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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

#181

Post by AbstractH24 »

AnotherGoodName wrote: post #151
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.

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

Why does that fact make it not worth questioning?

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

#182

Post by fivestones »

JeremyNT wrote: post #146
apothegm wrote: post #5

Earlier quoted context omitted.

CAC is the right test for people who already have identified that they have major risk factors such as metabolic syndrome/T2D, high cholesterol, etc. It identifies whether heart disease has already advanced enough that the risk factor has become a risk. Some of the tests you list (like A1C) are baseline things everyone should get checked every year. Agreed that the others could provide value for those who want to kno…

I've had high-ish LDL for ages and diet alone couldn't knock it all the way down. It's only the CAC score that provided me with peace of mind that I didn't need to reach for statins. The way I view this is that, if you can get more information, why wouldn't you? Cost of course, and I understand why insurance might not cover the procedure, but anybody of a certain age with any risk factors who is in a position to affo…

The problem we’ve found is that when you get more information, you are more likely to find things that look off somewhere, which may have no real bearing on your actual health but definitely can cause you to have a worse quality of life—whether because of stress or subsequent more invasive tests or just the time and energy it costs you.

This is why there are tests which previously were recommended to a wide range of people on a regular basis which are now only recommended in more limited settings. PSA is a good example of this.

The question to ask is, is doing this test likely to improve my life, or not? And while you probably can’t know the answer for a specific test in your specific case without trying, you can often know the probability that it will improve your life based on statistical analysis of other people who have gotten that test and how it went for them.

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

#183

Post by username135 »

smath wrote: post #135
username135 wrote: post #116

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?

You can have those tests done, it's just timing and cost.

For example: https://radiologyassist.com/MRI.html

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

#184

Post by OutOfHere »

agensaequivocum wrote: post #142
OutOfHere wrote: post #43

Earlier quoted context omitted.

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.

This guy talks about lowering his own with collagen and vitamin C https://x.com/gregmushen/status/1917780163242385586 And another guy lowering his with Amla, lysine and vitamin C https://x.com/gregmushen/status/1924660722786828584

It is nonsense because I have truly taken all four in good daily doses for years, and my value is still high.

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

#185

Post by lokrian »

breadwinner wrote: post #162

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…

Yes, trying to fight cardiovascular disease by getting rid of cholesterol is like trying to fight rust in your car by getting rid of the metal parts.

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

#186

Post by l8rlump »

gcanyon wrote: post #107
Theodores wrote: post #81

Earlier quoted context omitted.

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…

I know my cholesterol numbers going back almost twenty years, over something like 15 tests. This is because that first test around 2007 showed my HDL was ridiculously low. So I took steps to modify it, and tested again (and again...) to see how it was progressing.

How can you increase your HDL?

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

#187

Post by wrs »

LorenPechtel wrote: post #178
wrs wrote: post #158

Earlier quoted context omitted.

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.

I agree, it’s not recommended to get CTs on a whim. I have high risk factors, a high calcium score, and a bad family history, so getting the data to guide our mitigation approach was worth it.

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

#188

Post by Theodores »

LorenPechtel wrote: post #174
Theodores wrote: post #81

Earlier quoted context omitted.

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.

We don't even have the phrase 'bloodwork' in the UK. Also, in the UK, you can go to the doctor regularly for a checkup to never get this 'bloodwork' thing you Americans speak of. I have never had any done myself, all I get is my iron level when I donate blood, and I only ask about that after curiosity.

Healthcare is very different in America and I am not seeing the benefits of yearly 'bloodwork', it must be an upsell so they can get people onto statins and whatnot for life.

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

#189

Post by Theodores »

roryirvine wrote: post #147
Theodores wrote: post #81

Earlier quoted context omitted.

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…

In the UK, a cholesterol test is offered free of charge to everyone over the age of 40 by their GP, as well as younger people if they have a BMI over 25 or have a family history of high cholesterol levels or heart problems. They're also available from most community pharmacies (again free of charge for at-risk patients, but for everyone else it should be about £10 for a simple finger-prick test or £30-50 for a full l…

That is interesting to know, clearly I never knew. It takes about two months to get an appointment where I live so I am not inclined to get a cholesterol test with no good reason. When I registered a blood pressure test, height and weight was all that was needed. With healthy blood pressure and a BMI of 19.5, I would like to see that full lipid profile. However, if I was in the overweight category, the last thing I would want to see is the lipid profile!

By community pharmacy, does that include a typical Boots the Chemist?

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

#190

Post by roryirvine »

Theodores wrote: post #189
roryirvine wrote: post #147

Earlier quoted context omitted.

In the UK, a cholesterol test is offered free of charge to everyone over the age of 40 by their GP, as well as younger people if they have a BMI over 25 or have a family history of high cholesterol levels or heart problems. They're also available from most community pharmacies (again free of charge for at-risk patients, but for everyone else it should be about £10 for a simple finger-prick test or £30-50 for a full l…

That is interesting to know, clearly I never knew. It takes about two months to get an appointment where I live so I am not inclined to get a cholesterol test with no good reason. When I registered a blood pressure test, height and weight was all that was needed. With healthy blood pressure and a BMI of 19.5, I would like to see that full lipid profile. However, if I was in the overweight category, the last thing I w…

Yep, community pharmacy = anything outside of a hospital or similar setting. So Boots, Superdrug, or your nearest no-name chemist on your local high street.
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