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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

#141

Post by timr »

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?

Statins often have the side effect of raising blood sugar. So there’s a non-trivial tradeoff for a population that is usually on the edge of metabolic disease.

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

#142

Post by agensaequivocum »

OutOfHere wrote: post #43
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…

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

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

#143

Post by wrs »

Jarmsy wrote: post #73
wrs wrote: post #14

My cardiologist pointed out that hard calcified plaques are unlikely to come loose, so unless there’s significant narrowing, they’re not a big problem. However, that situation correlates with a high calcium score. So the calcium score is not always correlated to risk. A CT angiogram distinguishes soft vs. hard plaques (and shows narrowing), so that’s the ultimate way to clarify the situation. (Bearing in mind radiati…

Don't statins calcify plaques? So presumably being on statins would raise the score?

Exactly, the score would be going up, but for a good reason. Best to have no plaques, second best to have calcified ones.

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

#144

Post by dr_ »

CalChris wrote: post #36
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…

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...

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

#145

Post by dr_ »

throwaway7783 wrote: post #55
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.

There are some in trials. I'm part of one by Eli Lily. Lp(a) sucks, is genetic and so far there was no medication.

The best way to get tested may be in conjunction with a trial. This was can potentially enroll.

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

#146

Post by JeremyNT »

apothegm wrote: post #5
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…

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 afford it benefits from doing so.

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

#147

Post by roryirvine »

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…

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 lipid profile).

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

#148

Post by AnotherGoodName »

smath wrote: post #109

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…

A Doctors refferal for preventative tests are easy though. I've done this in the USA fwiw due to a family member having a heart attack at a very young age. Go to a doctor and state "I have risk factors for heart disease and would like a reference to https://stanfordhealthcare.org/medical-clinics/preventive-ca... ". Other hospitals (eg. Mayo clinic) have similar programs.

Any decent doctor should agree to this. Once you have a reference you'll be put through a battery of tests. Blood tests, ECG, ultrasound, etc. A lot of it was covered by insurance anyway but it was out of network for me. That didn't matter to getting the reference though. The tests they do are all non-invasive and not risky in the first phase so definitely worth doing.

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

#149

Post by AnotherGoodName »

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?

The preventative heart health program i linked above at Stanford does an echocardiogram calcium score rather than a CT scan for the first phase. Saves you from radiation unless they see something that warrants it.

It is no issue at all to ask for and receive an echocardiogram referral since it has no risk, just ask for a referral.

The unwillingness to do anything involving radiation unless warranted seems reasonable. Just do the echocardiogram and go from there.

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

#150

Post by hombre_fatal »

apothegm wrote: post #5
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…

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…

No, CAC only tests for end stage calcified plaque which is how your body tries to transform soft plaque. It's soft plaque that first lines your arteries and is capable of rupturing. You might be infested with soft plaque, but if none of it has calcified yet (which can take decades) then you'll have a CAC score of zero.

Using CAC store to gauge risk is like waiting until you have end stage symptoms of any disease before you consider yourself at risk. The ship has already sailed and you should have instead focused on prevention for decades.

The sibling comment is a great example of the misinformation here. They have high cholesterol but a CAC score of zero gave them the peace of mind to not use statins.

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