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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

#171

Post by ljf »

QuantumGood wrote: post #168
brandonb wrote: post #156

Earlier quoted context omitted.

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.

Tape on the posters name:

about: Data for good. Co-Founder at Empirical Health (https://empirical.health).

Before: Risk Engineering at Brex

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

#172

Post by brandonb »

QuantumGood wrote: post #168
brandonb wrote: post #156

Earlier quoted context omitted.

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.

Co-Founder of the company (it's on my profile). Yes, you're right--of the biomarkers listed, only eGFR and HbA1c are standard in a routine health check.

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

#173

Post by LorenPechtel »

CalChris wrote: post #159
dr_ wrote: 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…

Yeah. I've got that evil gene. Presumably took out my uncle at 55. But I'm much more active and my heart still works properly.

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

#174

Post by LorenPechtel »

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…

Upsell? It's never been a matter of discussion. Doctors orders some standard bloodwork every year. HDL and LDL are part of it.

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

#175

Post by LorenPechtel »

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.

And is that really so horrible? I would not own a chair flimsy enough that my wife couldn't sit on my lap when I was sitting in the chair.

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

#176

Post by LorenPechtel »

Theodores wrote: post #121
gcanyon wrote: post #108

Earlier quoted context omitted.

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 i…

No. There's a *big* difference between the load limit printed on something and it's true expected failure point. As somebody could be hurt by the chair failing I would expect the real strength to be in the ballpark of 3,000 pounds or even more. Figuring the permissible % of expected yield point is handled by the engineers, normally not by the end users.

Load ratings near the failure point are only done when the failure will not cause a problem, or when the failure is actually a desirable property (breakaway tethers of various types.)

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

#177

Post by LorenPechtel »

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?

You're assuming EKG is definitive.

I had an EKG last week, the analysis comes back "borderline". Running down every abnormality listed (I know my cardiologist has seen it, didn't consider it notable) has a range of possible causes, including the changes that come with good endurance.

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

#178

Post by LorenPechtel »

wrs wrote: post #158
smath wrote: post #135

Earlier quoted context omitted.

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 nurs…

CT is radiation. This is a case where too much testing is detrimental, not merely wasteful. You're sucking up 4 years worth of background for that CT angiogram.

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

#179

Post by breadwinner »

derektank wrote: post #169
breadwinner wrote: post #126

Earlier quoted context omitted.

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 glu…

If LDL cholesterol is the villain it is made out to be then lowering it — by whatever means — should produce a proportionate reduction in heart disease. It does not (see ENHANCE trial [1]).

And yet lowering cholesterol using statins has proved beneficial for people who have already suffered heart attacks. How do you explain this? One explanation is that statins work for these people not because they lower cholesterol but because they reduce inflammation and stabilize plaque.

The science behind this is not fully understood. Big Pharma 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.

[1] https://www.nejm.org/doi/full/10.1056/NEJMoa0800742

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

#180

Post by AbstractH24 »

kelipso wrote: post #133
AbstractH24 wrote: post #104

“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.

Yep, doctors in the US routinely prescribe statins for people with less than 5% risk. Very common.

Why does common equal not worth questioning?
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