9 ms·

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

214 points by brandonb 1y ago

toomuchtodo 1y ago
https://archive.today/ckFV7 https://archive.today/ckFV7 (coronary artery calcium testing)
- neonate 1y ago
  https://web.archive.org/web/20250726182350/https://www.nytimes.com/2025/07/26/health/coronary-artery-calcium-heart.html https://web.archive.org/web/20250726182350/https://www.nytim...
brandonb 1y 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-panel 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 1y 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 1y ago
    Lp(a) is a once in your lifetime test and also not very expensive.
    - dr_ 1y ago
      Sometimes free as well. Certain CROs offer free screening: https://cardiometabolicscreening.careaccess.com/en?_gl=1*1duvvfk*_ga*MjA4NDkwODc0MC4xNzUzNjM0MzE1 https://cardiometabolicscreening.careaccess.com/en?_gl=1*1du...
      - CalChris 1y ago
        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.
        deleted 1y ago
        [deleted]
        LorenPechtel 1y ago
        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 1y 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.
- coldcode 1y 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.
  - _zagj 1y 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.
- OutOfHere 1y 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.
  - throwaway7783 1y 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.
    - dr_ 1y ago
      The best way to get tested may be in conjunction with a trial. This was can potentially enroll.
  - _zagj 1y ago
    Oddly enough, there's evidence that saturated fat intake inversely affects Lp(a) levels: https://pmc.ncbi.nlm.nih.gov/articles/PMC10447465/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10447465/
    - OutOfHere 1y ago
      It doesn't help if LDL gets raised due to the SFAs, as LDL is an independent risk factor.
      - _zagj 1y ago
        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 1y 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-inhibitors https://my.clevelandclinic.org/health/drugs/22550-pcsk9-inhi...
- rsanek 1y 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-lipid-panel-with-inflammation-blood-test?srsltid=AfmBOoq1zfZCriYiFlr6a3LaAv9l7SBQuAFr4O8uhIVOD67l23uLwGwW https://www.walkinlab.com/products/view/cardio-iq-advanced-l...
  - brandonb 1y 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/46/27/2702/8125560 https://academic.oup.com/eurheartj/article-abstract/46/27/27...
- CalRobert 1y 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)
  - beacon294 1y ago
    Switch doctors? Ask on dutch social networks I think? Some stuff will also not be approved/covered.
- Theodores 1y 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 1y 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 1y 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.
      - Workaccount2 1y ago
        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 1y ago
      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 1y 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 1y 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.
  - brandonb 1y 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.
  - jgalt212 1y 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.
    - dugmartin 1y ago
      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 1y 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.
- QuantumGood 1y 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?
  - brandonb 1y 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.
    - QuantumGood 1y ago
      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 1y ago
        Tape on the posters name: about: Data for good. Co-Founder at Empirical Health (https://empirical.health https://empirical.health). Before: Risk Engineering at Brex
      - brandonb 1y ago
        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 1y ago
  I imagine nothing like this is available in Canada?
- pardner 1y 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.
Aurornis 1y 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.
- leereeves 1y 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 1y 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 1y 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.)
lawls 1y ago
I had a calcium score of zero, is that good? Hereditary high-cholesterol.
- Aurornis 1y 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.
- Buttons840 1y 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.
- rsanek 1y 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.
jgalt212 1y 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 1y ago
  my doc recommended doing alternative tests to monitor instead (eg echocardiogram)
klipklop 1y 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?
- DiabloD3 1y ago
  Yes.
  - anonzzzies 1y ago
    ... more info please..
    - DiabloD3 1y 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).
wrs 1y 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.)
- anonzzzies 1y ago
  It is free where I am but the radiation is a problem: maybe every 5 years is OK?
  - rsanek 1y ago
    yeah generally CT scan has crazy amount of radiation. want to probably switch to another test (like an echocardiogram) for long term monitoring
- throwaway7783 1y 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 1y ago
  Yeah. Dr. Ford Brewer(https://www.youtube.com/@PrevMedHealth 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 1y ago
  Don't statins calcify plaques? So presumably being on statins would raise the score?
zzzeek 1y 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.
- deleted 1y ago
  [deleted]
- Buttons840 1y ago
  Do you have side effects from the statin?
  - CalChris 1y 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.
    - shlant 1y ago
      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 1y ago
crdioptnt 1y 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 1y ago
  What were your lipids? Was a stress test not conducted?
- ars 1y 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 1y ago
    Did you mean Troponin? Troponin shows up in the blood when there's been damage to heart muscle.
    - ars 1y ago
      Yes I meant that! I spelled it wrong on Google, then copy/pasted the wrong word from the suggested replacement.
      - andy_ppp 1y 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.
busymom0 1y 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 1y 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 1y 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 1y 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 1y 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.
lazyasciiart 1y 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 1y 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
breadwinner 1y 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-e7d9d8eea983 https://medium.com/@petilon/cholesterol-and-statins-e7d9d8ee...
- rsanek 1y ago
  not sure I'm gonna trust a medium article that lists NYT and Bloomberg as references over what basically every single cardiologist recommends
  - breadwinner 1y 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.
- derektank 1y 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.
  - breadwinner 1y 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?
IAmGraydon 1y 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.
- rsanek 1y ago
  seeing soft plaque is critical, as is the structure of vessels such as the aorta. highly recommend getting the more expensive test.
- Mistletoe 1y ago
  How do you get one and what is the cost?
  - justlikereddit 1y 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.
  - IAmGraydon 1y 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.
- quantumwoke 1y 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.
rsanek 1y 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 1y ago
  Places around me do it even cheaper. $50.
cluckindan 1y 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-medicine-a-molecule-produced-by-gut-bacteria-causes-atherosclerosis-responsible-for-millions-of-deaths.html https://english.elpais.com/health/2025-07-17/revolution-in-m... Apparently eating too much cheese is a large risk factor.
- Etheryte 1y 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.
  - cluckindan 1y ago
    https://www.nature.com/articles/s41467-020-19589-w 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 1y 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).
jboggan 1y 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.
AbstractH24 1y 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 1y ago
  Yep, doctors in the US routinely prescribe statins for people with less than 5% risk. Very common.
  - AbstractH24 1y ago
    Why does common equal not worth questioning?
- AnotherGoodName 1y ago
  This is a recommendation done globally though. 20% risk = statins. This is true in Japan, Europe, China, Oceania, etc.
  - AbstractH24 1y ago
    Why does that fact make it not worth questioning?
smath 1y 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?
- username135 1y ago
  Its not impossible to get diagnostic tests done outside the scope of a GP. It's generally very expensive.
  - 2Gkashmiri 1y 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.
  - smath 1y 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?
    - AnotherGoodName 1y ago
      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.
jeremy151 1y 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 1y 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).
jgalt212 1y 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/estimate/ https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate...
breadwinner 1y 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.
- lokrian 1y 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 1y ago
https://archive.md/n9viB https://archive.md/n9viB
bookofjoe 1y ago
https://archive.ph/uqvkl https://archive.ph/uqvkl
kensai 1y 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.

