002 - The Deadly Lie of “You’re Fine”: Inside America’s Broken Heart Screening | ClearCardio
In this Clear Cardio "Prevention is Power" podcast, host JD Enright interviews Harvard‑trained cardiologist Dr. John Osborne to expose why heart attacks and strokes remain the leading causes of death despite being largely preventable. They explain that both conditions stem from ischemia—reduced blood flow—most often caused by arterial plaque buildup (about 99% of heart attacks and 80% of strokes). The conversation critiques common screening tools like EKGs and stress tests, noting they only assess the heart’s electrical activity and miss the underlying “plumbing” problems. They walk through the standard of care: measuring blood pressure, cholesterol, and using risk calculators (including the newer PREVENT calculator that now incorporates genetics) to estimate a 10‑year cardiovascular event risk, with a 7.5% threshold prompting statin therapy. Dr. Osborne debunks cholesterol myths, arguing that HDL is not protective and that traditional lipid ratios are largely meaningless. They discuss the high financial and health costs of interventional procedures (stents, catheterizations) and contrast reactive, invasive care with proactive lifestyle and preventive measures. A major portion of the episode is devoted to Clear Cardio’s novel imaging approach: a cardiac CT scan captured in a single second, processed by AI that analyzes over 2,000 grayscale shades per voxel, producing color‑coded 3‑D visualizations of plaque. The AI quantifies total plaque burden, distinguishes low‑density “lava” (red), medium‑density (yellow), and calcified (blue) plaque, and identifies plaque that is prone to rupture. They explain how plaque rupture—when a vulnerable soft plaque tears, releases thrombogenic material, and rapidly forms a clot—can cause sudden heart attacks or strokes even when traditional tests show normal results. The hosts compare calcium scoring (which only detects calcified plaque) to their “cardiac colonoscopy” that visualizes all plaque types, arguing that direct imaging provides actionable information that risk scores alone cannot. They describe the patient journey at Clear Cardio, from a brief 10‑minute CT scan to an AI‑generated report that shows exact plaque location, volume, and composition, enabling personalized treatment plans that may include lifestyle changes, medication, or targeted interventions. Personal anecdotes illustrate the emotional impact of finally seeing one’s disease and the relief of having a clear path to reversal. Throughout, the episode emphasizes that early detection, precise quantification, and preventive action can dramatically reduce morbidity, mortality, and healthcare costs.
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Welcome to Clear Cardio's Prevention is Power podcast, the podcast where we get real about your health, your future, and the steps you can take to live a longer, healthier life. I'm JD Enright, founder of Clear Cardio, and today we're tackling one of the biggest killers of our time: heart attacks and strokes. Now, these aren't random events that only happen to other people. These are preventable killers, and they don't care. If you're busy building your career, providing for your family, or enjoying your retirement. The good news, you're not powerless. You can take control of your heart health, and that's exactly what we're here to talk about. I'm so thrilled to have Dr. John Osborne here with us today. He's a Harvard-trained cardiologist, a pioneer in cardiology and preventive cardiology, and just great to have you here. I love doing these podcasts with you. We always have great conversation. We never know where it's going to end up, but usually we end up in a pretty good place. So welcome, Dr. Osborne.
Well, thank you so much, JD. It's always a delight and a pleasure to be here.
Yeah, thank you. So as I mentioned when I was opening up the podcast, you know, we've got the people that watch this podcast are really focused on, you know, heart health in general, healthcare in general, preventive heart care, what we call the worried well. And sometimes it's people that have just been You know, quite frankly, abused in the in the in the business of healthcare, and and also just really may not necessarily know. I think there's our audience is made up of people that really understand what what heart health is, and those of us who, like me, not too many not too many years ago, were clueless. Like we're going about our lives. We're businessmen and women. focused on our careers, our children, the stress of just living in today's society.
Well, the good news is here, we're here for the beginners, the rudimentary, the beginners, the intermediates, the advanced, the experts. So no matter where you are in that continuum, I think you'll find some really great stuff we're going to talk about.
Yeah. And one thing that's great about Dr. Osborne is he can speak at all levels, which is And usually it's the 12th grade level that he's talking to me about. So, so anyways, so today we're going to be talking primarily about heart attacks and strokes and the dangers of heart attack and strokes. So, you know, quite frankly, a lot of people may not know like what a heart attack or stroke is and what causes a heart attack and stroke.
Sure. Today you'll find out.
Okay.
So When we think about a heart attack, what that means is that for a variety of reasons, and we'll talk about the details, but for a variety of reasons, it just is a description where we've lost blood flow to the heart muscle. The heart has to have a large amount of blood going to it. It has to have oxygen, nutrients, et cetera. And if that's suddenly turned off, then that will cause damage to the heart muscle. Which can cause symptoms, which we can talk about.
What kind of damage though? When you say— so the blood is actually the carrier, brings the oxygen and all the stuff that the heart then—
And takes off all the bad stuff, right? So we have both. I like to think of it as the clean water coming in, but we also have a sewer system, right? So it dumps all the waste and all the nasty stuff we don't Yeah, because it's a muscle.
It's like a pump. It's sitting there pumping and it's circulating the blood. But at the same time, it's kind of a two-thing, right? You've got this muscle, this pump that's pumping the blood that has all this— it's rich in oxygen and all the things that your muscles and body need, your brain. So it serves that purpose to circulate all the blood to all of the organs and so on. But at the same time, it needs the same blood it's pumping.
Right.
For itself to survive, right? And so you're saying when that blood supply to the heart muscle itself is cut off, that's a heart attack?
That is a heart attack.
Okay. Then what's a stroke?
Well, a stroke, same concept, right? Blood flow, nutrients, oxygen, taking away all the waste, et cetera. that is a vessel going to the brain. So in fact, some people have said in the past, just to make this concept easier to understand, that we should talk about heart attacks and brain attacks, 'cause basically it's the same thing, right? Yeah, that concept never really stuck. So we still talk about strokes.
Stroke's an easier word to say than just brain attack.
Yeah, we're used to it. But there have been people that have tried to change the terminology because they're really much more similar than they are different. We're just talking about the blood flow to a given organ in the heart. If it's compromised, reduced, that's a heart attack. Blood flow to the brain, if it's compromised, produces brain damage, and that's a stroke.
So for the purposes of this discussion then, So what causes a stroke, which would be lack of blood oxygen to the brain, and what causes a heart attack, which would be lack of blood oxygen to the heart, is the same effect. It's the same thing that causes it, right?
There's a lot of overlap. They're not exactly the same, and I'll explain that.
Can we focus on what the similarities are?
Sure. A lot of strokes are what we call ischemic strokes. I apologize for dropping lingo, but Ischemia comes from the Greek word that means reduced blood flow.
Okay.
So you can see there's the commonality, right? So ischemia, reduced blood flow to the brain, or ischemia, reduced blood flow to the heart, causes dysfunction of that organ.
Just one's called a stroke for the brain and one's called a heart.
Precisely. So about 80%, rather, of strokes are what we call ischemic strokes. Right.
You said 80%?
About 80%.
80%. That's a big part of—
Yeah, that's a very, very large part of it. And ischemic because we have reduced blood flow to the brain. Now we'll talk about what are the things that can cause that ischemia, the next step in front of that, which is a little bit different from the brain, from the heart rather, but there's a very large overlap. of things that cause ischemia to the brain, ischemia to the heart. The number one by far of both of these is plaque that develops in the blood vessels. So if I got plaque in my blood vessels—
Like plaque in your teeth? Like when you brush your teeth?
Same term, right?
Right, because I always thought, like, you know, you don't want plaque in your teeth, you're going to get cavities.
Yeah, so there's stuff that we call plaque in our teeth, between our teeth, that's no good.
Yeah, that's not what we're talking about here. We're talking about something completely different.
And that's really due to dead bacteria building up amongst your teeth, and that's not a good thing. There is a pretty good large literature. Maybe one of these podcasts we can go into the deep and dirty on that and talk about perhaps the relationships between plaque in the mouth and plaque in the heart. But for our purposes today and all that, different animals. An interesting relationship, some correlations, but completely different as far as what causes those. Okay.
