At what age should one start to check calcium score? I have no significant family Hx of CAD. Just a couple parents with obesity and DM and HTN.
At what age should one start to check calcium score? I have no significant family Hx of CAD. Just a couple parents with obesity and DM and HTN.//
Usually insurance tells you when you are eligible for certain tests, mammograms, colonoscopy, etc, but since they dont actually pay for this one, it is our choice. Like I said before, I have had many friends die in workouts, the youngest 39 and 44, both high level athletes. One running and one in the pool. I wish I had started my testing in my early 30ās, if nothing else, just to see that 0 score and put it out of my mind(but probably not 0 in my case). I sure bet my friends had known their scores in their mid 30ās too, but of course that was the last thing on their minds, and no doubt had never even heard of this test.
So since you have to pay anyways(about $100 to $200 bucks most places) just go ahead and get it done. I see a lot of guys in these latest threads in their 40ās/early 50ās with scores from 400 to over a 1000, so no doubt it would have been picked up in their 30ās as something to look out for. IF nothing, then you can relax and wait for 5 or 10 years before another one. That is my non medical/non doctor advice as a long term heart patient who had his near fatal accident at 46ā¦But mine was not related to a high CAD score, but same logic appliesā¦
Thank you for sharing these videos.
x2 That first video provided me with a much better understanding of statins that what my doctor did. I thought they just lowered cholesterol. I didnāt realize that they could modify the plaque. Good stuff!
Apologies for the question and to the OP. I have just done a cholesterol test and my ldl is 3.2 (120) and the doc isnĆ¢ā¬ā¢t happy. Has given me 3 months to improve this number, otherwise I rekon he will be waiving statins in my face.
My questions is rather simple - those on statins and donĆ¢ā¬ā¢t get any sides of muscle soreness etc , I read that paper and it mentions reduction of mitochondria ? Does this means as a triathlete, we would find improvements in our peformance to swim bike run is diminished ?
Surely people have gotten faster even on statins ?
At what age should one start to check calcium score? I have no significant family Hx of CAD. Just a couple parents with obesity and DM and HTN.
Timing of cardiac screening is an individual thing. I never send my patients for ischemic testing of any sort at age 35 or less. I have, on occasion, done CACS on some patients in their 30ās to show their risk is truly low and that they have time *(as I expect it will be normal/0) to take better care of themselves.
I often say to patients that this is the only body you get, so take good care of it.
There are no guidelines for specifically what age to start screening of ālow riskā individuals but I did read an NIH paper saying 42 yo for M and 58 for F. I generally think ~45 yo for men an ~50-55 yo for women *(protected by hormones longer compared to M). Youād like it early enough to intervene meaningfully and not so early to cause anxiety for years.
It is still likely best for clinicians to use the ACC risk estimator and MESA calculators *(using CACS) to help assess risk.
https://tools.acc.org/.../calculate/estimate/
https://www.mesa-nhlbi.org/...Score/RiskScore.aspx
Hereās the article on āhardening of the arteriesā in athletes by Dr. Aaron Baggish of MGH.
https://www.ahajournals.org/...LATIONAHA.117.028750
The MESA %ile calculator using the CACS
https://www.mesa-nhlbi.org/Calcium/input.aspx
It is my belief that there will be a shift towards CTA and ultimately CTA with AI *(from coronary artery calcium scoring) to evaluate for soft plaques in the coronary arteries eventually. Weāll see. Itās been talked about for a long time but much closer to reality now.
Apologies for the question and to the OP. I have just done a cholesterol test and my ldl is 3.2 (120) and the doc isnĆ¢ā¬ā¢t happy. Has given me 3 months to improve this number, otherwise I reckon he will be waiving statins in my face.
My questions is rather simple - those on statins and donĆ¢ā¬ā¢t get any sides of muscle soreness etc , I read that paper and it mentions reduction of mitochondria ? Does this means as a triathlete, we would find improvements in our performance to swim bike run is diminished ?
Surely people have gotten faster even on statins ?