214 points by brandonb 1y ago

toomuchtodo 1y ago

https://archive.today/ckFV7 https://archive.today/ckFV7 (coronary artery calcium testing)

neonate 1y ago
https://web.archive.org/web/20250726182350/https://www.nytimes.com/2025/07/26/health/coronary-artery-calcium-heart.html https://web.archive.org/web/20250726182350/https://www.nytim...

brandonb 1y 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-panel 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 1y 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 1y ago
  Lp(a) is a once in your lifetime test and also not very expensive.
  - dr_ 1y ago
    Sometimes free as well. Certain CROs offer free screening: https://cardiometabolicscreening.careaccess.com/en?_gl=1*1duvvfk*_ga*MjA4NDkwODc0MC4xNzUzNjM0MzE1 https://cardiometabolicscreening.careaccess.com/en?_gl=1*1du...
    - CalChris 1y ago
      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.
      - deleted 1y ago
        [deleted]
      - LorenPechtel 1y ago
        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 1y 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.
coldcode 1y 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.
- _zagj 1y 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.
OutOfHere 1y 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.
- throwaway7783 1y 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.
  - dr_ 1y ago
    The best way to get tested may be in conjunction with a trial. This was can potentially enroll.
- _zagj 1y ago
  Oddly enough, there's evidence that saturated fat intake inversely affects Lp(a) levels: https://pmc.ncbi.nlm.nih.gov/articles/PMC10447465/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10447465/
  - OutOfHere 1y ago
    It doesn't help if LDL gets raised due to the SFAs, as LDL is an independent risk factor.
    - _zagj 1y ago
      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 1y 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-inhibitors https://my.clevelandclinic.org/health/drugs/22550-pcsk9-inhi...
rsanek 1y 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-lipid-panel-with-inflammation-blood-test?srsltid=AfmBOoq1zfZCriYiFlr6a3LaAv9l7SBQuAFr4O8uhIVOD67l23uLwGwW https://www.walkinlab.com/products/view/cardio-iq-advanced-l...
- brandonb 1y 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/46/27/2702/8125560 https://academic.oup.com/eurheartj/article-abstract/46/27/27...
CalRobert 1y 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)
- beacon294 1y ago
  Switch doctors? Ask on dutch social networks I think? Some stuff will also not be approved/covered.
Theodores 1y 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 1y 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 1y 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.
    - Workaccount2 1y ago
      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 1y ago
    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 1y 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 1y 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.
- brandonb 1y 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.
- jgalt212 1y 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.
  - dugmartin 1y ago
    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 1y 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.
QuantumGood 1y 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?
- brandonb 1y 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.
  - QuantumGood 1y ago
    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 1y ago
      Tape on the posters name: about: Data for good. Co-Founder at Empirical Health (https://empirical.health https://empirical.health). Before: Risk Engineering at Brex
    - brandonb 1y ago
      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 1y ago
I imagine nothing like this is available in Canada?
pardner 1y 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.