Got it.
So the vast majority of heart attacks and strokes are due to plaque that builds up in the blood vessels.
Interesting. So, okay, I've heard this. Obviously, I'm 57 years old, and I—
You're young.
Thank you very much. I appreciate that. But I'm 57, and most of my friends and colleagues are around that same age, maybe a little older, some a little younger. But around that time, that's just how it goes. And you happen to be my cardiologist, right? And so one of the things— By your choice. By choice, by choice, of course. Yes. Healthcare industry didn't force me your way. And one of our other podcasts talks about that specific thing about healthcare and the lack of and all of that stuff, which if you haven't, guys, if you haven't seen that podcast, I highly recommend you go check it out. It's really interesting. Very controversial, by the way. But anyways, I, for many, many years, I was going to see concierge medicine and not necessarily just to see a cardiologist, but going to get general wellness. I'd go to a very high-end location just because I had to have what they call key man insurance as a CEO of a company.
Because you played the keyboards.
Yeah, because I play the keyboards. Yeah, no, for keyman— for those of you who don't know, keyman insurance is, uh, when you are in position in a particular company that is considered critical, they need— they put life insurance on you. Um, and that life insurance is in case I get hit by a bus in my travels, uh, or drop dead of a heart attack or stroke, um, more likely, um, then the insurance company would pay to the company to help replace me.
It sounds kind of the reverse of a hit.
Exactly, yeah, exactly.
The inverse of a hit.
Yeah, exactly. Hitman out there.
Something bad happens to you, they get money.
They get money. My family doesn't, but it's to replace me because for whatever reason they thought I was important to the company. So they would— the insurance companies who were providing the healthcare insurance would make me go to a clinic. I went to a particular clinic that's quite Well-known. And I'm— we're in Dallas, Texas right now. This podcast is airing from Dallas, Texas. And I would go to a clinic.
People are Googling all that.
I know. So clinic, but I would go to this clinic and I'd go in, it was $10,000 for the day. I'd get there 6 in the morning. I'd be wearing basically like sweatpants, pajamas, what have you. 6 in the morning. I wouldn't leave till 6 at night. And I would go through a whole barrage of tests, like everything you could possibly— I mean, seriously, I was poked and prodded and violated and turn your head and cough.
And you paid for the privilege.
And I paid for the privilege. You know, I was like, yay, thank you. And I did MRIs and I did stress tests and running on the treadmill would look like I was Maverick flying in Top Gun with all of the stuff and EKGs and all that stuff. And they would tell me, they would say, you know, cholesterol's a little high, but other than that, you passed your stress test. Everything looks pretty decent. I know those of you out there probably had that done before. Um, but I'd get this big binder, I'd pay $10,000 and I'd go home and I'd go see my lovely wife, Yvette. And she'd say, hi honey, how did it go? Because I'd go twice a year, uh, to maintain my insurance. And, and I'd be like, I guess it went pretty good. I don't know. I, I'd open up the thing and it would have a bunch of numbers and, and some red things and some green things. But ultimately they said, you know, eat better, get more exercise, make sure you sleep well. Don't be so stressed out.
Change your ancestors.
Change your ancestors.
Yeah, right.
Yeah. Like your genetics could play a big role. We'll talk about that here in a minute. But because I know that's a big deal. I mean, people don't realize, but I wouldn't know what to do really, you know? And so, but I got the insurance.
And that's $20K a year.
And that was $20K.
2 days a year.
Yes.
And $20K.
$20,000, probably more than that when it's all said and done, you know. Um, and, but the insurance company put a stamp on it, right? So, um, but what I'm finding out was, um, through— thank goodness I met you and I met, um, my neighbor, Dr. Raju Kizori, who's a— unlike you, he's a, um, he's an interventional cardiologist. He's the one you don't want to end up going to see because, um, for those of you don't know, an interventional cardiologist is is the one that you actually, um, if you have a heart attack or stroke, or you are about to have a heart attack or stroke, uh, and, and you're lucky enough to have been diagnosed properly, properly early enough, right? Which I was one of those guys fortunate enough, but most people aren't. Um, you get that as a, like a, it's an interventional, uh, preventive Heart attack versus having the heart attack, right? Where they put a stent, they go in and it's invasive, right? They either go through your arm now and they go up through your—
Usually through the arm, but the old days back in the groin.
Up to the groin, right?
Nothing's pleasant.
But nothing's pleasant. And it's a general anesthesia, I guess?
Pretty much.
So that's risky. And they putting balloons and stents and all kinds of things, which we know historically, I think they're safe, now-er than they were before, but we know they had failures and recalls and things. Plus you can get infections, and it's $20,000 a pop.
Oh, oh, I'm sorry. I must correct you, JD. It's $20,000 to take the pictures that show you have a problem. Just to take the pictures. Just to say, oh, there's an issue.
I see.
Once we start putting in stainless steel, a stent, I always like to say $3,000 a stent, installation extra, I see. Now we're up to $50,000.
Oh my God.
At a minimum. For a stent? You get more stents and it's up from there. But yeah, it's $50,000.
Wow.
Is MSRP.
Yeah.
Manufacturer's suggested retail price.
Yeah.
For a stent.
Yeah. Well, I'll tell you what I know. We're either—
And that's just the money cost.
Yeah. I think we've already done a podcast or we're going to be doing a podcast about prevention versus reaction, which is a whole nother situation, which is really I'm excited to do that podcast with you. And I'm sure we'll touch on some of that today. But yeah, that is very reactive and therefore your costs, right? There's your costs, right? Versus doing something different.
And that's assuming you live.
That's assuming you survive it, yeah.
Because remember, big picture, 30,000-foot view, in those individuals who are going to have a heart attack or stroke, again, pretty much caused by the same thing, half the time, Before your heart attack, which can kill you easily, half the time you'll have no symptoms prior to the heart attack. You feel fine. You just did your stress test last week. You got patted on the back, said, you look great. You got the heart of an 18-year-old. And next week you have a heart attack. Happens all the time.
Yeah. So let's talk about that a little bit. So let's back up just a second. Strokes, heart attacks, 80% of the time they're ischemia. Ischemia? Am I saying that right?
That cause ischemia.
Ischemia, right? And that's basically lack of blood flow to the heart or stroke. And we talked about, or you've talked about, that it's based on plaque buildup in the arteries. So when I think about plaque buildup in the arteries, right, it was like I said, when I go to get this insurance-related or whatever, they didn't do cameras and they didn't do any of that. All they did was they did a bunch of tests. I ran on a treadmill, whatever. So help me understand, why can they pick up the plaque or did they not pick up the plaque? Where does the plaque accumulate? Help me understand that process. Help us understand that process, Dr. Osborne.
Let me preface my comments by they meant well.
Got it.
Right?
Yeah.
Unless you actually look at the blood vessels—
I hope they did. I hope they meant well. I'm sure they did, yeah.
Again, I'm an optimist. I believe in my human being, my fellow human being. So I'm going to say that they did it with all good intent. However, at the same time, the only way to see if you have plaque in the blood vessels, and here's the shocker, is to look to see if you have plaque in your blood vessels.
Seems pretty simple.
And I'll say that to make the point.
How do you do that though?
Well, okay, so a lot of people go because maybe they have symptoms or chest pain or breathing Or a family history, or someone says you got high cholesterol, whatever. So you get sent to me. Well, not necessarily to me, but one of my colleagues.
Those are the quality risks. The risks, right?
So you go to the cardiologist, and I'm going to dissect this a little bit to show you how useless most of this stuff is.
Okay?
And I'll be upfront and honest.
I'm sorry, did you say useless?
Useless.
Okay.
Okay? So he'll hopefully do a good history and physical.
That's a huge statement, by the way. That's huge.
Yeah.
Okay.
So hopefully he'll do a good history and physical. That's where 90% of the value comes from.
