[HN Gopher] Coronary artery calcium testing can reveal plaque in...
___________________________________________________________________
Coronary artery calcium testing can reveal plaque in arteries, but
is underused
Author : brandonb
Score : 189 points
Date : 2025-07-26 21:45 UTC (1 days ago)
(HTM) web link (www.nytimes.com)
(TXT) w3m dump (www.nytimes.com)
| toomuchtodo wrote:
| https://archive.today/ckFV7
|
| (coronary artery calcium testing)
| neonate wrote:
| https://web.archive.org/web/20250726182350/https://www.nytim...
| brandonb wrote:
| 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 liquid your kidneys can filter,
| and is an input to the latest heart disease risk models
| (PREVENT).
|
| Easy to order online:
| https://www.empirical.health/product/comprehensive-health-pa...
|
| CAC is great for detecting calcified plaque in your coronary
| arteries. But before you have calcified plaque, the above risk
| factors tell you about the buildup of soft plaque. And 4 out of 5
| of them are modifiable through lifestyle, exercise, and
| medication.
| apothegm wrote:
| 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 know more about their
| risk level; however, it's uncommon for those tests to turn up
| positives without one of the baselines having already raised at
| least a yellow flag.
|
| None of the tests you listed will tell you whether you have any
| soft plaque buildup. They just tell you more about your risk
| factors. However, there _are_ ultrasound tests that can detect
| increased blood pressure in major arteries, which IIRC does
| reflect soft plaque buildup.
| CalChris wrote:
| Lp(a) is a once in your lifetime test and also not very
| expensive.
| dr_ wrote:
| Sometimes free as well. Certain CROs offer free screening:
| https://cardiometabolicscreening.careaccess.com/en?_gl=1*1d
| u...
| CalChris wrote:
| 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 me out of the general population. The
| thinking is that Lp(a) clots and baby aspirin counteracts
| that.
| LorenPechtel wrote:
| 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.
| JeremyNT wrote:
| 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.
| hombre_fatal wrote:
| 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.
| coldcode wrote:
| My cardiologist did all of these except the eGFR. My calcium
| score was fairly high, but not high enough to be concerning
| since my cholesterol is controlled and my diet and exercise
| regime are good now. Until the CAC was done, I had no idea if I
| had any or not. It's better to deal with cholesterol earlier
| than I did.
| anonnon wrote:
| > My cardiologist did all of these except the eGFR
|
| eGFR is typically inferred from serum creatinine (not
| creatine!), which is part of both a comprehensive and basic
| metabolic panel (CMP/BMP), which your GP usually orders,
| along with a CBC, and perhaps an HbA1c.
| OutOfHere wrote:
| 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.
| throwaway7783 wrote:
| 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.
| dr_ wrote:
| The best way to get tested may be in conjunction with a
| trial. This was can potentially enroll.
| anonnon wrote:
| Oddly enough, there's evidence that saturated fat intake
| inversely affects Lp(a) levels:
| https://pmc.ncbi.nlm.nih.gov/articles/PMC10447465/
| OutOfHere wrote:
| It doesn't help if LDL gets raised due to the SFAs, as LDL
| is an independent risk factor.
| anonnon wrote:
| 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.
| d4704 wrote:
| I've read that (injection currently, not oral) 'PCSK9
| inhibitors' may help lower Lp(a) where few other things do
| today.
|
| https://my.clevelandclinic.org/health/drugs/22550-pcsk9-inhi.
| ..
| brandonb wrote:
| There's a clinical trial for a new drug, lepodisiran, which
| lowered Lp(a) by 93.9%.
|
| Outside of that, if your Lp(a) is high, then the first
| strategy would be to choose a lower ApoB target than you
| would otherwise. (Every Lp(a) particle is also an
| ApoB/cholesterol particle, but 6x more atherogenic. So by
| lowering ApoB, you are compensating for the effect of high
| Lp(a))
|
| Summary of the current research/evidence is here:
| https://www.empirical.health/blog/lipoprotein-a-blood-
| test/#...
| agensaequivocum wrote:
| 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
| rsanek wrote:
| I'd add in the LDL subcomponent assay as well -- LDL pattern,
| particle number, peak size, etc. you can get those and all the
| ones you mentioned for relatively cheap
| https://www.walkinlab.com/products/view/cardio-iq-advanced-l...
| brandonb wrote:
| The latest evidence is that if you have ApoB and Lp(a), then
| particle sizes don't add any more information. This is the
| most recent research (published July 2025):
| https://academic.oup.com/eurheartj/article-
| abstract/46/27/27...
| CalRobert wrote:
| 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)
| beacon294 wrote:
| Switch doctors? Ask on dutch social networks I think? Some
| stuff will also not be approved/covered.
| Theodores wrote:
| 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
| non-communicable diseases. You have to get a chronic disease,
| then the doctor will interpret the test results and not let you
| know what the numbers are, just what medication to take,
| optionally with lifestyle changes.
|
| As a consequence, nobody in the UK knows what their cholesterol
| levels and whatnot are, yet, in the USA, plenty of people know
| these numbers.
|
| Do healthcare providers actively upsell testing in the USA?
| djeastm wrote:
| >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.
| mbac32768 wrote:
| They are better. Life expectancy at birth in the US is
| dragged down by myriad societal issues but if you survive
| to middle age, life expectancy begins climbing to the
| highest in the world.
