Latest / Doctor Turned Health Coach / How To Know Your Real Heart Risk, Not Just Cholesterol

Transcript

How To Know Your Real Heart Risk, Not Just Cholesterol · Doctor Turned Health Coach

• 0:22
  Let's talk about coronary artery calcium score. Okay, so it's called CAC.
• 0:27
  Of all the weird names, it's called CAC. That's what we doctors refer to it as. And it's right.
• 0:33
  We get it for so many different reasons. But it's really important to understand
• 0:38
  that right now, as of 2025, we're maybe getting it too often.
• 0:43
  We're ordering this test way too commonly.
• 0:45
  And many times the insurance company won't cover it.
• 0:48
  The good news is that it's very inexpensive. It's $100 to $150. $50.
• 0:53
  I should also mention that it is a CT scan. There is radiation associated with it.
• 0:58
  The chance of you developing cancer from the amount of radiation is very low,
• 1:04
  but it is not insignificant.
• 1:06
  So it's something to keep in mind.
• 1:08
  Now, in my practice, I get a lot of different health coaching clients that come
• 1:13
  in and they want to discuss their overall health.
• 1:15
  Many of them will already have had this CAC done.
• 1:20
  Now, what is a CAC? Of course, it's a CT scan of your coronary arteries looking
• 1:24
  at the amount of little calcifications, kind of like bone, inside those arteries.
• 1:30
  Some AI algorithm does the math, calculates it. It can even tell us where most
• 1:36
  of that calcification is located.
• 1:39
  The limitations of this test. If it's completely negative, You have zero CACs.
• 1:45
  You have zero CAC. Your CAC is zero.
• 1:49
  Unfortunately, you could still have soft plaque that has not yet converted to calcified plaque.
• 1:55
  And the only way to see that is to go inside the arteries. Now, we can do a CT angiogram.
• 2:01
  That's a little bit more involved, a little bit more radiation,
• 2:04
  some contrast in your veins.
• 2:06
  And of course, when your doctor goes in to look and see if there's anything
• 2:10
  that can stent open, that's another way to visualize it.
• 2:16
  Now, if your CAC is zero, that's a good sign.
• 2:20
  That's already a good sign. But it's not, again, you can't just assume that
• 2:24
  everything's fine because there could be soft black.
• 2:27
  Now, if your CAC is very high, yes, that's a bit of a problem.
• 2:32
  And especially if you're younger and your CAC is very high, I'll say CAC from
• 2:37
  time to time too, so I'll keep saying CAC.
• 2:39
  But if your CAC is a little bit high and you're young, let's say it's 400, let's say it's 1500,
• 2:46
  let's say it's 4000, that would indicate that you have, for whatever reason,
• 2:50
  an accelerated process of creating a lot of plaques in your coronary arteries.
• 2:57
  A lot of patients get this test because they somehow want to avoid having to
• 3:02
  take any medications for their patients.
• 3:05
  Heart disease risk. And I understand the mentality, but it's not really the
• 3:09
  way this test should be used.
• 3:11
  It's really better for the person who's on the cusp.
• 3:15
  They're right at that border where their cholesterol isn't that bad,
• 3:18
  but man, their family history is really bad.
• 3:21
  And let's say their other tests are pretty normal.
• 3:25
  Now, of course, if you guys have listened to my podcast before,
• 3:28
  you know that the main cholesterol tests that I'm really interested in are triglycerides,
• 3:33
  your APOB, LP little a, and you know, there's other tests that are perfectly
• 3:37
  fine too. It's not like these are the end-all be-all.
• 3:40
  We can use the non-HDL cholesterol, we can use your LDL-C, but these other tests
• 3:44
  are just a little bit more predictive, a little bit more informative.
• 3:48
  So if this person has a very high family history, a very strong family history
• 3:53
  of heart disease, but their cholesterol numbers aren't that bad, we might get a CAC,
• 3:58
  and that can kind of help us decide what to
• 4:01
  do next another reason to get a CAC if
• 4:04
  somebody was older as you as you as you age your
• 4:07
  your risk goes up because your blood pressure naturally
• 4:10
  goes up your age goes up and the age itself is a risk factor if you're male
• 4:15
  if you have you know if you smoke if you have other risk factors like if your
• 4:22
  diet for example is very high in saturated fats and you may want to know you
• 4:26
  may want to know like, hey, should I change my diet around?
• 4:29
  This CAC could be informative.
• 4:32
  The difficulty, the problem is that we, many people often use the CAC and they
• 4:38
  make their decision based on the CAC. If the CAC is negative, great.
• 4:43
  I have nothing to worry about. But if my CAC is high, oh my gosh,
• 4:46
  I got to take a medicine. And it's not that simple.
• 4:50
  So if you're going to get it. You have to take it as kind of this whole big
• 4:56
  picture of all the other data points.
• 4:59
  And together with all of that, you can make a really good health decision for
• 5:03
  yourself. But it really shouldn't be just on its own.
• 5:06
  So I hope I gave you a little bit of an idea of how I sort of look at CAC scores.
• 5:12
  And if you have any questions, of course, feel free to reach out to me.
• 5:17
  Thank you for listening.