. In the brain, cholesterol is essential for building and maintaining neuronal membranes, supporting synapse formation, and enabling myelin production. Statins interfere with cholesterol synthesis in the brain and have been associated in some cases with brain fog or short-term memory issues.

Cholesterol itself is not inherently harmful. It is oxidized cholesterol that causes atherosclerosis.

Antioxidants such as those found in green tea help prevent LDL oxidation.

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

#163

Post by myth_drannon »

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 imagine nothing like this is available in Canada?

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

#165

Post by _zagj »

OutOfHere wrote: post #112
_zagj wrote: post #78

Earlier quoted context omitted.

Oddly enough, there's evidence that saturated fat intake inversely affects Lp(a) levels: https://pmc.ncbi.nlm.nih.gov/articles/PMC10447465/

It doesn't help if LDL gets raised due to the SFAs, as LDL is an independent risk factor.

I was just noting the oddness of Lp(a) responding inversely to SFA intake (the reverse of LDL), which also contradicts the conventional wisdom that Lp(a) isn't amenable to lifestyle interventions.

You could theoretically increase SFA to target Lp(a) while still using lipid-altering drugs to target LDL.

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

#166

Post by asdfj999 »

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...

Statins are a lot like climate change. Two sides, the establishment versus outsiders, each claiming their side is correct, arguing over mountains of data that you can never personally verify.

However, there is zero financial incentive for a physician to prescribe a statin. They are all generic medications. A month prescription is approximately $10.

We do not yet have final word on this topic, we will have a better understanding as time progresses, but until then I continue to recommend statins to my patients with appropriate risk factors, for the same reasons I find climate change credible. The data showing benefit is not just limited to the United States, it is international, and to essentially falsify something involving millions of individuals and thousands of researchers around the world just isn't feasible.

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

#167

Post by moltar »

DiabloD3 wrote: post #152
moltar wrote: post #62

Earlier quoted context omitted.

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…

Thank you for the thoughtful and thorough response!

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

#168

Post by QuantumGood »

brandonb wrote: post #156
QuantumGood wrote: post #154

Earlier quoted context omitted.

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.

Thanks, that's good information. What is your relationship to the company, if any? I wouldn't ask, but it's common when the answer is "none" to provide that info before anyone asks.

I believe eGFR (via creatinine testing) and sometimes HbA1c (if diabetes screening is ordered) are the only things listed may be part of a routine health check from a common/inexpensive blood test.

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

#169

Post by derektank »

breadwinner wrote: post #126
derektank wrote: post #64

Earlier quoted context omitted.

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?

Excess LDL and VLDL cholesterol have absolutely been shown to be harmful. We know from studies of familial hypercholesterolemia, a disorder caused by single mutation in the LDL receptor gene, that too much LDL cholesterol directly leads to artherosclerosis and early death from heart disease.

There's a pretty direct analogy to type 2 diabetes and metabolic disease generally. The human body naturally produces blood glucose and we would quite quickly die if our blood glucose levels went to zero. That doesn't mean that hyperglycemia is healthy and in fact, we know it directly causes all kinds of bad health outcomes. We absolutely need some LDL cholesterol, and in our evolutionary history when we faced famine there was probably some selection for people whose livers didn't aggressively metabolize LDL particles from the blood (an energetically costly process), but that doesn't mean that high LDL cholesterol today is safe if you're hoping to live a long life.

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

#170

Post by breadwinner »

asdfj999 wrote: post #166
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...

Statins are a lot like climate change. Two sides, the establishment versus outsiders, each claiming their side is correct, arguing over mountains of data that you can never personally verify. However, there is zero financial incentive for a physician to prescribe a statin. They are all generic medications. A month prescription is approximately $10. We do not yet have final word on this topic, we will have a better un…

> There is zero financial incentive for a physician to prescribe a statin.

Well, doctors make money when they prescribe drugs: Patients will make more doctor visits when they are on prescription medications than if they are not.

> The data showing benefit...

The reason for the benefit is not fully understood. The argument is that the benefit comes not from lowering cholesterol but from reducing inflammation and stabilizing plaque. The medical community has no incentive to research this because they are raking in money, and any further research could only slow down the gravy train at best.

Post reply on HN