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

https://www.nytimes.com/2025/07/26/health/coronary-artery-calcium-heart.html

by brandonb • 12 months ago

214 194 12 months ago

nytimes.com

toomuchtodo• 12 months ago

https://archive.today/ckFV7

(coronary artery calcium testing)

neonate• 12 months ago

https://web.archive.org/web/20250726182350/https://www.nytim...

brandonb7• 12 months ago

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• 12 months 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.

CalChris3• 12 months ago

Lp(a) is a once in your lifetime test and also not very expensive.

JeremyNT• 12 months ago

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• 12 months ago

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• 12 months 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.

_zagj3• 12 months 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.

OutOfHere3• 12 months 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.

throwaway77832• 12 months ago

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.

_zagj3• 12 months ago

Oddly enough, there's evidence that saturated fat intake inversely affects Lp(a) levels: https://pmc.ncbi.nlm.nih.gov/articles/PMC10447465/

d4704• 12 months ago

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...

brandonb7• 12 months ago

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• 12 months ago

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

rsanek8• 12 months ago

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...

brandonb7• 12 months ago

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• 12 months ago

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)

beacon2942• 12 months ago

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

Theodores5• 12 months 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• 12 months 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.

gcanyon4• 12 months ago

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.

roryirvine2• 12 months ago

In the UK, a cholesterol test is offered free of charge to everyone over the age of 40 by their GP, as well as younger people if they have a BMI over 25 or have a family history of high cholesterol levels or heart problems.

They're also available from most community pharmacies (again free of charge for at-risk patients, but for everyone else it should be about £10 for a simple finger-prick test or £30-50 for a full lipid profile).

LorenPechtel7• 12 months ago

Upsell? It's never been a matter of discussion. Doctors orders some standard bloodwork every year. HDL and LDL are part of it.

gcanyon4• 12 months ago

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?

radlad• 12 months ago

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.

brandonb7• 12 months ago

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.

jgalt2123• 12 months ago

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.

timr• 12 months ago

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.

QuantumGood2• 12 months ago

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?

brandonb7• 12 months ago

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.

myth_drannon• 12 months ago

I imagine nothing like this is available in Canada?

pardner• 12 months ago

Saw your link, did your test and here's my feedback.

No "share" or "download" button in the app? Sure, "apps are cool" and all that - but what about folks who want to archive or share their health data? AFAIK literally no provision to share all those nifty biomarkers with my doctor (except many, many screenshots)?

Nowhere in the "how to get blood test" email instructions does it bother to mention a urine sample will also be needed. Kinda useful to know if you should not pee right before heading to the lab.

Aurornis5• 12 months 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.

leereeves2• 12 months 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.

Aurornis5• 12 months 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.

Telemakhos• 12 months 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?

jrvarela56• 12 months 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.

Aurornis5• 12 months 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.

quantumwoke5• 12 months ago

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.

AnotherGoodName4• 12 months ago

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• 12 months ago

I had a calcium score of zero, is that good? Hereditary high-cholesterol.

Aurornis5• 12 months 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.

Buttons8403• 12 months 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.

rsanek8• 12 months 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.

jgalt2123• 12 months 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.

rsanek8• 12 months ago

my doc recommended doing alternative tests to monitor instead (eg echocardiogram)

klipklop• 12 months 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?

DiabloD33• 12 months ago

Yes.

anonzzzies2• 12 months ago

... more info please..

wrs5• 12 months ago

Normally yes, through some combination of diet, exercise, statins, and the new kid on the block, PCSK9 inhibitors.

FollowingTheDao• 12 months ago

Manganese has been show to reverse plaques.

https://medicalxpress.com/news/2023-11-manganese-bullet-card...

ethan_smith• 12 months 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.

