#34

My understanding (I haven’t had one) is that it takes a skilled and experienced operator to get a good image (ultrasound) and that it’s wise to use the same person if you want to compare results over time.

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#35

Oh so the carotid test is the CIMT, the one that shows soft plaque - I thought it was just like the CAC but showed soft vs hard wherever the CAC examined. Interesting! I had one then but it was thru Lifeline which I’ve heard isn’t reliable. Thanks for the info!

#36

CIMT and a “cardio test” are two different test.

“CIMT (Carotid Intima-Media Thickness) Test”

“What is Carotid Intima-Media Thickness (CIMT) Testing?”

“CIMT testing is a specialized type of ultrasound that is done on the carotid arteries (in your neck) to assess the lining of these arteries. Regular carotid ultrasounds evaluate the blood flow in the neck (which would be affected by larger blockages), but a CIMT test can measure the actual degree of inflammation and plaque that exists in the lining of the artery. It can also differentiate between soft plaque (the dangerous kind that can rupture and lead to a sudden heart attack or stroke), and hard plaque (calcified plaque that is more stable but when large enough can obstruct blood flow and cause serious complications). CIMT measurements can be done every 6 – 12 months to follow the course of disease, helping to verify improvements from prescribed medical interventions, or document that the disease is worsening and the patient warrants more aggressive treatment.”

Above copy is from;

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#37

Also review;

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#38

@Candleflower Your situation reminds me of what I recently went through with my 75 yo mother. She was diabetic (HBA1C of 10.5%) yet very low LDL at 96. So we never thought she would have a heart attack. She did the Lifeline screening every year and the results were always 0. There was no problems according to them.

9 months after her last Lifeline screening, she had stomach pains and thought it was food poisoning. She procrastinated but finally went to the hospital. When they were checking her in, they told her she was having a heart attack right then and they gave her baby aspirin and wheeled her off to the Cath lab where they put in 3 stents. She was very lucky. While they were checking her out, she also had a stroke which they then took care of. They kept her in the hospital for a few days and noted she had developed Afib.

She went home with a monitor, and the hospital noted that her heart would stop for up to 10 seconds at a time so she went back in and had a pacemaker put in instead of ablation. She was very fatigued and confused all the time before the pacemaker.

Now she is on about 14 different meds for her diabetes - Metformin and Empagliflozin ( 6.4% HBA1C now), she is on Lipitor (LDL of 32 now). Telmisartan (SBP went from 160s to 100s) Amiodarone for Afib, and a host of others. She is finally back to her old self and is going to cardiotherapy.

I hope that some of this may be a good reference for you. Find a good cardiologist and listen to him or her. If your insurance won’t provide you with the proper medications, order from India. We had to buy the Empagliflozin (Jardiance) from India as it was too expensive otherwise.

I hope that you and my mother will return quickly to good health and live long and prosperous lives.

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#39

I would work to get that down as much as possible; that is what I’m doing. I take a statin, bempadoic acid, and ezetimibe (1/4 tablet).

Read up here:

and if you really want to get into the science:

and

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#40

Hi Chris I remember your mentioning this in my other thread when I found out I had high ApoB but before my scan, which you all suggested. Did your mom have a CAC done? I’m wondering which is more important. Isn’t it the hard plaque that can break off and cause a stoke? I don’t think I need a cardiologist what would they do other than put me on a statin which I intend to go on, but will ask my PCP. Thanks for the info and glad your mom is ok!

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#41

Calcified plaque doesn’t do anything other than stiffen your arteries. It is the soft plaque you need to look out for.

#42

Thanks I will read as am confused Re these two tests, exactly where they each look etc.

#43

Geeze why do most docs order the CAC then? Oh well even if I have the test again (assuming the Lifeline was flawed) the only treatment would be a statin anyway I would think….

#44

Thanks I’ll listen to this episode today. I wanted to try just Crestor alone for 3 months to see if it brings it down (why add more drugs if one works) given my CAC score is 0 but now wondering if that’s even relevant, if the soft plaque is all that matters.

#45

A positive CAC score indicates hardened plaque which indirectly confirms that you have loads of soft plaque.