| Workaccount2 wrote:
| Really you just need to look at it by state to see the
| huge difference. There is almost a 10 year difference
| between the best and worst states.
| beacon294 wrote:
| 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 one measure
| of health.
| gcanyon wrote:
| 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.
| Theodores wrote:
| 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 if a 50Kg person gets on. This
| can be incredibly dangerous. Hence every chair should
| have a secondary support structure, in some cases this
| can be wire under tension, other times it might have to
| be steel tubing.
|
| There are thousands of chair designs, none of them built
| for the ultimate eventuality of catastrophic failure.
| LorenPechtel wrote:
| 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.)
| dylan604 wrote:
| > That says something sad about the U.S.
|
| That a lot of couples like to share the same chair??
| LorenPechtel wrote:
| 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.
| gcanyon wrote:
| 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.
| roryirvine wrote:
| 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 PS10 for a simple finger-prick test or
| PS30-50 for a full lipid profile).
| LorenPechtel wrote:
| Upsell? It's never been a matter of discussion. Doctors
| orders some standard bloodwork every year. HDL and LDL are
| part of it.
| gcanyon wrote:
| 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?
| johnmaguire wrote:
| 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.
| brandonb wrote:
| I used to work with a cardiologist who joked that "we should
| just add statins to the water," so you have a point.
|
| The current guidelines for prescribing statins are based on
| your risk of a major cardiac event in the next 10 years
| (forecasted using a statistical model). But given that plaque
| builds up in your arteries over your lifetime, there's a
| strong argument for using a 30-year or lifelong time horizon.
| jgalt212 wrote:
| > 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.
| dugmartin wrote:
| 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.
| timr wrote:
| 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.
| QuantumGood wrote:
| 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?
| brandonb wrote:
| 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.
| QuantumGood wrote:
| 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.
| ljf wrote:
| Tape on the posters name:
|
| about: Data for good. Co-Founder at Empirical Health
| (https://empirical.health).
|
| Before: Risk Engineering at Brex
| brandonb wrote:
| 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.
| myth_drannon wrote:
| I imagine nothing like this is available in Canada?
| Aurornis wrote:
| This test is also being heavily misused and misinterpreted in
| some online communities. There are a lot of people posting CAC
| scan results after something like a year of keto dieting in their
| 20s or 30s and using that to conclude that the saturated fat
| connection to atherosclerosis is a myth or that high cholesterol
| is fine.
|
| These tests don't have perfect accuracy and resolution, so low or
| zero results don't mean that a lifetime of high cholesterol won't
| catch up with someone in their 60s and 70s, yet a lot of
| podcasters and social media influencers are making those claims.
| leereeves wrote:
| I agree the results after one year of a keto diet don't prove
| much, but getting that test seems like a good idea. I hope
| they'll keep testing and reporting the results for years, so we
| can learn more about the long term effects of a keto diet. And
| if it does cause problems, they'll want to know ASAP.
| Aurornis wrote:
| CAC tests come with a non-trivial radiation exposure if
| someone is getting them every few years.
|
| The other problem is that they're picking and choosing which
| tests to believe and which to ignore.
|
| They disregard their cholesterol tests because they don't
| like the results, but embrace one or two CAC tests because
| they do like the results (when they're young).
|
| However the CAC results are a lagging indicator of cumulative
| damage that has been done. Cholesterol tests are correlated
| with the rate of damage occurring.
|
| So embracing CAC and using it to justify ignoring LDL and
| others is the problem.
| leereeves wrote:
| I think the unknown factor here is whether other benefits
| of keto over a standard American diet--possibly including
| reduced inflammation, BP, blood glucose, and body weight--
| balance out the effect of cholesterol. CAC measures actual
| damage already done, while cholesterol is just one of many
| factors.
|
| The downside, of course, is that once the damage is done,
| it's done, so it's a risk. (And as you said, they won't see
| the damage in their 20s.)
| Telemakhos wrote:
| Is this a keto diet that's mainly leafy greens with healthy
| protein like salmon? Or is this the "keto" diet of bacon and
| steak and as much fast as one can shove in the food-hole?
| jrvarela56 wrote:
| I don't understand why some prople claim that diet does not
| impact cholesterol. I did 'keto' with bacon/steak/chicken/etc
| for 3 months, got bloodwork done before and after and my LDL
| went through the roof.
| Aurornis wrote:
| There's an offshoot of the keto community that has become
| die-hard cholesterol deniers. They don't necessarily argue
| that keto doesn't raise cholesterol. They argue that it
| doesn't matter to have high cholesterol. They believe
| doctors and science are wrong on the subject. They think
| statins are evil. They embrace a few fringe doctors who
| agree with them.
|
| If you do try keto again, bacon and such are the worst way
| to do it. Getting your fat content from a monounsaturated
| source like avocado oil can be helpful. Taking statins is
| also a good idea.
| Buttons840 wrote:
| In contrast, I had a high LDL of 190, largely genetic, and
| panicked and switched to a vegan diet. I had my LDL tested
| again 10 days later and it was 120. I couldn't keep up with
| the strict diet, but learned some good habits and to avoid
| saturated fat. My doctor hasn't recommended statins... yet.
| moltar wrote:
| Have you seen/read cholesterol code? It doesn't deny
| cholesterol but rather has interesting, and unusual
| findings.