Like I go to get a physical, you do well.
Yeah, and ask about symptoms and risk factors and cholesterol and blood pressure.
So Q&A between you and the physician.
Exactly, right? The history and physical, right? That's key, really a key critical thing.
You're not talking to a cardiologist at that point. You're just, you're basically talking to a general practitioner.
Yeah, and then he may decide, I'm concerned or I'm worried or it's out of my forte.
So he or she, your general practitioner, Right. Assuming you go. Guys like me, just for a second, I'd never just get up and say, you know what? I want to go see my general doctor to get a checkup. I mean, I don't just— and most of the people that I know—
If it's not broken.
Yeah. I think women, and I don't want this to come across sexist or anything, but to me, because I just look at my wife, I look at my daughter, I look at my mom, I look at my sister, Those are the kind of like my the people that I can kind of relate to. They're very, for the most part, what I've heard they call worried well. They they're not ill, but they're worried about getting ill. So they take like they wear they take vitamins and creams, and they they you know this is what you should be eating, and they take yoga classes and all this stuff. Whereas myself, my dad, my brothers, my buddies. We're all like, how are you doing? I'm doing all right. And they could be limping down the golf course. They could be like coughing and like, I'm going to be okay. I can hang. I'm going to, I can, I can handle this, man.
Just but a scratch.
Just cut the arm off at the nub. You know, I'll be fine. It's like, give me a club that can, you know, we just kind of handle it, you know what I mean? Like, so, so, you know, just backing up, like assuming we get to—
Women do live longer than men.
Yeah. Fair enough. I can see why. Right. But, you know, in the event we do see a general practitioner, that's when— which is why probably more— a lot of guys die of heart attacks and strokes because they don't go to see that.
But you never get to first base.
Yeah, but what you're saying is even if I did that, even if we all did that collectively as men, we all got together, every walk of life and said, we're going to be preventive now. We're going to go see our general practitioner. You're saying there's still a problem? Oh gosh, yeah.
Okay, so let me, let me break this down to you. Okay, so you, so you end up going to the cardiologist, right? So first level, your primary care doc, then you go to the cardiologist. They'll do an EKG. Okay, your primary care doc may do an EKG. EKG is where we put those electrodes, as we call them, on your chest.
Okay, electrocardiogram.
Electrocardiogram. Okay, EKG in Germany, actually, we still call it EKG just because that's how we learned.
Okay.
Kardiogram with a K. In the US, technically it's an ECG, but if I say EKG, ECG—
Got it.
I'm just— I've got one foot in Europe and one in the US. Okay.
So they're putting the leads on there and they're measuring what? What are they measuring?
All they're measuring is the electrical output from the heart. Why?
Why do you want it? Why do you care?
Well, so from that, we can look at your heart rate. Okay. That's important.
Like how many beats a minute?
How many beats per minute.
Okay.
Right. We can look at your heart rhythm. Is it regular? Is it irregular? Right? So there literally are tons of different heart arrhythmias, as we call it, arrhythmia, meaning out of rhythm, that we can see on EKGs.
So for a guy like me who's— I'm 57. Yeah, 57. So for the guys in their 50s, 40s, 50s, 60s, what should a heart rate be?
Great question. So According to textbooks, what we all say is, you know, all agree on these numbers, seated, resting, or laying down, resting blood pressure, resting—
Like I'm doing right now.
Heart rate, right? Should quote unquote be 60 to 100.
60 to 100 beats.
Anything in that range is normal.
Beats per minute.
Right. Now, are there people like Lance Armstrong and people that are highly conditioned that run in their 30s, and that's normal for them?
Yeah.
40s.
Yeah.
A lot of people run in the 50s. They're perfectly fine. And then on the other side—
So athletes have lower heart rates?
In general, right?
Okay.
Part of it is genetic. Part of it is conditioning.
Okay.
Can also be due to other things. Drugs can lower it, raise it, whatever. And then there's some people that maybe the heart rate just runs a little fast, right? Either maybe they're deconditioned, maybe they're dehydrated, they're dry, or a variety of medications that can cause their heart rate to be above 100, but they're still fine. But 60 to 100 is going to be what I will quote, as I like to say, that's what we would find on the board question, 60 to 100.
So if I'm a guy, so I am 57, and I'm relatively active, I go to the gym, I'm not in the best shape of the world, but I'm not overweight. I don't have, to my knowledge, I don't have high blood pressure. I've been paying attention to that now, thanks to you, Dr. Osborne. But in general, if my heart rate was say 100, 120, what would that indicate? Would that make you nervous?
Well, in general, if it's above 100, I'm going to say something's funny.
Something's funny. Heart-related.
It doesn't give us diagnosis per se, but it says something's funny. I mean, you're, you know, I always think of this as the Gaussian bell-shaped curve, right? I mean, we'll say average heart rate is probably 70, 75, right? And it can go down to 60. That's fine. It can go up to 100. That's fine. But when it starts getting out to the extremes, it probably says there could be something going wrong. Now, again, it could be you're conditioned, or it could be genetics or whatever. It could be explained by medications that can lower or raise heart rate. But it says, yeah, we should, we should look at that.
But it's an indication.
It's an indication. We should look deeper.
Fair enough. So heartbeat is important.
Yeah, so heartbeat, heart rhythm, we can tell on an EKG reasonably accurately, not terribly, but reasonably accurately, things like if you have thickening of your heart muscle. That's important. That goes along with things like high blood pressure and a variety of other conditions.
So thickening of the heart muscle, that happens how?
Well, most commonly, right, there's a variety of things that cause it, but most commonly it's a condition where we thicken the heart muscle. So the heart muscle should run within an X number of millimeters thickness. If it gets thicker, by far the most common cause of that is high blood pressure that's not been well controlled. So the heart being a muscle pumps blood. When it becomes harder to pump the blood because your blood pressure is high, the muscle, like any muscle responding to a stress or a load—
Gets stronger.
Will Bulk up, bulk up, bulk up, right?
Which is not a good thing.
Which is not a good thing.
You think when you build muscle you want to have a for for that kind of muscle it's fine. Not for the heart.
Not for the heart. Okay, so you want it lean mean exactly pumping machine right yeah so that that's something we might be able to see on an EKG not all the time but maybe you can look at without getting too much the details you can look at at The electrical signals in the heart travel along a certain pathway. And anywhere along that pathway of electrical activity, I call it the electrical system of the heart, the wires of the heart, right? It has its own dedicated wiring system. And anywhere along that pathway in the heart, you can develop electrical blockages, not plaque blockages, not blood vessel blockages, Hmm. blockages. That's on the plumbing side of things. But you can also develop blockages in the electrical system of the heart. So you can use the EKG to see if you have a blockage in the electrical system and not plumbing, the electrical system. And you can also see where in that electrical system that blockage is located.
So that'll be very helpful. That'll show up like in an arrhythmia or something like that where the heart— like fibrillation or something like that?
Well, that would be more arrhythmia where the heart is out of rhythm.
Okay.
You could be in rhythm, but still see on an EKG, there's a blockage of the electrical activity. Now, the heart being smart, will develop ways of bypassing that electrical divot, that electrical blockage, but you can see that on an EKG.
Okay.
So there's a lot of things you can see on an EKG. Let me tell you what an EKG is not helpful for. So an EKG, again, electrical signals given off by the heart. I can see your heart rate. I can see a variety of heart rhythm issues. I can see if there's thickening of the heart muscle, sometimes, not all the time. I can see if there's been an old heart attack, sometimes, but not all the time. Right?
So—
Really?
On an EKG, you can see if you had a heart attack before?
Sometimes. But however, I can tell you, yeah, I get people with really funky looking, scary looking EKGs, their heart's fine.
Because I've seen an EKG on my own. It's just a bunch of lines that go up and down.
I mean, it's kind of like reading—
It's kind of like right here. When you look at this, that's an EKG signal, right? How does that tell you if you have a hardening of the—
Well, it's kind of like reading hieroglyphs.
