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 · 11h ago
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 · 9h ago
Lp(a) is a once in your lifetime test and also not very expensive.
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)
coldcode · 10h ago
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 · 3h ago
> 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.
Theodores · 1h ago
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 · 1h ago
>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 · 14m ago
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.
OutOfHere · 8h ago
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.
d4704 · 19m ago
I’ve read that (injection currently, not oral) ‘PCSK9 inhibitors’ may help lower Lp(a) where few other things do today.
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.
pugworthy · 9h ago
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.
agumonkey · 4h ago
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 · 3h ago
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?
agumonkey · 2h ago
I wonder if all symptoms would show on an EKG though. Would reduced coronary blood flow alter electrical signals ?
andy_ppp · 1h ago
That’s what’s fascinating about AI it might find patterns with enough data that we don’t see.
refurb · 48m ago
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.
justlikereddit · 3h ago
"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 · 1h ago
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 · 11m ago
>I just finished doing an intensive ML bootcamp
Then maybe learn a bit more about the domain before posting silly things.
quantumwoke · 1h ago
EKG changes are a late sign. You need structural imaging like CAC or CCTA or echo.
dreamcompiler · 6h ago
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.
potamic · 3h ago
When did you previously have a stress test before this? Would you also mind sharing what your blood pressure levels were at?
djoldman · 9h ago
What were your lipids? Was a stress test not conducted?
justlikereddit · 3h ago
>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.
ars · 9h ago
> 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 · 9h ago
Did you mean Troponin? Troponin shows up in the blood when there's been damage to heart muscle.
ars · 9h ago
Yes I meant that! I spelled it wrong on Google, then copy/pasted the wrong word from the suggested replacement.
andy_ppp · 3h ago
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 · 9h ago
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.
jboggan · 23m ago
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.
cluckindan · 5h ago
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.
Apparently eating too much cheese is a large risk factor.
Etheryte · 4h ago
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.
”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 · 47m ago
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 · 17m ago
”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.
wrs · 10h ago
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.)
01100011 · 4h ago
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 · 3h ago
Don't statins calcify plaques? So presumably being on statins would raise the score?
throwaway7783 · 6h ago
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
anonzzzies · 10h ago
It is free where I am but the radiation is a problem: maybe every 5 years is OK?
rsanek · 6h ago
yeah generally CT scan has crazy amount of radiation. want to probably switch to another test (like an echocardiogram) for long term monitoring
quantumwoke · 1h ago
Better characterisation on CAC is key. This is a software problem - AI will help.
balderdash · 9h ago
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 · 8h ago
>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 · 7h ago
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 · 43m ago
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.
rsanek · 6h ago
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 · 3h ago
Places around me do it even cheaper. $50.
klipklop · 11h ago
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?
ethan_smith · 3h ago
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.
wrs · 10h ago
Normally yes, through some combination of diet, exercise, statins, and the new kid on the block, PCSK9 inhibitors.
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 · 1h ago
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.
DiabloD3 · 10h ago
Yes.
anonzzzies · 10h ago
... more info please..
DiabloD3 · 8h ago
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 · 4h ago
Since you appear to be quite knowledgeable on the matter, I wonder what’s your opinion on Cholesterol Code and Dave Feldman? Thank you.
lawls · 11h ago
I had a calcium score of zero, is that good? Hereditary high-cholesterol.
Buttons840 · 9h ago
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.
Aurornis · 10h ago
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.
rsanek · 6h ago
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.
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.
m_a_g · 1h ago
That’s a horrible article to share as a source. Literally almost everything written there is wrong. What you’re doing is dangerous.
rsanek · 6h ago
not sure I'm gonna trust a medium article that lists NYT and Bloomberg as references over what basically every single cardiologist recommends
lazyasciiart · 8h ago
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 · 6h ago
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
For those who supplement with vitamin d and calcium, do you know the benefits of vitamin k2 to prevent calcium deposit in arteries?
jgalt212 · 11h ago
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 · 6h ago
my doc recommended doing alternative tests to monitor instead (eg echocardiogram)
zzzeek · 9h ago
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 · 9h ago
Do you have side effects from the statin?
CalChris · 6h ago
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.
IAmGraydon · 7h ago
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.
quantumwoke · 1h ago
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.
Mistletoe · 3h ago
How do you get one and what is the cost?
justlikereddit · 2h ago
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.
rsanek · 6h ago
seeing soft plaque is critical, as is the structure of vessels such as the aorta. highly recommend getting the more expensive test.
Aurornis · 11h ago
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.
Telemakhos · 10h ago
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?
Aurornis · 10h ago
> 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.
jrvarela56 · 10h ago
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.
david-gpu · 1h ago
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.
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 · 4h ago
Have you seen/read cholesterol code? It doesn't deny cholesterol but rather has interesting, and unusual findings.
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.
leereeves · 11h ago
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 · 10h ago
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 · 10h ago
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.)
* 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.
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.
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.
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?
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.
https://my.clevelandclinic.org/health/drugs/22550-pcsk9-inhi...
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.
Happy you got stents at the right time.
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.
Are there any labeled datasets "
-Some Software dude, every month since 1971
Then maybe learn a bit more about the domain before posting silly things.
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.
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.
What about troponin? I was told by a Dr that it's more accurate than an EKG.
Edit: I had the word tryptophan before.
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.
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.
https://english.elpais.com/health/2025-07-17/revolution-in-m...
Apparently eating too much cheese is a large risk factor.
”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.
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).
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.
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.)
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.
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.
Look at the adoption of CAR-T therapies. It took 3-4 years before they were regularly used in the US.
Can this plaque be reversed?
https://medicalxpress.com/news/2023-11-manganese-bullet-card...
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.
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).
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.
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.
(coronary artery calcium testing)
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.
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.
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.
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.
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/
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
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.
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.
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.)