|
| https://cholesterolcode.com/
|
| There's a good talk as well that presents this information
| in a very accessible way:
|
| https://youtu.be/jZu52duIqno?si=NCEf4UGtgHG9sBOP
| david-gpu wrote:
| Years ago I also experienced very high LDL after a few
| months of low carb. A doctor was convinced it was genetic
| (familial hypercholesterolemia) even though multiple
| earlier tests over the years had been in the normal range.
| He had never heard of low carb cholesterol hyper responders
| and dismissed that diet could have to do with it.
|
| Nowadays I am convinced that what happened was completely
| explainable by the Lipid Energy Model [0]. Five days a week
| I was doing 60~90 minutes of cardio in the morning after
| skipping breakfast. Exercising in a fasted state while on a
| low carb diet meant that I had very low glycogen in my
| muscles and liver, which meant that the muscles had to
| mobilize fat as an alternative source of energy. Since fat
| is not water soluble, transporting fat through the blood
| stream requires packaging it inside a micelle wrapped in
| phospholipids -- a lipoprotein. Hence the elevated LDL &
| apoB.
|
| The solution is simple: consume some carbs before and/or
| during exercise, and learn about the translocation of GLUT4
| receptors if you are concerned about hyperinsulinemia.
|
| [0] https://pmc.ncbi.nlm.nih.gov/articles/PMC9147253/
| shlant wrote:
| no surprise that your reference is from Nicholas Norwitz.
| It's good he self-owned with the KETO-CTA trial and
| showed everyone that isn't already bought into the low
| card dogma that it's clearly a disaster for CVD risk
| Aurornis wrote:
| > keto diet that's mainly leafy greens with healthy protein
| like salmon?
|
| A ketogenic diet is 70% fat.
|
| It's literally impossible to get into keto with a diet of
| leafy greens and salmon. You would have to augment with a lot
| of fat from some other source and also limit salmon intake to
| avoid consuming too much protein. Salmon has too much protein
| and not enough fat to even come close to keto ratios.
|
| You must be thinking of a different diet. A lot of people
| think keto is another word for low carb, but a real keto diet
| is very low carb and low protein.
| quantumwoke wrote:
| This is correct advice, thank you. I am reminded once again
| that correlation != causation and that doing tests 'just to be
| sure' is not a healthy or safe way to live. There is a lot of
| literature out this on what makes a good screening test.
| AnotherGoodName wrote:
| Also age is huge so people shouldn't be reading much into a
| reading of 0 unless you're over 65.
| https://dirjournal.org/articles/coronary-artery-calcium-scor...
| (see table 2)
|
| Imagine claiming "my diet is great, i got 0% on my calcium
| score" when that just means you have the same score as 95%+ of
| people at age 40.
|
| By 55, 25% of people start showing some % of calcium and at 65,
| 75% of people have a reading on calcium score.
|
| So anyone under 45 being proud of a zero score is just silly.
| lawls wrote:
| I had a calcium score of zero, is that good? Hereditary high-
| cholesterol.
| Aurornis wrote:
| If you're young: Good but doesn't guarantee anything.
|
| If you're old: Great! Keep an eye on cholesterol.
|
| CAC is a lagging indicator. Its usefulness is more about
| assessing damage done, not rate of change or future risk.
| Buttons840 wrote:
| It is expected to be 0 if you're under 45 years old or so, I
| think. When I did a CAC test, the results came with charts
| showing where I was compared to the expected value for my age.
|
| Also, taking a statin can increase the CAC score because
| statins cause fat build ups to calcify faster which makes them
| less likely to break free and cause big problems.
| rsanek wrote:
| hard to say. the score itself is just a small part of what is
| included in the report. ask to see the full one to see what all
| the radiologist found.
| jgalt212 wrote:
| These tests expose one to a fairly high dose of radiation. From a
| quick googling, there does seem quite a range in exposures for
| this test. That being said, you probably don't want to get one of
| these scan every year.
| rsanek wrote:
| my doc recommended doing alternative tests to monitor instead
| (eg echocardiogram)
| klipklop wrote:
| What I always wondered is if I get this test done, what would I
| even do with the results? If my arteries are already clogged,
| etc.
|
| Can this plaque be reversed?
| DiabloD3 wrote:
| Yes.
| anonzzzies wrote:
| ... more info please..
| DiabloD3 wrote:
| So, the simple explanation is this: Cholesterol is a
| necessary and important chemical, specifically, it is a
| sterol, and a precursor for Vitamin D, cortisol, estrogen,
| testosterone, and the substance that makes up the myelin
| sheath is. Cholesterol is not, and never will be, "the bad
| guy". Your body produces almost a gram of it a day, but
| dietary amounts are only about a third of that.
|
| It it also the backbone of apolipoprotein, which is the
| actual thing your Doctor is talking about when they say
| "good cholesterol" and "bad cholesterol". Apo combined with
| other things (triglycerides and phospholipids) make HDL,
| LDL, and other familiar "cholesterol particles".
|
| Since they shuttle fatty acids around, these fatty acids
| can be oxidized. When there are too many lipoprotein
| particles than your cells can safely clear, macrophages end
| up being targeted by the particles. Macrophages that take
| on too many damaged particles (damaged by the fatty acid
| oxidizing) can ram into arterial walls, which summons
| platelets to try to fix it.