Got it. You've got to be you to pick it up. Yeah.
I mean, you get good after you've got—
You've got to be a Dr.
Osborne to pick it up. Yeah. 15 years of training and read about 10,000 of them. Then you start getting good.
So, got it.
But yeah, there's a lot of things you can tell you about what's going on in the heart. But really, what an EKG is going to tell you is the electrical system of the heart. Okay? Because it's just electrical signals coming from the heart.
Yeah.
It's really not going to tell you anything about the plumbing. So someone sends you the cardiologist because they're worried about your plumbing, right? I mean, that's why most people know there are lots of reasons why you won't. Might go to a cardiologist. But the way I like to explain it is that pretty much you got a plumbing problem, you got an electrical problem. And for the most part, there's not much overlap between those two.
So you're one of those few guys, right? And women a lot more, man or woman, who goes into the general practitioner, right? Because they're being proactive, right? Or maybe they did get sick or something and they just, the doctor happens to take a look at them. And they do an EKG and they look at the EKG and everything could look fine. Normal EKG. Or even if there was a little abnormality, they're not going to send you to, or me, to a cardiologist typically, will they? If everything's fine? If it looks fine?
If they saw something abnormal, they might go, yeah, they might say, eh, it's okay. Or they might go, I don't know. I feel a little uncomfortable.
But if it looks fine, Yeah, they may not. Yeah. Well, no, if your EKG looks great, why would they send you to any cardiologist?
Well, here's the problem. So as I said before, the EKG really is just telling me about electrical issues.
Electrical. It has nothing to do with—
Has nothing to do with the plumbing.
Plaque.
Right? So imagine, I don't know, you have some problem with your speedometer, right? Or some electrical system, or your windows won't go up or whatever. And the next thing I ask you is, well, what kind of gas have you been putting in your car? Has your car been producing smoke out the tailpipe? And you go, what the flip does that have to do with—
Exactly. Yeah. My window's going up and down. Nothing.
Nothing. Nothing.
Right? Yeah. No, it makes sense. Okay. Yeah. When you put it that way.
So EKG is great for electrical problems of the heart, of which there can be many. And that's fine. We're not going to talk much about that today, but it's great for electrical problems of the heart. It pretty much tells you nothing about the plumbing.
Which is what causes the heart attack and stroke.
Yeah, exactly. Right.
All right. So it's not a heart attack or stroke really predictor. Yeah.
So that's why I said before, a few minutes ago, yeah, pretty much useless.
Okay.
As far as the heart goes, your EKG will only— has the potential to be abnormal. The potential could still be normal if you're in the setting of a heart attack, What do you mean by the setting? So I'm talking about you're now having squeezing what we call substernal sternum, breastbone. So behind the breastbone or left-sided, we call it, well, chest pain, but it's a whole variety of collection of things from heaviness, tightness, pressure, burning, ache. Usually it's that kind of—
You're showing symptoms of a heart attack.
Right.
Okay. All right.
So So you'll— you can, but not all the time, see changes in the EKG that reflect that thing we talked about earlier called ischemia. Okay, so you might be able, when you're having those symptoms, you might be able to see changes in the EKG.
Okay, but you have to be under EKG in the moment.
Having EKG when you're having the symptoms.
Yeah.
Okay, you don't have symptoms, probably not going to show anything.
Got it.
The other thing is, Let's say you're going to have a heart attack next week, okay? Because you didn't come to see us. So you're going to have a heart attack next week.
Us being Clear Cardio, by the way.
Clear Cardio. So you're going to have a heart attack next week. I look at your EKG this week, it's completely normal. You didn't go to see Clear Cardio. You have your heart attack. You survive. I like to say you're in the top half of the class because the bottom half of the class just died.
Hold on, hold on. Let's just touch base on that. So what you're saying is, what you're telling our listeners is that Half of the folks, roughly half of everybody who has a heart attack or a stroke dies?
Yeah.
With no symptom?
Nope. No preceding symptom.
Wow.
Until you died.
That was your symptom? Death?
Yeah.
Okay. We'll get back to that in a minute. All right. Keep going.
Right?
Yeah.
So they do an EKG the week before, whatever. Maybe you are having symptoms, but EKG is normal, very typical. You have the heart attack.
Yeah.
You're in the bottom half of the class, you die. Right? Well, that EKG did nothing for you. Yeah. Let's say you're in the top half of the class, you survive, right? But now you go to the hospital, it's a big, big deal, life-threatening. They got to put— do a heart cath on you within minutes. They hopefully put a stent in that blood vessel that's blocked off within minutes.
There's 50,000. Assuming you survive.
And then, well, then that's just the That's just for the heart cath. Forget the hospitalization and other tests.
Oh yeah, you're talking $100K.
Oh, easily.
Oh my goodness.
Yeah, that's just, yeah, easy, right? Without complications.
Yeah.
Right? After your heart attack, your EKG may or may not show evidence you had a heart attack. It could be completely normal.
Even after you had a heart attack?
Yeah.
Okay.
So an EKG for a heart attack—
It's a very limited tool.
Will only be useful If you're having symptoms at that moment, even then it may not detect it. And it may show evidence of an old heart attack on your EKG.
But it may not.
But it may not. So just remember, the important take-home is an EKG tells me about the electrical system of the heart. It really tells me very little, with a few exceptions, as I mentioned, having symptoms, or maybe after a heart attack, but even then can be normal. An EKG will only tell you about the electrical system of the heart. It tells you nothing about the plumbing, because I never looked at your plumbing.
Yeah, okay, fair enough. So moving off the EKG now for a minute, which I'm super depressed about that now, but it is what it is. It is what it is. Knowledge is power. And that's what this podcast is all about. Knowledge, uncovering and tearing back the covers. What is the standard of care today for those of us who aren't involved with Clear Cardio or companies like Clear Cardio, who just stumble in, maybe have a symptom or two, maybe they don't, they just being going to see their general practitioner, they get an EKG, there's nothing there that jumps out at you, and it doesn't tell you anything about the plumbing anyways. How do we find out if we have heart disease or if we have a problem with a heart? What's the next test that they'd do?
So I'm going to hold you to this because you said standard of care.
Yes.
Which means this is just something everybody should do. If you don't, it's malpractice.
Yeah. What do they do today? What do they do today? How do they—
Well, what we do is we check your blood pressure, we check your cholesterol, Okay, so blood pressure.
So what is blood pressure? Let's talk about that.
So blood pressure is, you know, we use the term high blood pressure, right? Half of US adults have it. So 50% of you have it. Many of them don't even know it. Also called hypertension.
So that's why they call it the silent killer, right?
Exactly.
Because you could have high blood pressure.
Completely normal.
And you don't feel like you have high blood pressure.
So high blood pressure is very simple. Your blood is flowing into a pipe, we call them arteries, and the blood in that pipe is going to push against the walls of that artery, the pipe. And if you were to measure that pressure, that's blood pressure, right? So blood pressure is a good thing, right? Much better than having no blood pressure. That's a really bad thing.
Yeah.
But it should be within a certain range, right? If your blood pressure's too low, You don't— we use the term perfuse, but you don't send enough blood pressure at the right pressure to your brain. Brain doesn't get blood and you're dizzy, lightheaded, you faint, you pass out.
From low blood pressure.
From low blood pressure. And plus, all your other organs have to have blood flow to them, right? Liver, kidneys, et cetera. So low blood flow is just a bad thing, right?
Yeah. So 1,000 years ago, I went to school for engineering, and we talked a lot. I like the way you use the terminology. You give me— I can visualize it. So if you think of your arteries being a pipe, right? I think most of us understand what a pipe is.
And let me just say, as a reminder, really, I'm just a general contractor. I do some electrical, I do some plumbing.
Fair enough. Yeah, got it. So if I think about that, I remember I used to have to do calculations to size the size of the pipe properly. And whatever fluid you're putting in has different viscosities, right?
Exactly.