Theodores5• 12 months ago

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.

quantumwoke5• 12 months 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.

lokrian2• 12 months ago

At least one clinical trial is underway for a drug that can remove the plaques: https://www.lifespan.io/news/cyclarity-launches-human-trial-... But yeah, we badly need more companies doing more research in this space.

wrs5• 12 months 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.)

anonzzzies2• 12 months ago

It is free where I am but the radiation is a problem: maybe every 5 years is OK?

rsanek8• 12 months ago

yeah generally CT scan has crazy amount of radiation. want to probably switch to another test (like an echocardiogram) for long term monitoring

throwaway77832• 12 months 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

01100011• 12 months 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• 12 months ago

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

wrs5• 12 months ago

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

quantumwoke5• 12 months ago

Better characterisation on CAC is key. This is a software problem - AI will help.

zzzeek2• 12 months 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.

Buttons8403• 12 months ago

Do you have side effects from the statin?

CalChris3• 12 months 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.

zzzeek2• 12 months ago

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• 12 months ago

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• 12 months ago

What were your lipids? Was a stress test not conducted?

ars2• 12 months 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.

pugworthy3• 12 months ago

Did you mean Troponin? Troponin shows up in the blood when there's been damage to heart muscle.

pugworthy3• 12 months 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.

pugworthy3• 12 months 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.

j_bum• 12 months ago

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.

dreamcompiler2• 12 months 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.

srameshc• 12 months ago

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

agumonkey3• 12 months 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_ppp6• 12 months 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?

potamic• 12 months ago

When did you previously have a stress test before this? Would you also mind sharing what your blood pressure levels were at?

justlikereddit3• 12 months 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.

anonymars• 12 months ago

excretion

Heh, I think you mean exertion

AnimalMuppet• 12 months ago

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• 12 months ago

For those who supplement with vitamin d and calcium, do you know the benefits of vitamin k2 to prevent calcium deposit in arteries?

balderdash• 12 months 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• 12 months 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• 12 months 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.

lazyasciiart• 12 months 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.

rsanek8• 12 months 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

breadwinner7• 12 months ago

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...

rsanek8• 12 months ago

not sure I'm gonna trust a medium article that lists NYT and Bloomberg as references over what basically every single cardiologist recommends

breadwinner7• 12 months ago

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.

derektank2• 12 months ago

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.

breadwinner7• 12 months ago

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?

m_a_g• 12 months ago

That’s a horrible article to share as a source. Literally almost everything written there is wrong. What you’re doing is dangerous.

breadwinner7• 12 months ago

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• 12 months ago

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.

breadwinner7• 12 months ago

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.

IAmGraydon2• 12 months 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.

rsanek8• 12 months ago

seeing soft plaque is critical, as is the structure of vessels such as the aorta. highly recommend getting the more expensive test.

Mistletoe2• 12 months ago

How do you get one and what is the cost?

justlikereddit3• 12 months 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.

IAmGraydon2• 12 months ago

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.

quantumwoke5• 12 months 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.

rsanek8• 12 months 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.

Mistletoe2• 12 months ago

Places around me do it even cheaper. $50.

cluckindan3• 12 months 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.

https://english.elpais.com/health/2025-07-17/revolution-in-m...

Apparently eating too much cheese is a large risk factor.

Etheryte• 12 months 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.

cluckindan3• 12 months ago

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.

jboggan• 12 months 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.

AbstractH243• 12 months ago

“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• 12 months ago

Yep, doctors in the US routinely prescribe statins for people with less than 5% risk. Very common.

AbstractH243• 12 months ago

Why does common equal not worth questioning?

AnotherGoodName4• 12 months ago

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

AbstractH243• 12 months ago

Why does that fact make it not worth questioning?

smath2• 12 months ago

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?

username1352• 12 months ago

Its not impossible to get diagnostic tests done outside the scope of a GP. It's generally very expensive.

2Gkashmiri• 12 months ago

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.

smath2• 12 months ago

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?

benrapscallion• 12 months ago

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.

AnotherGoodName4• 12 months ago

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• 12 months ago

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• 12 months ago

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).

jgalt2123• 12 months ago

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...

breadwinner7• 12 months ago

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.

lokrian2• 12 months ago

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

lazyeye• 12 months ago

https://archive.md/n9viB

bookofjoe• 12 months ago

https://archive.ph/uqvkl

kensai• 12 months ago

What about going all in and doing a CT coronal scan with contrast? This is even better than the CAC scan, but of course the radiation is higher.

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

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