|
| The platelets use a calcium-based substance to fix the
| damage. Its sorta like organic concrete. Over a lifetime,
| your arteries become clogged with the concrete.
|
| _So_.
|
| The western diet and lifestyle lacks many important things
| required for healthy living. One of these is sufficient
| sun. Although Vitamin D supplementation is absolutely
| required for many people (most science is indicating that
| 2000 IU isn't even enough but is a bare minimum), we also
| have extremely little K2 in our diet compared to our
| ancestors, since it comes from certain fermented foods, and
| we largely no longer eat the correct fermented in
| sufficient amounts foods, even though it has been a staple
| of our diet at least 20 or 30 thousand years; long enough
| that it has changed our gut bacteria to basically
| necessitate it for many reasons.
|
| K2 is required for signaling of arterial plaque removal,
| among other things. That organic concrete? It's not meant
| to be permanent, its meant to merely to stop you from
| potentially hemorrhaging.
|
| Also, fun fact, anticoagulants that act as K2 antagonists
| (Warfarin, etc) lead to vastly increased arterial
| calcification (since, as an antagonist, it blocks K2
| signaling). Those anticoagulants also can lead to brittle
| bones, because K2 is also used for signaling in a few
| biological processes that want to deposit the calcium in
| the right place.
|
| So, I could just say "eat healthily", but nobody knows what
| the fuck that means. Beef liver and hard cheeses are good
| sources of K2, so is Sauerkraut and Kimchi. Supplement
| companies also sell good Vitamin K-focused multivitamins,
| many of which are a oil-filled gelcap with K1, K2 MK4, K2
| MK7, and a meaningful D dosage (so its a drop in
| replacement for your daily D gelcap) (ex: Jarrow K-Right,
| but all the major good ones have a product like that).
| moltar wrote:
| Since you appear to be quite knowledgeable on the matter,
| I wonder what's your opinion on Cholesterol Code and Dave
| Feldman? Thank you.
| DiabloD3 wrote:
| 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 research
| endocrinologists) have given favorable commentary about
| it, but it isn't perfect and has small gaps.
|
| I have seen him speak about his theory on a few well
| known medical/science podcasts, so I am a little familiar
| with his work so far. I find it interesting that he isn't
| a career biologist in any way, but a software engineer.
| So, I imagine he'd fit in with the HN crowd quite well.
|
| The major part of his theory I think that is interesting
| is people who have weird insulin responses (ie, have been
| or are insulin resistant; so, have, had, or will have
| Diabetes) have largely shaped what we consider normal
| cholesterol numbers. Also, people who are lean and eat
| low carb may just naturally have different ratios of
| cholesterol numbers; iirc part of his argument involves
| the LDL-P(articles) to LDL-C(holesterol in the particles)
| ratio or LDL-C to TG ratios, and how it may be that they
| have "bad" ratios that most doctors would try to treat
| with statins, but there is actually nothing wrong with
| them, as other biomarkers and CAC scans indicate there is
| no increase in arterial damage even though they have
| "bad" ratios.
|
| So yeah, I'd consider it worth watching, but don't take
| it as gospel. If it shows up on a streaming service I
| have, I'll consider giving it a watch.
| moltar wrote:
| Thank you for the thoughtful and thorough response!
| wrs wrote:
| Normally yes, through some combination of diet, exercise,
| statins, and the new kid on the block, PCSK9 inhibitors.
| FollowingTheDao wrote:
| Manganese has been show to reverse plaques.
|
| https://medicalxpress.com/news/2023-11-manganese-bullet-
| card...
| ethan_smith wrote:
| Plaque regression is possible through aggressive LDL lowering
| (statins+ezetimibe/PCSK9i), lifestyle changes, and has been
| documented in clinical trials like REVERSAL and ASTEROID
| showing 6-9% regression with intensive therapy.
| Theodores wrote:
| I hope so!
|
| There are many different schools of thought regarding diet and
| nutrition. No topic is more controversial since everyone with a
| stomach has an opinion.
|
| There is science but that has to be believed in. Depending on
| your favourite foods and your values, you have to dismiss one
| half of the science as paid for by big beef or the other half
| as vegan propaganda.
|
| A change in my environment led me to re-evaluate my food
| choices and I was open minded to completely changing
| everything. However, I did not go down the butter and bacon
| route. I became strictly whole food, plant based. This means
| always cooking from scratch with no processed foods or animal
| products. It is just an ongoing experiment with a study size of
| just one.
|
| I did my research and upped my kitchen game. I was surprised at
| how much I used to enjoy no longer interests me and how easy it
| has been to stick to a diet rich in vegetables, beans, pulses
| and much else that I previously never cared for.
|
| So, why am I telling you this?
|
| Well, some believe that a whole food, plant based diet is best
| for your arteries. Having given it a spin to have a body that I
| am happy with, I am hoping they are right.
|
| Do your own research with scepticism. Remember that nutrition
| is highly controversial and, just out of intellectual
| curiosity, see how it goes on a whole food, plant based diet.
| Originally I was only going to try and go without processed
| food for a month, but, with that target met, I kept going and
| learned more about nutrition just in case there was anything I
| was missing out on. The only thing turned out to be vitamin
| B12, which I supplement, with that being the only supplement.