So you have water versus oil versus gas or something, but you need to have a certain size pipe at a certain flow volume, at a certain pressure for things upstream and downstream to work, like pumps and things like that. Otherwise you get Cavitation, or how many times have you like opened up the faucet in a place where the pipes were all clogged up and you get this dribbling little— and there's no water pressure? Or like, for example, when I go on vacation sometimes and my wife wants to kill me because I chose a place that has no water pressure and the shower just dribbles out. But it was cheap. And it takes 3 and a half hours for her to like rinse her hair out. Like, you know, that's awful. So apply that to your body. Your body's going through the same either starvation, and that's why you pass out and whatever, or shortness of breath, things like that, or your blood pressure's too high. What are some of the symptoms when your blood pressure's too high?
In the vast majority of people, none.
So that's okay. Fair enough. At least you have a symptom when it's too low.
Exactly. But when it's too high, To detect high blood pressure, here's the kicker, you got to measure it.
Yeah.
Right?
Yeah.
Just as in business. If you don't measure it, you can't manage it.
Well, it's the same thing. When we used to design mechanical systems that had hydromechanical systems, we used to put valve meters and pressure meters so you could see what the pressure was and then you could tweak it Exactly.
Accordingly. Right?
Yeah.
So if—
So it makes sense that we would do that to ourselves.
Yeah. I mean, again, electrical and plumbing, it's very simple stuff. Yeah.
Fair enough.
Yeah.
You're just a glorified plumber, right?
I am. I am. Yeah. I wish I get paid their rates, but— Yeah.
Fair enough.
Right?
Yeah.
Yeah.
We'll talk about that in another podcast.
That'll be our CLEAR Plumbing pod series. Yeah.
But blood pressure.
So high blood pressure, again, most people have it, have no symptoms. You feel fine. Okay. But high blood pressure over time, not controlled, turns the lining of the vessel, we call it the endothelium for the record, but you don't have to remember that. It's called the endothelium. It's a very thin single-cell layer.
That lines the inside of the artery.
Lines the inside of that pipe, your artery, just one single-cell layer thick that stands between the muscle of the blood vessel, and your blood. So critical, does lots of very important things. But that lining should be very slick. It should be Teflon.
Right? Interesting.
Because otherwise, if it's not slick, you get blood clots, you've— things stick to it. That's not good in engineering. And it's not good in my world either. If you have high blood pressure, amongst other things, but we'll talk about blood pressure for right now. High blood pressure converts that lining from Teflon into Velcro.
Oh, boy.
So now you have a wonderful sticky mess of a pipe that begins to— things stick there, right? And the big thing, of course, is cholesterol.
Okay.
And that is what down the road contributes to the buildup of plaque, one of the things. That contributes to the buildup of plaque.
So when I think about how pipes clog up, and when you open the faucet and you get that little dribble, drop, whatever, eventually nothing comes out, and that's a heart attack effectively.
I'm sorry, were you talking about your prostate?
Yeah, no, no, no, no, no. I'm good there. I'm good. But no, but it doesn't work the same way in blood vessels, right? Plaque doesn't build up on the inside of your arteries, right? It builds up somewhere else, doesn't it?
But what happens is the vessels get very sticky.
Okay. Because of the high blood pressure.
Because high blood pressure and other things, which we'll talk about later.
Genetics, right?
Genetics, wrong choices, bad diet.
Got it.
Diabetes, smoking.
All those risks that you read on those pamphlets.
Exactly right. A lot of those, Why they are a risk is they give you sticky vessels, right?
Got it. There you go.
Sticky vessels. You don't want sticky vessels.
Yeah. So those are risks that cause something that allows the plaque to build up.
Exactly. So they get sticky. And what happens is cholesterol, which is the culprit 100% of the time that forms plaque, 100% of the time. There is no such thing as plaque that forms in the absence of cholesterol. It is mandatory, necessary.
Got it.
Has to be there, always there at the scene of the crime.
So is plaque— I mean, is cholesterol— so this is really interesting. So is cholesterol— so as I understand it, our own body generates cholesterol, correct? And then we also convert food into cholesterol.
We do.
Like, so, so they Is that the difference between good cholesterol, bad cholesterol?
Nope.
No. Okay.
As it turns out, there's not good cholesterol or cholesterol. There's just cholesterol.
Okay.
Right?
Really?
Yeah.
Because I always heard there's bad cholesterol, which is LDL, and there's good cholesterol, which is something else.
LDL, for the audience, right? Lousy lethal.
Okay.
You want that low.
Okay.
Right? And we used to think, this has really been disproven over the last 10 or 15 years, but the myth is still out there. That another form of cholesterol, and it's all about the density of the cholesterol. We have less dense cholesterol, LDL, less dense, lower density LDL, lower density lipoprotein. And we have higher density lipoprotein, HDL.
Oh, so that's what that means.
Yeah. HDL stands for high density lipoprotein.
Lipoprotein.
LDL is low density lipoprotein.
So it's the high-density lipoprotein—
That was thought to be good and protective. And in fact, actually would do what we call reverse cholesterol transport, right? Because you go, well, if there's a pathway in, there should be some kind of pathway out. So the idea behind HDL cholesterol is that that would be the pathway out. So if we start putting cholesterol, depositing cholesterol in our blood vessels, which is never good, Then HDL was our savior. It's the happy heavenly cholesterol that should be high. All that's incorrect, but you thought so.
You thought so.
But we used to think of it that way.
Yeah.
But you brought up good cholesterol.
Nobody's talking about that.
Yeah, I know. Well, we are here.
We are here.
And keep listening. You've heard it first right here from Dr. Osborne. Lots and lots of surprises coming. Okay. By the way, everything you thought about heart Was wrong, but keep listening. So yeah, so HDL cholesterol is not helpful. It's not protective.
Okay.
And in fact, particularly as we get older, look at particularly postmenopausal women as an example, HDL can go high in them. It offers no protection. In fact, there's a lot of people have very high HDL. I've seen HDLs of 3 digits. Right? Well into the hundreds. The highest HDL I ever saw was 215, which is kind of wild.
Wow.
And you'd think, well, if you got— if the HDL, the good, happy, heavenly cholesterol hypothesis is correct, well, that person would never get heart disease. Yeah, no, it's the exact opposite. In fact, people with high HDL, particularly like 90s, triple digits, etc., they actually have higher rates of cardiovascular events, strokes and heart attacks for that matter, than people with actually somewhat lower levels of HDL. So if anyone tells you HDL is great, or— and this still occurs and it so galls me— they'll say, oh, well, your LDL is high, but your HDL is good, so therefore you're off the hook.
So the offset.
Yeah.
I've actually been told that.
It's 100% steaming.
I have. I've been told that.
Yeah.
I was told that my cholesterol, my bad cholesterol at the time, which was the LDL, right?
Right.
Was 2-something. But my HDL— That'd be walking. I know, right? Well, now it's 40. Yeah. Yeah. It's like 45.
Better living through chemistry.
Yeah. My last blood test with you was amazing. You actually said it was amazing. So I'm going to take you on that.
I scribbled all the numbers in myself.
Thank you.
No problem. What number you want?
Yeah. No, but they don't listen. Clinic. This is the clinic. I'm telling you, I was there at the clinic and they said, you have high cholesterol. This, it was 230-something, right? And then they said, but oh, but your low, your, your good cholesterol is like 1-something-something. So that kind of balances it out. So they didn't put me on a statin or anything like that. They just said, you know, drink, eat less red meat, which now I find is nonsense, right?
Yeah.
And whatever. But I have all the pasta and cheese you want. But but anyway, so I'm sorry, getting off track. But but it's it's I'm passionate about it because it's you know it's my life and it's the life of our listeners and and and our patients right here at Clear Cardio. But and backing up, so so you've got this cholesterol myth now. Yeah. Right, which is nonsense. So yeah.
So so if someone says yeah your HDL is high, you're fine.
Yeah.
Or a lot of times too, they'll create ratios, right? The ratio of Total to HDL.
Yeah.
HDL to triglycerides, another fat that we measure in the blood as well.