Aurornis 1y 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.

leereeves 1y 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 1y 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 1y 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.)

lawls 1y ago

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

Aurornis 1y 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.
Buttons840 1y 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.
rsanek 1y 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.

jgalt212 1y 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 1y ago
my doc recommended doing alternative tests to monitor instead (eg echocardiogram)

klipklop 1y 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?

DiabloD3 1y ago
Yes.
- anonzzzies 1y ago
  ... more info please..
  - DiabloD3 1y 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).

wrs 1y 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.)

anonzzzies 1y ago
It is free where I am but the radiation is a problem: maybe every 5 years is OK?
- rsanek 1y ago
  yeah generally CT scan has crazy amount of radiation. want to probably switch to another test (like an echocardiogram) for long term monitoring
throwaway7783 1y 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 1y ago
Yeah. Dr. Ford Brewer(https://www.youtube.com/@PrevMedHealth 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 1y ago
Don't statins calcify plaques? So presumably being on statins would raise the score?

zzzeek 1y 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.

deleted 1y ago
[deleted]
Buttons840 1y ago
Do you have side effects from the statin?
- CalChris 1y 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.
  - shlant 1y ago
    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 1y ago

crdioptnt 1y 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 1y ago
What were your lipids? Was a stress test not conducted?
ars 1y 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 1y ago
  Did you mean Troponin? Troponin shows up in the blood when there's been damage to heart muscle.
  - ars 1y ago
    Yes I meant that! I spelled it wrong on Google, then copy/pasted the wrong word from the suggested replacement.
    - andy_ppp 1y 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.

busymom0 1y 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 1y 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 1y 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 1y 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 1y 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.

lazyasciiart 1y 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 1y 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

breadwinner 1y 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-e7d9d8eea983 https://medium.com/@petilon/cholesterol-and-statins-e7d9d8ee...

rsanek 1y ago
not sure I'm gonna trust a medium article that lists NYT and Bloomberg as references over what basically every single cardiologist recommends
- breadwinner 1y 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.
derektank 1y 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.
- breadwinner 1y 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?

IAmGraydon 1y 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.

rsanek 1y ago
seeing soft plaque is critical, as is the structure of vessels such as the aorta. highly recommend getting the more expensive test.
Mistletoe 1y ago
How do you get one and what is the cost?
- justlikereddit 1y 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.
- IAmGraydon 1y 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.
quantumwoke 1y 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.

rsanek 1y 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 1y ago
Places around me do it even cheaper. $50.

cluckindan 1y 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-medicine-a-molecule-produced-by-gut-bacteria-causes-atherosclerosis-responsible-for-millions-of-deaths.html https://english.elpais.com/health/2025-07-17/revolution-in-m... Apparently eating too much cheese is a large risk factor.

Etheryte 1y 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.
- cluckindan 1y ago
  https://www.nature.com/articles/s41467-020-19589-w 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 1y 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).

jboggan 1y 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.

AbstractH24 1y 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 1y ago
Yep, doctors in the US routinely prescribe statins for people with less than 5% risk. Very common.
- AbstractH24 1y ago
  Why does common equal not worth questioning?
AnotherGoodName 1y ago
This is a recommendation done globally though. 20% risk = statins. This is true in Japan, Europe, China, Oceania, etc.
- AbstractH24 1y ago
  Why does that fact make it not worth questioning?

smath 1y 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?

username135 1y ago
Its not impossible to get diagnostic tests done outside the scope of a GP. It's generally very expensive.
- 2Gkashmiri 1y 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.
- smath 1y 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?
  - AnotherGoodName 1y ago
    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.

jeremy151 1y 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 1y 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).

jgalt212 1y 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/estimate/ https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate...

breadwinner 1y 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.

lokrian 1y 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 1y ago

https://archive.md/n9viB https://archive.md/n9viB

bookofjoe 1y ago

https://archive.ph/uqvkl https://archive.ph/uqvkl

kensai 1y 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.