| quantumwoke wrote:
| AIUI per my doctor wife, plaque cannot currently be reversed
| with a medication. It's about minimising future risk rather
| than reversing damage. Remodelling the plaque with medications
| does happen to a limited extent as commented elsewhere in this
| thread.
| wrs wrote:
| 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 radiation exposure risk and cost, of course.)
| anonzzzies wrote:
| It is free where I am but the radiation is a problem: maybe
| every 5 years is OK?
| rsanek wrote:
| yeah generally CT scan has crazy amount of radiation. want to
| probably switch to another test (like an echocardiogram) for
| long term monitoring
| throwaway7783 wrote:
| Calcium score is mostly for trends over a period of time, to
| get a sense of progression of disease. A single reading is not
| very useful is what I was told
| 01100011 wrote:
| Yeah. Dr. Ford Brewer(https://www.youtube.com/@PrevMedHealth)
| talks a lot about this. I find him to be pretty current and he
| translates things into an easily understood format.
|
| Basically the calcium stabilizes the plaque. Unstabilized
| plaque is what can rupture, squirting out from the artery wall
| into the blood and forming a clot. High cholesterol can cause
| deposits in the artery wall simply due to chemical diffusion.
| Inflammation, often caused by metabolic syndrome/diabetes
| expands the plaques. Idk, I probably got that wrong, but anyway
| calcium scores aren't well correlated with risk.
| Jarmsy wrote:
| Don't statins calcify plaques? So presumably being on statins
| would raise the score?
| wrs wrote:
| Exactly, the score would be going up, but for a good reason.
| Best to have no plaques, second best to have calcified ones.
| quantumwoke wrote:
| Better characterisation on CAC is key. This is a software
| problem - AI will help.
| zzzeek wrote:
| This article is so anathema to me.
|
| My experience is, your total cholesterol is over 200 (with some
| more specifics about LDL I can't recall, like 130 or something),
| all doctors everywhere will then hound you incessantly to get on
| Crestor, immediately. Diet and exercise don't matter (they cite
| research showing it doesn't make a difference). Whether you have
| plaque or not isn't considered, you need to be on Crestor right
| now to prevent it from starting anyway.
|
| My cholesterol started really going up in my late 40s and I can
| concur an aggressive change to my diet where I significantly
| reduced my saturated fat intake and I lost about 20 pounds made
| absolutely no difference, and my total cholesterol started
| hitting 300, so I'm on the Crestor. My initial dose did cause me
| to have elevated liver enzymes and my total cholesterol went to
| about 170 in about a month, so I'm on an extremely low dose on
| alternating days.
| Buttons840 wrote:
| Do you have side effects from the statin?
| CalChris wrote:
| I initially had an LDL of 152 and was prescribed Atorvastatin
| which gave me dizziness. So I switched to Pravachol with no
| side effects. But I needed to increase my dosage to get under
| 100 LDL and Pravachol is limited to 80mg. So I switched again
| to 10mg of Rosuvastatin which took me from 114 down to 83
| also without side effects.
| shlant wrote:
| I got dizziness from lipitor (only in the hours after
| taking it) and I determined it seemed to be due to
| dehydration so now I just make sure to drink enough water
| and no more dizziness. Cut my LDL in half in 3 months and
| now I take every 2 days
| zzzeek wrote:
| i had the elevated liver enzymes on a higher dose (10 mg /
| day which is not considered a high dose) and jury is out on
| whether or not I perceive muscle weakness. unsure
| crdioptnt wrote:
| 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 catheterization revealed 95%
| blockage of the Left Anterior Descending artery, the widowmaker.
| After placing two stents in the LAD I'm back to normal. It's a
| small miracle I didn't die that day on the tennis court. The CAC
| definitively diagnosed the life threatening blockage when I had
| absolutely no symptoms. I recommend everyone get this simple scan
| to find out if you have this killer inside of you.
| djoldman wrote:
| What were your lipids? Was a stress test not conducted?
| ars wrote:
| > EKG showed no sign of heart attack
|
| What about troponin? I was told by a Dr that it's more accurate
| than an EKG.
|
| Edit: I had the word tryptophan before.
| pugworthy wrote:
| Did you mean Troponin? Troponin shows up in the blood when
| there's been damage to heart muscle.
| ars wrote:
| Yes I meant that! I spelled it wrong on Google, then
| copy/pasted the wrong word from the suggested replacement.
| andy_ppp wrote:
| It's only if heart muscle dies does that show up, you can
| have an important artery narrow without symptoms until
| suddenly a bit of plaque breaks off completely blocking a
| path causing bits of muscle to actually die.
| pugworthy wrote:
| What I was told in the ER is that troponin basically only
| shows up when there's been heart muscle damage so is a pretty
| clear sign. It doesn't show up immediately though - typically
| a rise within a few hours of the heart attack.
|
| RE: EKGs. There are clear signs in the more detailed 12 lead
| EKG that can show irregularities in the electrical patterns
| and specifically help pinpoint the location of the active
| problem.
| pugworthy wrote:
| 63, no history of heart disease, all my numbers in the "normal"
| range, fit, don't smoke, not overweight, good diet, etc. I was
| building a greenhouse in the back yard and went from feeling
| kind of "shitty" to classic left chest and back of arm pain.