Right?
All that's a pile of crap.
Meaningless.
Meaningless.
As a predictor— Wow. You heard it here. It's a pile of crap, guys.
As a predictor of something that I could look at and go, oh, you're at higher or lower risk. Not valuable at all. In fact, it's actually inversely related in many people.
Okay. Well, some people say, I've heard some physicians say, That you have to have a cholesterol level that is decent because your brain myelinization requires cholesterol for all of that stuff. Is that not true?
No. I mean, we could spend a whole podcast on this, and we should at some point, but that concept that the measured cholesterol in your bloodstream— remember, when we're measuring cholesterol in the bloodstream, It literally is just sampling for your bloodstream. Tells me nothing about, is it getting deposited in your blood vessels? Got it.
Right? Okay.
So let's— I have no idea. All right.
So let's move on. So you got— Okay. So we got—
we'll come back.
So you got the EKG.
So you get your EKG.
Yeah. You get your cholesterol level, your blood pressure.
And measure blood pressure. So historically, and it's still taught, right? So the standard of care is that we would then enter in your age, your sex, Now we use other calculators that include your kidney function. That's very important too, to heart health, actually. Your HDL, your triglycerides, your total cholesterol, your blood pressure, whether you have diabetes, whether you smoke, and a few other variables. We then come up with a risk number.
So this is the standard of care today?
Exactly.
Right, what everybody does.
And it's been the case for, well, as long as I've been around in medicine.
Fair enough, okay.
And so we'd come up with a number. So I'll make up a number.
What about a stress test?
Well, we're not even there yet.
Okay, not even there yet.
No, no, no. I mean, this is all the stuff that should be done.
Got it.
Okay.
Okay.
But we'll come up with a number. And let's say that number is 10%. Okay, so that what that means is you have with these numbers, or the way I like to say it is, in someone who looks like you, your age, your HDL, your, your total cholesterol, your blood pressure, smoking, diabetes, Age, sex, in someone who looks like you, 10% of those people who look like you, but aren't you, will go on to have a cardiovascular event in 10 years.
When you, when you say cardiovascular event, you mean?
So I mean, a stroke, a heart attack, balloon stents, bypass surgery, cardiovascular death.
Okay. Okay. So you said earlier, half of the people die without a symptom. So that's—
Exactly.
And how many people is that a year, roughly?
It's about 800,000 a year.
Wow. Yeah.
Have a heart attack and about half of will die.
Wow. Okay. Fair enough. Okay. So, but that's, that's, that's so impersonal. Like impersonal. Is that even a word? Impersonal.
So imagine, yeah.
It's not me. To me, it's just any, like 10%.
Well, exactly. So, and I always think about this when I tell somebody, if I do that, do this, although honestly, and we'll get into the why I don't really do that. Well, I might do it, but I do not take that to the bank.
Got it.
Okay. Because does that mean I got 10% plaque? Or 10% of my vessels are plaque? No, means nothing of that. It's just saying, in someone who looks like you, who's not you, based on a population, based on correlation, Someone like you with those numbers has a 10% chance over the next 10 years of a cardiovascular event. Now, here's what's amazing. Okay, now what you do not know is the guidelines say, if I do that calculation, and your risk is greater than 7.5% over the next 10 years, that would put you at a high enough risk where I and the standard of care would say that you need a statin. to lower your cholesterol. That's why we do this whole process.
So at that point, anything over 7.5%, that is the trigger. That's the trigger. That's the trigger that takes you to, I'm going to put you on medication.
Exactly.
We're going to take some interventional steps.
Precisely. Beyond diet, exercise, eat right, don't smoke, whatever.
Is that considered interventional or is that considered—
Yeah, it is. I mean, an intervention, you know, we think of interventional cardiology as my colleagues that puts in balloons and stents and The more dramatic stuff. But in reality, the interventional term just means I'm doing something. So my telling you to quit smoking is an intervention. My telling you to quit drinking is an intervention, right?
It's prevention. Yeah, it's prevention when you don't have any disease.
Right. Or that you aren't aware of or thinking.
Right.
Fair enough.
Right. But once you know—
So up to this point, just to, you know, as a mile marker here, we still don't know what your blood vessels look like.
Got it.
So you had an EKG, it's fine.
So it's all guesswork right now?
Oh yeah.
It's complete blind guesswork.
So I add some, I do my calculations, right? We call it the latest calculator that's endorsed by the American Heart Association is called the PREVENT calculator, just abbreviation for putting together these risk factors. And we're going to draw a very firm line between what is disease versus what is a risk factor. Okay? Risk factor says you might have a condition. I don't know, but you might have a condition.
Okay?
So those are risk factors.
So everything you've told me thus far, the EKG, the blood pressure—
I still have no idea whether—
If I have disease or not.
Whether you have disease. Okay.
So I could be false diagnosed?
Oh, absolutely. Either way, right?
Either way, right? False positive, false negative.
I put you on drugs you don't need because your vessels are perfectly normal, or else Even worst case is your numbers look okay. Let's say your risk is six percent. Well, I'd say eat right, exercise, don't start smoking. You're fine. And next week you kill over a heart attack. Happens all the time.
Wow! Because I never that's so sad.
I never that's sustainable care at the blood vessel.
Yeah, right? Yeah.
So imagine to to set this scenario straight. You go to a GI doc. Okay. And here's not discussion about plaque. The concern is colon cancer, right? Because everybody in your family has colon cancer.
GI doc, for those of us.
Gastroenterologist, a GI doc, right? The people who do those unpleasant colonoscopies and scoping.
Okay. I should know that. I've had one and it's awful. Yeah. I don't suggest anybody. I mean, no, everybody should get one. Yes. Right?
I completely agree.
But they're not pleasant. Right.
Or as I like to say, I'm the guy below the neck and above the diaphragm.
Yes.
Below the diaphragm people.
Got it.
Yes. I stay above it.
Yes.
Okay. So you go to GI doc and you're worried, and I'm making this up, this is not you, but everybody in your family has colon cancer. They got polyps, blah, blah, blah. It happens early. So you're worried about colon cancer, right? You have no symptoms. There's no blood in your stool. You have no symptoms. So your colon cancer or your colon doc, right? Your gastroenterologist, your GI doc says, okay, well, I've done this calculation. To find out what your risk of colon cancer is. So I do the calculation, put in family history and age and whatever.
All the risk factors.
All the risk factors, right? I still don't know whether you have polyps or colon cancer or whatever, but I put in the risk factors. And guess what? He calculates the number and the number comes out to show you're at high risk for colon cancer. Well, you didn't need to go to medical school or do several years of training afterwards that to figure out if everybody in your family, mom and dad, has polyps and colon cancer, that you're probably at high risk. Okay, but he does this for the record. Okay, so he calculates this number, says you're high risk. He then follows this, right? Because this is how it works in heart disease, in cardiology.
Okay, so they're correlating the two.
Right? So he says you're at high risk. So therefore the logic is, because you're at high risk for colon cancer, without ever having looked in your colon to see if you have the disease, polyps, cancers, whatever, he's going to say, because you're at high risk, I'm going to recommend 6 months of chemotherapy.
Wait, they're not doing that.
No.
No, but it's—
No, you should run.
Right, right. Yeah, right.
If you follow that logic.
That would be awful. Like, they should go to jail for doing it.
Exactly.
Yes.
And they should. I agree. Right.
But you're saying, you're saying in the cardiology space—
In the cardiology space—
They are doing that.
I still have no idea whether you have the disease. I know you might have risks. I've done my calculation. I've said your risk is now 10%. That says standard care is we should have a discussion whether you should take a drug, because that threshold is 7.5%. Okay. Here's the other thing, because I've thought of this discussion. If I were the patient, and I'm hearing the doc say, you got a 10% 10-year risk, okay, I go, so you mean I don't exercise, I eat highly processed foods, I eat junk all the time, I don't move, I smoke. Got a horrible lifestyle. So you're saying I continue on that path the next ten years, my likelihood of a heart attack, stroke, balloon stents, bypass surgery is only ten percent. So you're saying I can do all this crap that I really like doing that's really bad for my health that anyone would agree, but I only have a ten percent chance of a heart attack over the next ten years. Doc, thank you so much. It's been great. I'm out of here. I'm back to my couch.