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#46

This isn’t exactly true because the biggest danger of calcified plaque is restricting or blocking of the blood flow in the arteries, although hardening of the arteries is also unhealthy. Soft plaque is more likely to rupture and cause dangerous clots. However, your zero CAC score (assuming it’s accurate) is more important than your high ApoB (Attn: @RapAdmin and @Virilius). Cardiologists and lipidologists agree that (short of other complications) a zero CAC score means that your chance of major adverse cardiovascular events (MACE) over the next 5 years is very low. That’s great for your age. That’s why you do a CAC test. With a zero CAC score the chance of having any soft plaque is less than 1 in 10, especially at your age. Higher ApoB does increase the risk of developing plaque, so to be safe, you should optimize all the major risk factors including ApoB, blood pressure, HbA1c/HOMA-IR, Hs-CRP and BMI (basically metabolic health).

It sounds like you’re in pretty good metabolic health and with a CAC score of zero, that’s great! So don’t let @RapAdmin and @Virilius alarm you. It would be smart and safe to lower your ApoB (so you can live forever) and starting low dose statin plus ezetimibe is the most recommended, simplest, cheapest way.

#47

Hey, we still haven’t found a solution to cancer and dementia yet.

#48

Thanks Mike that’s really good to know having soft is less than 1 in 10 if 0 CAC and I’ll give at least some importance to the Lifeline score.

HsCRP is another thing I recently learned - always thought it was just a more sensitive test than the CRP but now know it’s specific to the heart. I have a normal CRP and homocysteine (as of 7 or so years ago) but will ask for this too along with fasting insulin. Although I feel like crap and am tired so much of the time due to fibromyalgia, other than cholesterol, my blood markers have always been within normal range. Not that those are necessarily ideal, but at least ok.

I do get a bit confused with all the different opinions and thoughts but appreciate all of you giving your input. I’ll get on a med and check in in 3 or 4 months after next blood draw.

#49

Just heard from doc she agreed with all of you will put me on Crestor (no added zitia for now) and check chem profile and CK in a month and lipid profile in 6. I suppose the 1 month checks are for side effects due to possible liver damage and such. The 6 month wait seems a little long to me but first things first hopefully I tolerate the drug. Thanks again!

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#50

No, not heart specific, it’s general inflammation. And yes Hs just means high sensitivity. But because CVD involves inflammation, if your Hs-CRP is low (so it’s good and cheap to check), you are at lower risk of CVD. There are more specific measures of cardiovascular inflammation, like Lp-PLA but I don’t think you need that if Hs-CRP is low. And remember the Lifeline score may not be reliable.
Keeping an optimistic and positive outlook can add years to your life (don’t tell @Virilius). I don’t know anything about fibromyalgia but maybe improving exercise and sleep would help.

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#51

Oh, so I was right about it after all. Someone told me it was heart specific. If it’s cheap to check, and a better test than regular CRP, why do docs not always just order the better one? I know you don’t have a reasonable answer to that. And I won’t tell Virilius. :slight_smile:

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#52

Lots of utterly miserable people lived very long lives :wink:

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#53

See this commentary on CAC scores. A CAC of “0” isn’t necessarily a “free pass” on APO-B levels:

A 2013 study, for example, looked at a group of 17 patients who died from an acute myocardial infarction (AMI) and compared them to 15 age-matched controls without a history of cardiovascular disease (CVD). The investigators studied 960 coronary segments in these patients and found calcification in 47% of the segments in the AMI group and in 24.5% in the controls. The calcification was not correlated with the presence of unstable plaques. The study’s conclusions are summed up by the article’s title: “Coronary calcification identifies the vulnerable patient rather than the vulnerable plaque.”

In other words, more than half of the lesions leading to sudden death in the AMI group exhibited little to no calcium. Unstable plaques, the ones more likely to cause grave damage, showed a lower degree of calcification compared to stable plaques. A low to zero CAC score suggests a lower risk of future events, but it does not mean a zero risk of future events. A CAC score is predictive (multiple clinical studies of varied populations have validated the CAC scan as a valuable risk-assessing tool as the extent of CAC accurately predicts 15-year mortality in asymptomatic patients) and diagnostic, certainly a tool worth having in the toolbox, but it doesn’t tell you what else is under the hood.

and

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