|
| It's amazing how fast you get into the ER when you come in like
| that. I got an angiogram within 45 minutes and also had 2
| stents in the LAD with 90-95% blockage.
| j_bum wrote:
| Glad you're ok. Stories like this are good to rebase myself
| and remember how important it is to enjoy life now while I
| can. No matter how healthy I try to keep myself, luck can
| change things in an instant.
| dreamcompiler wrote:
| 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 tens of minutes without going away.
|
| PSA: If you experience either type of symptom above, call 911.
| Don't wait around and don't drive yourself to the hospital.
| Take an aspirin if you have one handy and you're not allergic
| to it. Real aspirin, not ibuprofen or tylenol.
| srameshc wrote:
| Since you mentioned take asprin, just curious , how does that
| help ?
| egberts1 wrote:
| Blood thining characteristics
| dreamcompiler wrote:
| Aspirin is not a blood thinner per se. It interferes with
| platelet action so it reduces the likelihood of clots
| forming.
| magicalhippo wrote:
| It prevents platelets from clotting further[1].
|
| [1]: https://www.fda.gov/drugs/safe-use-aspirin/aspirin-
| questions...
| agumonkey wrote:
| 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.
| andy_ppp wrote:
| 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?
| justlikereddit wrote:
| "It should be very easy for an AI to look at an x-ray, CT,
| ultrasound or MRI image and tell what disease a human got,
| even some that humans don't know of.
|
| Are there any labeled datasets "
|
| -Some Software dude, every month since 1971
| andy_ppp wrote:
| 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 result. Thanks for
| your constructive comment though, I've never seen ones
| like this here before!
| meindnoch wrote:
| >I just finished doing an intensive ML bootcamp
|
| Then maybe learn a bit more about the domain before
| posting silly things.
| andy_ppp wrote:
| 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.
| agumonkey wrote:
| I wonder if all symptoms would show on an EKG though. Would
| reduced coronary blood flow alter electrical signals ?
| andy_ppp wrote:
| That's what's fascinating about AI it might find patterns
| with enough data that we don't see.
| refurb wrote:
| That's a stress test.
|
| Attach an EKG, have the patient ride a bike with
| significant exertion.
|
| If there is a lack of blood flow, it will show up in the
| EKG as alteration of the electrical signals through the
| heart.
| agumonkey wrote:
| Well I've been subjected to these tests and I fell
| between the lines, I was clearly below normal health (had
| trouble walking) but they said there was no issues. So I
| wondered if there's not more subtleties. Like lag between
| effort and signals showing up, or vascular issues like
| micro clotting impeding flow.
| quantumwoke wrote:
| EKG changes are a late sign. You need structural imaging
| like CAC or CCTA or echo.
| andy_ppp wrote:
| 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
| brandonb wrote:
| Eric Topol has a cool post on "machine eyes" -- using deep
| learning to identify subtle signals in ECGs and medical
| images that would be invisible to the naked eye:
| https://erictopol.substack.com/p/the-amazing-power-of-
| machin...
|
| There are still regulatory/deployment/reimbursement
| barriers to cross, but this is happening.
| LorenPechtel wrote:
| 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.
| potamic wrote:
| When did you previously have a stress test before this? Would
| you also mind sharing what your blood pressure levels were at?
| justlikereddit wrote:
| >when I had absolutely no symptoms
|
| Chest pain during excretion is a symptom in my book.
|
| >Recommend everyone to get it
|
| A calcium scan is a ECG gated CT scan(a heart CT). It takes
| time from the CT machine schedule and it requires radiologists
| to describe it, meaning it's not infinitely accessible.
| anonymars wrote:
| > excretion
|
| Heh, I think you mean exertion
| AnimalMuppet wrote:
| For me, it was different.
|
| A cardiologist told me (after a calcium test showed 95th
| percentile for calcium) that what I was looking for was a rapid
| drop in ability. Not over a decade, but over a couple weeks or
| a month. Well, I play ultimate, and one day I realized "I
| didn't get this winded a month ago". So I got a stress test,
| and it showed "abnormal motion of the heart wall under stress"
| (that is, not enough oxygen getting to all the heart muscles).
| They did a catheterization, and I wound up with two stents.
|
| I mean, look, if you get the chest pains, _don 't ignore that_.
| But it doesn't have to be that way. If you lose athletic
| ability, or wind, or endurance, in a short amount of time, get
| a stress test.
| busymom0 wrote:
| For those who supplement with vitamin d and calcium, do you know
| the benefits of vitamin k2 to prevent calcium deposit in
| arteries?
| balderdash wrote:
| I got pitched (along with a bunch of other people at an
| investment conference) on an insanely expensive concierge
| medicine service and they trotted out some super impressive
| doctor who was fascinating. Anyway the thing that stuck was that
| he said it takes 10-20 years for meaningful advances in medicine
| to show up in general use, which was a little depressing
| trogdor wrote:
| >he said it takes 10-20 years for meaningful advances in
| medicine to show up in general use
|
| Could it be that it takes that long to determine whether those
| advances are actually worthwhile? I can't count the number of
| HN posts I've seen touting breakthroughs in medical research
| that ultimately didn't pan out.
| zargon wrote:
| No, this is the time it takes for the proven treatment
| advances to reach rank-and-file doctors (and insurance
| policies). I've read the numbers 17 to 22 years I think.