I like those odds.
Yeah.
Those are good odds. Yeah. And I can keep doing what I'm doing. Exactly. Yes. 20 pounds overweight. I can't walk up the stairs.
That's probably terribly helpful.
Yeah. No, that's awful. That's awful.
I still don't know.
I don't know.
My goodness. Because your GI doc, where you come up high risk, right? You don't use a risk score for colonoscopy for polyps because everybody gets it.
Yeah.
We don't risk you.
No, they go in there every— they told me. The risk is A. I remember when I was my 30s, they said, 20 years from now, you're going to go get a colonoscopy.
Yeah. Well, we've now lowered that to 45. We'll probably be lowering it to 40.
How many people die of colon cancer a year?
About 2%.
I'm sorry, what?
2%.
2%.
2 out of 100.
How many? Okay. Percentage-wise, how many people die of heart attacks or strokes a year?
40.
40%.
40%. So you do your prep. Wow. Right. Which is probably the biggest complaint.
Yeah.
You take a day of your life, you get general anesthesia because you don't want to be awake when they're putting that needle in.
No, I know. I said, give me extra. I said, give me extra.
IVs, all that stuff, right? Prep is really, really unpleasant. You go through all that. It's thousands of dollars.
Yeah. And it's embarrassing when you wake up and look in the doctor's eyes and go, I know what you've been looking at.
Well, mine sends me chocolates and flowers.
You guys are dating now.
Exactly.
Fair enough. No, no, I remember. I remember.
Right?
The prep was terrible.
For a disease that 2% is still too high.
Yeah. And everybody should get a colonoscopy until they can do something other than that.
Yes.
Do it. But what we're saying is they were doing it for that. Yet 40%, and that's 2%, 40% of us.
And what do we do to detect the disease that kills 40% of us? We ask what your blood pressure is, whether you have a family history, what your Oh, by the way, until this latest predictor that only came out about a year ago, family history was not part of the—
Is that the Lp thing?
Oh, that's not even on that. Oh, no, no.
So calyricardia is way advanced.
Wait for our lipids talk. It's going to get deep and heavy. But anyway, but yeah, so I mean, I'm just asking, do you have high blood pressure? What your blood pressure is, your total cholesterol, your HDL, age, sex, whether you smoked, have diabetes. Kidney function now goes in there, didn't before. But also family history, which is very, very important.
Yeah.
Right? Yeah.
Was only added— Genetics.
Genetics was only added with this latest calculator that came out a year ago. Up until then, family history wasn't even asked about. No kidding. Wasn't even on the calculator.
Wow.
Which is crazy.
Yeah.
Right?
That is crazy.
Because a lot of your risk is genetic.
It is.
Right?
Yeah.
So, but yeah, so we do this colonoscopy thing, screening, and we should, we absolutely should. I don't want anyone to think that I'm in any way opposed to that. We should. But just appreciate what's the bang for the buck? It's something that kills about 2% of us.
Okay. So we understand what— so, okay. Those are all the risk factors, right? That's the standard of care today.
Remember, risk is not disease.
No, fair enough. No, fair enough. I'm with you 100% on that.
Yeah, exactly.
I think our viewers are as well. Okay. So we understand what causes our heart attacks. or stroke. It's basically, for 80% of the time, it's ischemia, and that's reduction of blood flow, and that's caused by plaque buildup, which blocks the arteries, right? And one way to figure that out, if you have— and that's heart disease, right? That's considered heart disease.
Yeah. I mean, heart disease is a really broad term, right? Because you got valve problems. That's a whole separate thing.
Okay. So arterial sclerosis, is that what it's called?
Atherosclerosis, right?
Atherosclerosis.
Most people talk about it in a, in a non-precise way about heart disease. They're talking about plaque.
Okay, okay. So plaque. So plaque is the, is the, is the only cause for, well, 80% of the time for heart attacks and strokes?
About 99%.
99% of the time heart attacks and strokes?
Well, heart attacks. Strokes are a little different. So strokes, 80% are ischemic.
Okay. Blockages, right?
Twenty percent are what we call hemorrhagic. You bleed into your brain.
Oh, like a like a like an embolism or something?
Well, an embolism would still be ischemic because it's going to block off the vessel. Oh, but high blood pressure, right? If I turned up your blood pressure high enough, blow a vessel, you blow a pipe, right? Back in engineering, right?
Yeah.
We talk about low flow and drips and all that.
I saw a six hundred pound steam pipe burst, right? It was.
The opposite of that is, right, from high blood pressure and other things too, is you blow the pipe, right? That would be what we call a hemorrhagic stroke. So heart attacks, about 99% are due to plaque. With strokes, a mere 80%, with the other 20% being what we call hemorrhagic, or you bleed or the pipe disperses. Got it.
So let's focus on the 80 to 90%. Which is huge.
The Pareto rule, right? 80/20.
Yeah, exactly. So is plaque.
Yeah.
Okay. So plaque. And now we're talking about how we detect plaque, because if you have plaque in your arteries, that means you have arteriosclerosis.
Yep.
Okay.
100%.
Full stop.
End of story.
Done.
That's it.
All right. And you've got to do something about it or it's going to get bad. Yeah.
Okay.
Heart attack or stroke. Okay. We don't want heart attacks and strokes. And I don't want any of our listeners to have a heart attack or stroke. So let's figure this out.
I'm going to say, I like to say, being a preventative guy with all the cool technology we have, I'm really not going to let that happen on my watch.
Fair enough, which is why you're my doctor. So, okay, we've heard about the EKG, the blood pressure. We've heard about this. We haven't gotten to the stress test yet, right?
Yeah.
How do we know now that we 100% have arteriosclerosis, plaque in our arteries?
So we do the calculation. Let's say it's high, high enough that the cardiologist says—
It's over 7.5.
Yeah, it's 7.5. The cardiologist said, we need to see if you have a blockage.
Okay.
So he orders a stress test. Now, let me just admit, there's a whole bunch of different kinds of stress tests and flavors of stress tests, but they are unified by the fact that all of these different kinds of stress tests look for reduction in blood flow down the vessel.
Okay, okay.
We could use MRIs, we can use nuclear cardiology, we can use echocardiograms, we can use treadmills, we can use bikes, we can use drugs, we can put any of these things together. So there's a lot of different flavors. Most typically, it'd be a treadmill. We do millions of what we call nuclear cardiology tests a year.
What is that?
So that is a test where generally, Again, this is in general. So, but in general, we put you on a treadmill. Well, before then, we take a set of pictures of the heart after giving you an injection of a radioactive dye. Okay.
Is that— is that an MRI or CT scan?
This is actually called a nuclear cardiology scan.
Okay.
Or myocardial perfusion scan, or typically, for the record, it's called a SPECT, S-P-E-C-T.
What machine do they use for that?
It's called a gamma counter. So it picks up the radiation from the radioactive tracer we inject in the heart. So we take 2 sets of pictures. We take one set of pictures at rest, okay? And it goes from your vein to your heart. And wherever there's blood flow in the heart, it'll show the blood flow, okay? And ideally, that should be normal, right? If it's abnormal, it means you could already have had a heart attack.
Okay.
And yes, you can have silent heart attacks.
Okay. Well, we'll cross that bridge when we get there.
Yeah, we'll burn that bridge when we get there.
Yeah.
But the blood flow to the heart should be normal, right? Makes sense. We then put you on a treadmill. EKGs, we talked about before, right? We're looking at those to see if there's any change in the EKGs that might indicate reduced blood flow, ischemia. But we don't really trust those because they're not very accurate. Okay. So we then at Peak exercise, so you're running, you're running, you're hot, you're sweaty, you can't go any further. At peak exercise, we're going to give you another injection of the isotope, goes to the heart, and shows what the blood flow is at peak exercise under max load.