This is the downside of Rx with statins-issues with the muscles aka SAMS *(statin associated muscle symptoms)ā pain/achiness/muscle inflammation-myopathy/myalgia/concern about performanceā¦ It is real and varies in studies. Probably 5-25% of patients have some issue related to the muscles but it is still risk vs benefit and the discussion about an individualās personal risk and best plan to optimally treat needs to be shared decision making with the patient and the provider. The actual % of patients that have very significant issues may be as low as 1%, but that is not 0. There has never been any paper saying statins truly reduce muscle function but if they hurt, you will not be training appropriately. Some of the statins seem to affect the muscles more than others and there have been papers also suggesting that CoQ offsets this and that is why it is suggested-even though there is no hard clinical data to prove a benefit. Many of these studies are small so hopefully over time there will be better information to make informed choices. *edited to add: the meta analysis of all co Q 10 studies was only about 6 or 8 studies of ~240 participants. That muscle biopsy study you cited only had 48 patientsā¦
It is suggested that diagnosis should be based on the triad of (i) temporal relationship of symptoms and/or CK elevation to initiation of statin therapy; (ii) disappearance of symptoms on withdrawal; and (iii) re-appearance on re-challenge with statin therapy
SAMS can be further classified based on muscle symptoms, the presence and degree of CK elevation. Muscle symptoms with no elevation in CK, often referred to as myalgia, is regarded as the mildest form. The term myositis is sometimes used to describe symptoms associated with significant CK elevation (>10 times upper limit of normal range). Rhabdomyolysis is the most severe form, and may result in myoglobinuria and renal impairment. CK levels in rhabdomyolysis may rise to >40 times upper limit of normal range.
The pathophysiology of and mechanisms leading to SAMS is yet to be fully understood.
Going ālow and slowā and finding a statin that is tolerated can be a challenge and take some time and effort. Multiple with-drawl trials are usually needed and re-challenging to find out if symptoms are truly related and to assess severity. It is still best to do whatever is necessary to optimally treat patients despite how difficult the effort.
It always starts with assessing riskā¦
While scrolling around, I did see a nice summary from the ACC about Primary Prevention and Reclassification of Risk using CACS so I copied those below.
Top 10 Take-Home Messages for the Primary Prevention of Cardiovascular Disease
The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life.
A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions.
Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinicianĆ¢ā¬āpatient risk discussion before starting on pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin. The presence or absence of additional risk-enhancing factors can help guide decisions about preventive interventions in select individuals, as can coronary artery calcium scanning.
All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, red meat and processed red meats, refined carbohydrates, and sweetened beverages. For adults with overweight and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss.
Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity.
For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations are crucial. If medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist.
All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit.
Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit.
Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low-density lipoprotein cholesterol levels (Ć¢ā°Ā„190 mg/dL), those with diabetes mellitus, who are 40 to 75 years of age, and those determined to be at sufficient ASCVD risk after a clinicianĆ¢ā¬āpatient risk discussion.
Nonpharmacological interventions are recommended for all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy, the target blood pressure should generally be <130/80 mm Hg.
Utility of CAC in Reclassifying ASCVD Risk
For individuals with intermediate predicted risk (Ć¢ā°Ā„7.5% to <20%) or for select adults with borderline (5% to <7.5%) predicted risk, CAC measurement can be a useful tool in refining risk assessment for preventive interventions (e.g., statin therapy). In these groups, CAC measurement can reclassify risk upward (particularly if CAC score is Ć¢ā°Ā„100 Agatston units or Ć¢ā°Ā„75th age/sex/race percentile) or downward (if CAC is zero) in a significant proportion of individuals.
In adults at intermediate risk, CAC measurement can be effective for meaningfully reclassifying risk in a large proportion of individuals. In such intermediate-risk adults, those with CAC Ć¢ā°Ā„100 Agatston units or CAC Ć¢ā°Ā„75th percentile have ASCVD event rates for which initiation of statin therapy is reasonable. Those with CAC scores of zero appear to have 10-year event rates in a lower range for which statin therapy may be of limited value. Therefore, for patients with CAC scores of 1-99, it is reasonable to repeat the risk discussion. If these patients remain untreated, repeat CAC measurement in 5 years may have some value, but data are limited. It is important to note that the absence of CAC does not rule out noncalcified plaque, and clinical judgment about risk should prevail. Clinicians should not down-classify risk in patients who have CAC scores of zero but who are persistent cigarette smokers, have diabetes, have a family history of ASCVD, or, possibly, have chronic inflammatory conditions. In the presence of these conditions, a CAC score of zero may not rule out risk from noncalcified plaque or increased risk of thrombosis.