| There are studies on this, but I don't have references handy.
| refurb wrote:
| That's not true in my experience.
|
| Look at the adoption of CAR-T therapies. It took 3-4 years
| before they were regularly used in the US.
| lazyasciiart wrote:
| After I had a heart attack I was told that there's no value in
| doing this test at that point. A couple years later at age 40
| another doctor did order it for me and my score was 0, which
| apparently tells me I'm not on the verge of another heart attack,
| so that's nice.
| rsanek wrote:
| the score itself isn't the only relevant thing in the report.
| ask to see what the radiologist actually wrote and read it
| yourself. ai, aided by clarifications by a cardiologist, helped
| me understand the details immensely
| breadwinner wrote:
| 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...
| rsanek wrote:
| not sure I'm gonna trust a medium article that lists NYT and
| Bloomberg as references over what basically every single
| cardiologist recommends
| breadwinner wrote:
| Cardiologists don't do their own research. Drug companies do
| the research, and cardiologists are limited to just trusting
| the drug companies. So then the question is how trustworthy
| are the drug companies? Pfizer's Lipitor raked in $125
| billion between 1996 to 2012, becoming the world's best-
| selling drug of all time. You don't think drug companies are
| even a little bit motivated by profits?
|
| You are right about one point: You should absolutely not
| trust a random medium article, anyone can write medium
| article. Instead you should follow the links, then decide
| whether the experts quoted in the NYT and Bloomberg articles
| have a point.
| derektank wrote:
| 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.
| breadwinner wrote:
| 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?
| derektank wrote:
| 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.
| m_a_g wrote:
| That's a horrible article to share as a source. Literally
| almost everything written there is wrong. What you're doing is
| dangerous.
| breadwinner wrote:
| And you're offering nothing to back up your claim. Literally
| everything written in the article is backed up by sources
| such as New York Times, which in turn quotes experts in the
| field.
|
| - Is it not true that the existence of a link between high
| cholesterol and heart disease is only a hypotheses that
| originated in the 1950s, not a scientifically proven fact?
|
| - Is it not true that the FDA generally has not required drug
| companies to prove that cholesterol medicines (such as
| statins) actually reduce heart attacks before approval?
|
| - Is it not true that lowering cholesterol by different means
| (i.e., other than statins) is not beneficial, and does that
| not mean cholesterol is not the villain it is made out to be?
|
| - Is it not true that the only large clinical trial funded by
| the government (rather than drug companies) found no
| statistically significant benefit at all?
|
| What exactly are you saying is wrong?
| asdfj999 wrote:
| 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.
| breadwinner wrote:
| > _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.
| IAmGraydon wrote:
| CAC is pretty common, but I prefer Coronary CT Angiography, which
| is much more detailed CT of the heart and coronary arteries using
| IV contrast. It's a bit more radiation, but it shows soft plaque
| and arterial narrowing, which CAC does not.
| rsanek wrote:
| seeing soft plaque is critical, as is the structure of vessels
| such as the aorta. highly recommend getting the more expensive
| test.
| Mistletoe wrote:
| How do you get one and what is the cost?
| justlikereddit wrote:
| A CAC scan is a non-contrast CT scan and a coronary
| angiography is a contrast CT scan.
|
| They are both ECG gated scans of the heart otherwise so
| they're pretty much the same scan area and same scan
| duration, if you're hooked for a Coronary CT angiography you
| can easily get the CAC at the same time by doing a scan sweep
| before contrast administration (at the cost of 2 minutes of
| time and an extra dose of radiation)
|
| Though the logistics surrounding contrast administration
| makes it a bit more fiddly with a slightly higher risk
| profile.
| IAmGraydon wrote:
| I got one a couple of years ago when I was 41 due to a
| recurring palpitation and non-standard EKG reading. They are
| more commonly used to really get a good view of things before
| heart surgery, but it really depends upon your doctor. The
| cost usually ranges from $300 to $1,000.
| quantumwoke wrote:
| It's better, but the contrast and much higher radiation dose
| compared to CAC carry their own risks. Individuals can evaluate
| their own risk but I wouldn't get this test under the age of 40
| or 45 or so unless I had diabetes.
| rsanek wrote:
| can attest that this test is worth it. despite having no symptoms
| i decided to take at 32 yo it since I have a family history of
| cardio problems. altho no calcified plaque was found, it
| uncovered other serious issues I wouldn't have know about
| otherwise for probably a decade or two. if you call around
| different radiology labs you can get it for as low as $200 -- be
| warned tho many places (esp hospitals in my exp) will quote far
| higher numbers.
| Mistletoe wrote:
| Places around me do it even cheaper. $50.
| cluckindan wrote:
| Researchers have discovered that gut bacteria produce a molecule
| that not only induces but also causes atherosclerosis, the
| accumulation of fat and cholesterol in the arteries that can lead
| to heart attacks and strokes.
|
| https://english.elpais.com/health/2025-07-17/revolution-in-m...
|
| Apparently eating too much cheese is a large risk factor.
| Etheryte wrote:
| I'm not sure quip generalizations like that are useful. If it
| was as simple as cheese bad, we would see the dutch and the
| like as outliers in statistics, but that's not the case.
