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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

#101

Post by beacon294 »

CalRobert wrote: post #63
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…

Anyone know of an equivalent in Europe? Dutch doctors always ignore me and say to come back after I’m dead. (But will happily tell me to take Tylenol)

Switch doctors? Ask on dutch social networks I think? Some stuff will also not be approved/covered.

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

#102

Post by andy_ppp »

meindnoch wrote: post #99
andy_ppp wrote: post #89

Earlier quoted context omitted.

No the examples you give are extremely difficult compared to the 2D graphs of an EKG. The Apple Watch is clearly doing some fairly accurate inference with a single lead around arrhythmias, for example. I’m really sorry for being enthusiastic about machine learning, I just finished doing an intensive ML bootcamp and it was fun getting results. I also actually have some heart issues so I’d love to see if I could get a…

>I just finished doing an intensive ML bootcamp Then maybe learn a bit more about the domain before posting silly things.

I'm not talking about me successfully building an AI that can do better than humans or identify all the worlds heart diseases I'm more looking to have fun and play around with some data (and yes learn more about the domain by doing!). I was maybe a bit too excited about seeing what would happen with a real dataset like this, but it's a hacker news comment not a PhD defence, no need to be so negative. Thanks.

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

#103

Post by srameshc »

dreamcompiler wrote: post #47
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…

I'm sure your doc already told you this but chest pain while playing tennis that goes away quickly sounds more like angina than a heart attack. IOW your episode was not a heart attack but rather a strong indicator that a future heart attack was likely and that further tests were warranted. A real heart attack (MI) -- the kind that can kill you quickly -- is usually not exercise related and the pain continues for many…

Since you mentioned take asprin, just curious , how does that help ?

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

#104

Post by AbstractH24 »

“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.

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

#105

Post by andy_ppp »

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?

There is a decent looking dataset available here, let's see my model can generate random numbers from this for each of the diseases: https://www.nature.com/articles/s41597-022-01403-5

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

#106

Post by gcanyon »

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…

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?

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

#107

Post by gcanyon »

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…

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.

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

#108

Post by gcanyon »

beacon294 wrote: post #100
djeastm wrote: 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.

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.

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

#109

Post by smath »

One thing I’ve wondered is why getting a diagnostic test done out of pocket in the US of your own volition (without a doc prescription) isn’t possible. Why does it need to be controlled by a doc and insurance?

In India this is common. They probably use the same expensive machines for x rays and MRIs but anyone can walk in, and pay for a diagnostic test and get numbers (well, not everyone can afford it, but generally middle class folks can). I’m not saying the healthcare system in India is great, but this distinction intrigues me. Maybe the volumes are much higher in India so the diagnostic center can recoup costs? Are there laws preventing this business model in the US?

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

#110

Post by radlad »

gcanyon wrote: post #106
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…

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?

I know a number of people who report memory issues since starting statins. They also clearly exhibit memory issues but it's hard as an outsider to pinpoint when they started. Unfortunately, they really do need statins.
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