CAC might also be considered in refining risk for selected low-risk adults (<5%), such as those with a strong family history of premature coronary heart disease. CAC measurement is not intended as a screening test for all but rather may be used as a decision aid in select adults to facilitate the clinician-patient risk discussion. The following candidates for CAC measurement may benefit from knowing that their CAC score is zero:
Patients reluctant to initiate statin who wish to understand their risk and potential for benefit more preciselyPatients concerned about the need to reinstitute statin therapy after discontinuation for statin-associated symptomsOlder patients (men 55-80 years of age; women 60-80 years of age) with low burden of risk factors who question whether they would benefit from statin therapyMiddle-aged adults (40-55 years of age) with pooled cohort equations-calculated 10-year risk of ASCVD 5% to <7.5% with factors that increase their ASCVD risk.
I hope this helpsā¦
Absolutely brilliant. I did see reccomendations for statin therapy with ldl greater than 190. I am 120, however my dad had a heart attack at 58 (IĆ¢ā¬ā¢m 43), and was on statins. My two much older brothers (55) are on statins however not active at all, one a heavy drinker and smoker.
My kick in the teeth is I have type 1 diabetes. I am not overweight, am fit, but I have a need to consumer sugar more than IĆ¢ā¬ā¢d like. ItĆ¢ā¬ā¢s a nasty co-factor that increases risk for every other fricken disease I swear. Perhaps why doc isnĆ¢ā¬ā¢t happy with 120 ldl reading, itĆ¢ā¬ā¢s not just that number, but family hereditary link and t1. Anyway thanks again for this information, it is very helpful.
Dan has graciously linked this thread to the āHot Forum Topicsā so people can see the links and comments regarding Coronary Artery Calcium Scoring.
many, thanks dan-
Dan has graciously linked this thread to the āHot Forum Topicsā so people can see the links and comments regarding Coronary Artery Calcium Scoring.
many, thanks dan-
Wow, thatĆ¢ā¬ā¢s great. Important topic for all of us athletes to be educated about. Thank you!
Just had this done and was shocked to receive a 433. Now my cardiologist wants to do either a CT angiogram of my coronary arteries or cardiac catheterization (with angiogram).
Back in May 2023, I had sudden onset of terrible vertigo and pulsatile tinnitus (sounded like ocean waves in my ear that corresponded with my heart beat). It was definite vertigo, and not dizziness. I mentioned I did have occasional dizziness but it would come about with rest or activity and seemed to be more related to work related anxiety/stress than anything else. I mentioned I thought the vertigo could be instigated by my anxiety as wellā¦one episode hit me when I was sitting in my car waiting to return to work after lunch. Because of all of this, the cardiologist/ENT requested multiple different scans (hearing test, MRI brain, CT angiography of brain, EKG, holter monitor, and the coronary calcium scan). They believe I may have Meniereās Disease (except I donāt have hearing loss yet) but wanted to be safe on the cardiac part.
I ride with a group of 20-30 year old guys (I am 53yo) so my heart rate is maxed out on multiple occasions (and without any chest pain or new excess fatigue or any other adverse cardiac signs). Now that I have this calcium score, and after reading about otherās heart āmisadventuresā on here, I am paranoid about being the āfit lookingā guy with hidden heart disease. Genetics may have doomed me as everyone on my fatherās side has had stents placed and/or open heart surgery (none of them were healthy eaters or active).
Iāve read papers that endurance athletes can have calcium scores over 300 without the associated cardiac risk percentages as inactive adults but I am not going to put weight to that until I get further testing.
Sorry, I am rambling here and just concerned.
Very timely thread, thanks.
After a quite sudden drop of āformā in April - a week after setting a 20min power record, I decided to get a few things checked out. My mother died from some blockages, and i am on statins as my cholesterol started creeping up a few years ago.