| cluckindan wrote:
| https://www.nature.com/articles/s41467-020-19589-w
|
| "we evaluated the full spectrum of nutrient intake and
| identified a significant positive correlation between ImP
| [imidazole propionate] and saturated fat intake (driven by
| high cheese intake)"
|
| Perhaps this depends on the type of cheese consumed.
|
| Of course, it's a correlation; ImP could be modulating eating
| habits and making people prefer eating cheese.
| fcpk wrote:
| This is much more likely related to gut microbia metabolism
| than it is to histidine. Unlike the dogma wants it to be
| believed, high protein and fat intake does not necessarily
| lead to cardiovascular issues. It does when combined with
| other lifestyle(sedentary, low intensity),
| metabolic(diabetes/prediabetes, inflammation),
| nutritional(highly refined carbohydrates, nitrated
| compounds, oxalate/other anti nutrients and refined seed
| oils) and dysbiosis issues.
|
| There is an enormous scandal to come behind the
| vilification of cholesterol and the simplification of its
| level's interpretation to come, which led to the current
| epidemic of obesity and metabolic/inflammatory/autoimmune
| diseases. Cholesterol levels vary hugely based on the
| genetics, epigenetics and lifestyle of an individual, and
| there is a very large amount of individuals that are within
| normal range with much higher ldl levels. For example, the
| cholesterol levels of centennials are usually extremely
| high.
|
| Things to look out for: - high very small LDL(you need a
| proper analysis of your LDL levels with a histogram of the
| size distribution, which is very rarely done and more
| expensive) - high Triglyceride/HDL ratio(in US units,
| anything above 2 is not a very good sign) - high hbA1C
| (metabolic issues) - high lp(a) and/or lp(b) - high hs-CRP
| (general inflammation, but can be caused by infection if
| you are sick)
|
| Usually those are all related and high when affecting a
| normally healthy individual).
| cluckindan wrote:
| "This is much more likely related to gut microbia
| metabolism than it is to histidine"
|
| Yes and no: the study linked to in the El Pais article
| suggests that certain bacteria are converting histidine
| to imidazole proprionate.
|
| More histidine -> more food for those bacteria ->
| bacterial overgrowth, dysbiosis and increased ImP levels
| -> eventually atherosclerosis.
|
| There are probably some microbe(s) capable of
| outcompeting the ImP-producing ones even in the presence
| of increased histidine, which would serve as a mitigating
| factor.
| jboggan wrote:
| I got a CAC scan for $75 just to catch anything crazy and I found
| out that I don't have a right coronary artery and also that I
| have 2 superior vena cava. My calcium score was 0 though so
| that's awesome.
|
| One close friend died of a heart attack at 42 and another found a
| 95% blockage after his CAC scan came back north of 900 at age 40.
| I'd get it if it's available, the ability to catch certain
| catastrophic conditions is invaluable.
| AbstractH24 wrote:
| "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.
| kelipso wrote:
| Yep, doctors in the US routinely prescribe statins for people
| with less than 5% risk. Very common.
| AnotherGoodName wrote:
| This is a recommendation done globally though. 20% risk =
| statins. This is true in Japan, Europe, China, Oceania, etc.
| smath wrote:
| 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?
| username135 wrote:
| Its not impossible to get diagnostic tests done outside the
| scope of a GP. It's generally very expensive.
| 2Gkashmiri wrote:
| I get a 6 monthly KUB ultrasound and xray for around 1k inr
| which is around us$10. If I go to a government hospital and
| ask the emergency doctor for a test when there is a lean time
| for them, they prescribe the test and its done for a hundred
| bucks or $1.
| smath wrote:
| 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?
| AnotherGoodName wrote:
| 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.
| wrs wrote:
| 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
| nurse, and a CT machine, in a trailer in a parking lot!)
| Insurance doesn't pay for imaging like this until things
| have already gone very wrong, and she feels it should be
| used much earlier for people who have risk factors.
|
| [0] https://prenuvo.com/
| LorenPechtel wrote:
| 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.
| benrapscallion wrote:
| Some of these imaging that are overdone in India involve
| radiation: the most problematic being (not low dose) CT. So
| there is a rationale for controlling these modalities.
| AnotherGoodName wrote:
| 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.
| jeremy151 wrote:
| I recently requested this test from my doctor. The lab technician
| asked if I had requested it or my doctor, and gave a very
| judgmental "that's what I thought" type response. Ends up I was
| 95%-tile and put on an aggressive statin therapy, from a risk
| profile that otherwise didn't determine statin use. The test was
| easy and (relatively speaking) inexpensive. It helped me in risk
| stratification in a determinative way.
| TechDebtDevin wrote:
| It cost <$200 to go pay cash and get a calcium score yourself.
| Its hard to talk a cardiologist into getting your insurance to
| pay for it if you're young. As a male who had a grandfather die
| in his 30's from heart disease it was even hard. If you're
| worried about this at all just pay for it yourself. I also
| reccomend getting Lp(a) testing (<$50) if this concerns you,
| DYOR, but it will give you a better grasp on how your body is
| handles bad cholesterol (everyone is different).
| jgalt212 wrote:
| If you have all your numbers, you can run your own risk
| calculation. Definitely useful before deciding on this scan, or
| when talking to your doctor about statins (a lifetime drug).
|
| https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate...
| breadwinner wrote:
| 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.
| lazyeye wrote:
| https://archive.md/n9viB
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