So you may ask, what's this blog doing on the Conscious Cooking website? By eating more plant-based, you can lower your risk of heart attacks and death. And it's an extra incentive to know if you have it!

Let's talk about John. He was a 58-year-old doctor with a bit of high blood pressure that had been well controlled on medications. His BMI was normal at 25 and he was in great health. His total cholesterol was minimally elevated at 210, triglycerides great at 84, HDL nice and high at 62 with a ratio of 3.4 (very good). His LDL cholesterol was a bit up at 131. I suggested he have a coronary calcium score to be safe. This is a 5-minute CT of the heart that shows calcified plaque, costs about $150 (insurance does not pay for this test), but does have some minimal radiation (about 2 mammograms). But we usually just do it once, maybe again 10 years later... Normal is 0, with high being considered over 400. His was 1285. We referred him immediately to a cardiologist, and one month later he had his stent. When he had his asymptomatic brother have the same test - he ended up with an emergency quadruple bypass. Two of my 6 brothers are the picture of health - thin, physically active, with good cholesterols, and one with a bit of hypertension. In their 60's I convinced them to get a calcium score. One was over 1000, and the other in the mid-400s. Both are now on statins and doing fine.  

Here's the point. Coronary artery disease can be sneaky. There is some "je ne sais quoi" that we have yet to discover. Maybe some is due to TMAO, some due to LPa , (factors most doctors don't routinely screen for), or other as-yet-unknown metabolic risk factors. But while we are learning, it's my practice to suggest a coronary calcium score for men over 50-55 and women over 55-60 (or younger depending on risk factors). I've had too many surprises. Doesn't it make sense to screen for our number one killer? Of course, we add it to other important risk factors such as age, sex, family history, cholesterol, blood pressure, hs crp, HbA1c for diabetes... but the CCS just gives us that much more information. You might say, well, why don't you just get a stress test. Because it's too little too late. The horse is out of the barn. Stress tests usually don't find a problem until it is somewhat advanced. I know bikers, swimmers, and runners who run the stress test into the ground with great results - but have a high calcium score.  

By the way, if you are a man with erectile dysfunction, it is often the canary in the coal mine for cardiovascular disease. The American Heart Association recommends men with ED have a prompt investigation to rule out coronary artery disease.  

Also, people can have plaque that is not calcified, especially if they are younger. It's like COVID testing - if it's positive, it's positive. If it's negative, there's still a possibility you have plaque. We think it's about 60-70% predictive.  

We recommend colonoscopies for everyone over 50 - and yet our colons cause magnitudes fewer deaths than our hearts. Isn't it time?  

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