During the following 10 weeks, I did ZERO intensity on the bike, whilst getting some tests done, the last of which was a CT calcium check a couple of weeks ago. To my (and my cardiologistās) shock - my reading was zero.
Like others in this thread, I started to fear becoming the āfit guy who dropped deadā.
If nothing else, getting yourself checked out gives you peace of mind.
Oh yeahā¦ my issue? Likely over trainiing - a cross between too many hard days & not doing āeasyā days easy enough.
@EyeRunMD I had a score of 364 at age 53 (Iām 55 now). Like you, I was surprised and immersed myself gathering knowledge to understand this issue. For what itās worth, hereās the Cliff Notes version of some key learnings:
-
LDL isnāt the best metric for identification of heart disease, itās actually the number of LP(a) particles as the primary driver. Amgen has a drug in a clinical trial to reduce LP(a) and thus slow the progression of coronary artery disease (CAD). I donāt want to get too technical here, so hereās a link about it if you want to read up: https://www.amgen.com/stories/2023/02/8-things-to-know-about-lipoproteina
-
PSK9 Inhibitors is the only treatment know to reduce LP(a) concentration, but most insurance wonāt pay for it, so the best alternative option is a statin that reduces your total LDL number. Interestingly, statins increase the LP(a) concentration; however, this risk is overwhelmed by the benefit of total LDL decrease. For what itās worth, my cardiologist has me on 40mg of Rouvastatin and 10mg of Ezetimibe to keep my LDL under 70. And yes, I take CoQ10 to offset muscle fatigue.
-
People who exercise generally have better plaque composition. Thereās a ton of research in this area using athletes over age 50, but my takeaway was the process of exercise functions similar to a statin in that it turns soft plaque into a safer denser plaque. Itās the dense plaque that gets shown in your calcium score, not the soft plaque, so ironically people with a lower calcium can in some cases be at more risk. Lastly, athletes tend to build collateral pathways to promote blood flow leading to my next finding.
-
Stress test results and METS achieved have prognostic charts similar to calcium score charts. Based on my calcium score, I was in the bottom 5% with the highest risk. Based on my stress test, Iām at the top 5% with the lowest risk.
Overall, I think thereās A LOT still being learned about CAD in athletes, but exercise serves as a protective mechanism which could enable us to live to be 100 years old with arteries full of dense calcium. Perhaps even taking a statin is redundant and unnecessary, but we arenāt far enough along our learning cycle to say that with confidence. It sucks that you were dealt a bad hand, but realize itās not all gloom and doom. Just keep doing what you enjoy and follow your cardiologistās advice to slow the progression of the disease and calcify the soft plague. Good luck!
Thereās not much I can add but I had the Calcium Score Test in March and got a 755. I also had it 5 years ago and got a 455. Both times all follow up tests including a angiogram the first time and a cardiac stress test the second time were fine.
I was against going on a statin but agreed to take 10 mg of atorvastatin and a baby aspirin after the first one and doubled the statin after the second one. My first cardiologistās attitude was that since Iām a long term long distance runner with no chest pains, I didnāt have anything to worry about. After the second test, my new cardiologist at first told me to keep HR under 142. I did a max HR stress test and I got it up to 161. I think I could have gotten it higher if the test was different but it was designed to get you to failure not to make it easy but that doesnāt matter.
I still run 5 or 6 days a week but with a different attitude. I donāt push myself and I just keep my HR in my safe zone. It probably ruined my racing career but maybe it will extend my happy life. I just did an 8 mile trail run Upstate, running at my relaxed pace. I got creamed in my age group but I still enjoyed to run. Iām going to run a very hilly 10k on Long Island in a few weeks at my relaxed pace, then hit a few 5k races and see if I can pick it up some still keeping the HR under 161.
At least Iām still running and enjoying life. The last thing I want to see on my grave stone is āāHe died doing what he lovedāā!
Dan has graciously linked this thread to the āHot Forum Topicsā so people can see the links and comments regarding Coronary Artery Calcium Scoring.
many, thanks dan-
i have never before been accused of exhibiting grace. i think i said it once.
@EyeRunMD I had a score of 364 at age 53 (Iām 55 now). Like you, I was surprised and immersed myself gathering knowledge to understand this issue. For what itās worth, hereās the Cliff Notes version of some key learnings:
-
LDL isnāt the best metric for identification of heart disease, itās actually the number of LP(a) particles as the primary driver. Amgen has a drug in a clinical trial to reduce LP(a) and thus slow the progression of coronary artery disease (CAD). I donāt want to get too technical here, so hereās a link about it if you want to read up: https://www.amgen.com/...w-about-lipoproteina
-
PSK9 Inhibitors is the only treatment know to reduce LP(a) concentration, but most insurance wonāt pay for it, so the best alternative option is a statin that reduces your total LDL number. Interestingly, statins increase the LP(a) concentration; however, this risk is overwhelmed by the benefit of total LDL decrease. For what itās worth, my cardiologist has me on 40mg of Rouvastatin and 10mg of Ezetimibe to keep my LDL under 70. And yes, I take CoQ10 to offset muscle fatigue.
-
People who exercise generally have better plaque composition. Thereās a ton of research in this area using athletes over age 50, but my takeaway was the process of exercise functions similar to a statin in that it turns soft plaque into a safer denser plaque. Itās the dense plaque that gets shown in your calcium score, not the soft plaque, so ironically people with a lower calcium can in some cases be at more risk. Lastly, athletes tend to build collateral pathways to promote blood flow leading to my next finding.
-
Stress test results and METS achieved have prognostic charts similar to calcium score charts. Based on my calcium score, I was in the bottom 5% with the highest risk. Based on my stress test, Iām at the top 5% with the lowest risk.
Overall, I think thereās A LOT still being learned about CAD in athletes, but exercise serves as a protective mechanism which could enable us to live to be 100 years old with arteries full of dense calcium. Perhaps even taking a statin is redundant and unnecessary, but we arenāt far enough along our learning cycle to say that with confidence. It sucks that you were dealt a bad hand, but realize itās not all gloom and doom. Just keep doing what you enjoy and follow your cardiologistās advice to slow the progression of the disease and calcify the soft plague. Good luck!
Thanks for the info. Good to see others experiencing similar feelings/concerns over this. IĆ¢ā¬ā¢m scheduled for a stress test, and echo, in about three weeks so IĆ¢ā¬ā¢m really hoping/praying for good news. But, IĆ¢ā¬ā¢ll try to take it in stride. If I find out I have significant blockages, I look at it as Ć¢ā¬Åwell at least I found out so I can do something about it and be able to live a long life (hopefully)Ć¢ā¬Ā
Thereās not much I can add but I had the Calcium Score Test in March and got a 755. I also had it 5 years ago and got a 455. Both times all follow up tests including a angiogram the first time and a cardiac stress test the second time were fine.
I was against going on a statin but agreed to take 10 mg of atorvastatin and a baby aspirin after the first one and doubled the statin after the second one. My first cardiologistās attitude was that since Iām a long term long distance runner with no chest pains, I didnāt have anything to worry about. After the second test, my new cardiologist at first told me to keep HR under 142. I did a max HR stress test and I got it up to 161. I think I could have gotten it higher if the test was different but it was designed to get you to failure not to make it easy but that doesnāt matter.
I still run 5 or 6 days a week but with a different attitude. I donāt push myself and I just keep my HR in my safe zone. It probably ruined my racing career but maybe it will extend my happy life. I just did an 8 mile trail run Upstate, running at my relaxed pace. I got creamed in my age group but I still enjoyed to run. Iām going to run a very hilly 10k on Long Island in a few weeks at my relaxed pace, then hit a few 5k races and see if I can pick it up some still keeping the HR under 161.
At least Iām still running and enjoying life. The last thing I want to see on my grave stone is āāHe died doing what he lovedāā!
Wow thatĆ¢ā¬ā¢s quite an increase. I think IĆ¢ā¬ā¢d be scared to recheck mine in five years, but it would be interesting to know. I started atorvastatin and an aspirin once I received my CAC score. I
was hoping to get a coronary CT angiogram but my insurance has denied it since IĆ¢ā¬ā¢m asymptomatic during activity. I told them IĆ¢ā¬ā¢d be willing to pay out of pocket for the test because, in addition to the stress test and echo, it will give me more piece of mind knowingĆ¢ā¬Ā¦ā¦whether good or bad.
Did your cardiologist explain the reasoning for recommending keeping your heart rate below 142?
Hereās the link to the Amgen clinical trial: https://classic.clinicaltrials.gov/ct2/show/NCT04270760
.
I thought the Youtube video posted on the previous page gave a plausible explanation of why the score would go up after starting statins. In my understanding of the video, the statins are turning the soft plaques into calcified hard plaques (a good thing) increasing the score. That video also implied (my understanding) that a 0 score doesnāt mean you might not have a soft plaque waiting to break off at some time.
I posted earlier that I had a panic attack in the swim at Nationals due to thinking about my CC score and the cold water, tight wetsuit, going out to fast, out of breath experience. This Sunday I raced another Oly in 82 degree water. I had a much better swim. And that was after my inconclusive stress test and reading and thinking about the three swim deaths posted on here (My bet is they were cardio related).
For me, the warm water swim relaxes me to where I feel much more comfortable (and safer) in the water.
Iām still waiting to see a cardiologist. My appointment is not till the end of September. I tried to keep my heart rate down during the race (as per primary care doc) and for the majority of it I did.
As long as I donāt have physical symptoms Iām still training/racing until I talk to the expert or get different advice.
Thanks for the Clif notes on LP(a). I had never heard of it.
I had blood work done last week and a DEXA scan, mostly for thyroid questions, but the doc ordered 27 different tests (8 vials).
Even though I carry too much body fat, all of my cholesterol values (and other blood work) have always been excellent and Iād never had the LP(a) tested but this was one of the 27 tests done last week. No cardiovascular symptoms at all, just to too high body fat percentage.
My LP(a) number came back at 152, so they postponed the VO2 max test that I had scheduled and today I got the Coronary Calcium test done. That came up at 26, so the doc wasnāt too concerned, especially as a female who has been without the protective effect of estrogen for nearly 20 years. Time to buckle down on increasing the exercise and watching the diet more closely.
@eyerunmd - Hope everything works out.
This thread popping up was perfect timing for me. IĆ¢ā¬ā¢m 47 years old, had my first child 4 months ago, and just went in and got a high coronary calcium score, 77 I think it was.
IĆ¢ā¬ā¢ve been very active my entire life, never been overweight, but I have the hereditary high cholesterol. Sky high last it was checked, 400Ć¢ā¬ā¢s I think. Doc put me on a statin, but I donĆ¢ā¬ā¢t really tolerate it, makes me feel terrible.
Trying to figure out a plan not to die before my kid gets through grade school.
Hi Matt J.
I have posted in other posts on this issue and as a result, IĆ¢ā¬ā¢m very reluctant to engage. I would suggest looking at the following at the science behind heart disease (coronary artery disease) and a whole food, plant-based diet. There are lots of resources out there for lay people (if thatĆ¢ā¬ā¢s you) and lots of peer reviewed science if you are savvy with reading the scientific literature (pubmed). Some suggestions for where to start:
Read Ć¢ā¬Åprevent and reverse heart diseaseĆ¢ā¬Ā by Esselstyn and/or Ć¢ā¬Åchina studyĆ¢ā¬Ā by Campbell and/or Ć¢ā¬ÅHow not to dieĆ¢ā¬Ā by Greger
Watch Ć¢ā¬ÅForks over knivesĆ¢ā¬Ā documentary- streams for free on website
Watch videos/read blog on nutrition facts.org
Listen to any podcast with Kim Williams, MD
Tons more ways to access this information. Your MD should know, but as you can see even from the posts above, it is a blind spot for our society and culture which includes our physicians.
The leading cause of death among cardiologist is heart disease just like everyone else.
Heart disease is universal with a western diet by age 10.
Ć¢ā¬ÅThere are 2 kinds of cardiologists- vegans and those that havenĆ¢ā¬ā¢t read the scienceĆ¢ā¬Ā
This topic is triggering and I am not going to engage a debate (again) here. I do feel morally obligated to share.
Take it or leave it- but try to know for yourself.
Best wishes to you!