Got it. So you're running on a treadmill and someone comes over, you've got an IV in your arm, and they just zip this radioactive material in there.
And then they're going to do another scan on the gamma counter. Exactly. Mr. Parker. And they'll put you in the gamma counter, which counts the X-rays coming to your heart. And if they see an area where there is now— there was flow before at rest. Now, if they see an area where there's less flow or maybe no flow, ah, that indicates there's probably a blockage.
Okay. A blockage.
A blockage. However, You could easily have a stress test with severe blockages and it'd be completely normal. That'll occur about 25% of the time, probably closer to 40%.
No kidding.
Oh yeah. So there are blockages there.
So all of that and you could do— it could be like, ah, maybe, maybe not.
You still miss it 25 to 40% of the time.
Got it. Okay. And so what do they do if they do find that there's a blockage?
Well, if— so remember, I don't know there's a blockage. I'm just saying your stress test looks Okay, got it.
Okay, okay.
Right?
Okay.
You get a mammogram.
Okay.
It's normal. You're probably low risk, or it looks abnormal. I don't say you have breast cancer. I'm just saying it looks abnormal. You need a biopsy.
Got it.
Right? We got to get tissue.
Got it.
Same kind of concept. So we do the stress test, it looks abnormal. I mean, and again, 25 to 40% of the time, the stress test will not pick up a blockage, even though there is a more than 70% blockage.
More than 70% blockage?
Yeah. Because here's the thing I did not tell you.
That's a lot. Wow.
Here's the thing I did not tell you. Our vessels are bigger than they need to be. We have massive reserves in our blood vessels, right? We're designed to have massive reserves. So it will take at least a 70% blockage of that blood vessel before blood flow goes down with exercise.
And it's the plaque that's causing the restriction on the blood vessel.
Exactly, right? Growing inward, restricting the blood vessel.
So how does that work? Do you have a— do we have a— I think we might have a visual.
I think we have a nice visual.
Yeah, could we take a—
So this is a time for a visual.
Yeah, this is a perfect time for that, to see how that works. Let's just scroll through. Keep going, keep going. Yeah, let's take a look at over here. Keep going, keep going.
And Right here.
Here we go. Okay. So what are we looking at right here?
So let me just orient you here. This is actually from a cardiac CT. So this is putting you in a CT machine. We'll get into all the details later if that's not a familiar term for you, but putting you in, I call it the magic donut. Donut of destiny.
So this is what Clear Cardio does?
This is what we do.
Okay. So this is the real deal stuff. This is the real deal. This is the good stuff. Okay.
Got it. And so we put you in the CAT scanner and we take these images of the heart. Okay.
So for purposes of this conversation, you would never see this in anything that we've just discussed. No, this is next generation. This is what Clear Cardio does. However, what we're trying to show is where the plaque builds up and how it creates the blockage that they may or may not see at all in today's methods.
Because again, stress tests, yeah, 25 to 40% of the time there is a severe blockage. Yeah, it appears normal.
Got it. Okay, so where does the plaque build up then?
Okay, so this is very, very important. So everybody in the audience, listen, this is critical.
Okay.
All right. This is the stuff that you thought you knew and you don't.
Okay.
Or maybe just didn't know it in the first place.
Okay.
I'd rather start with a clean slate.
Or didn't know you had to care about. Exactly. Because I didn't.
Right.
Yeah.
Okay, so this stuff here, color-coded in red and yellow and blue, is plaque.
Okay?
All of that is abnormal.
But what's that thing in the middle?
So the middle is actually We call it— no, technically, I'll use these terms, but we call that technically the lumen. Just means the channel. The channel the blood flows down.
So that's the blood vessel? Yeah.
This is the inside of the hose.
That's your artery?
That's the artery.
Okay. So what is gray there, that's the artery?
Yep.
And all that stuff on the— all that gunk on the outside, on the top and bottom, you're saying that's plaque?
That's plaque. All right.
So we were talking about what's all— does all that stuff on the outside of the artery there, That is plaque.
Okay.
Yeah.
So let me walk you through the colors.
Okay. There we go.
So all plaque will evolve in a very prescribed, reproducible way, right?
Okay.
So it's predictable. It all starts out, it's all predictable. So we'll start here. Okay. And you can see these colors.
Yes.
So the red is what we call low-density, non-calcified plaque.
Okay, so if you think low density, which means it's very, it's very, yeah, it's not dense. It's like the difference between brie cheese and like hard, like exactly.
So this is brie.
So this is the lava. Yeah, I like it. Like lava.
Yeah, this is lava. Yeah, only this is the lava coming right out of the volcano. This is as hot as it gets.
Got it.
Which is why it's really bad stuff.
Got it.
Okay. Yeah, this is How plaque always starts, right? Cholesterol get floating down the bloodstream.
Yeah.
In the setting of a variety of things: bad genes, you chose the wrong ancestors. I like to say crappy foods, crappy foods, all that processed, sedentary, and smoking, high blood pressure, cholesterol, diabetes, blah blah blah. Yeah, right. Will be floating down the blood vessel. And then depending on how much cholesterol you have, as it turns out, it's the bad cholesterol, the LDL. And we'll talk about, even get into more deep stuff about cholesterol later. But the bad cholesterol floats by. Now, if you have vessels like Velcro, like Teflon, it just keeps floating right by, doesn't stick. But if you have vessels that are Velcro from all those things we talked about, Well, that LDL, the bad cholesterol, will start to get attached to the vessel wall and then go into what I call the donut. So think of this as a donut.
So it goes out of the artery into the wall of the artery.
Into the wall of the vessel.
It seeps through like lava going outside. Okay. So it's not on the inside. It's in the wall of the artery.
It's all going to go out.
Okay.
Not in the donut, only in the donut hole. Not in the donut hole, rather, only in the donut. Okay?
Okay.
So the early place where plaque always forms is in the donut itself or in the wall of the vessel.
Okay. So if you think of the artery being like this—
A donut.
Yeah. And where there's a hole where all of the fluid, the blood flows through, but then in the donut is where all the chocolate chips and stuff are, right? Where the good stuff is. But in this case, it's not good stuff. It's the cookie dough. The cookie dough, yeah. But this is— okay.
It'll go into the vessel wall. And early on, just as it's shown here, these kind of look like pimples, right?
It looks awful.
Yeah, it does, right? But imagine we're on the inside. You just see it looks a little irregular.
That's not mine, is it? This isn't my—
No, yours are far worse. But if you imagine yourself inside the vessel, And you're looking at the walls, they go, yeah, it's a little lumpy, bumpy, a little irregular.
But they don't see plaque.
No.
Because all the plaque is out there.
Is in the donut. It's not in the donut hole.
They can't see that.
Can't see it.
And anything you just described, all the stress tests and all that stuff.
All the stuff we talked about.
It's just risk factors and indicators.
Tells us nothing about what we're showing you here.
Even the nuclear stress test.
Nothing.
Nothing.
Yeah. None of it shows this.
So nothing definitive. Right.
Okay. And by the way, we talked 25%, 30%, 40% false negative rate. There are severe blockage, okay? And your test looks normal. You get pat on the back. You have the heart of an 18-year-old, right?
Yeah.
25% to 40% of the time, the stress test looks funky, looks abnormal.
Yeah.
They then take you for a $20,000 invasive heart cath. You're excited. Your insurance company's excited, right? Because they're going to have to pay out $20,000 plus Whatever you pay for deductibles, copays, et cetera.
But eventually you go through that process. Well, yeah, they go, hey, I won the lotto again. Cha-ching.
And you go through the process, the $5,000 stress test, the $20,000 heart cath. All they can see is the inside here. And they go, I don't know, looks fine. Or else maybe a little lumpy bumpy. There's no blockage.
So they wouldn't even see that.
And they couldn't see it.
So all of that for nothing.
Yeah.
Or they don't do that, and you have a bunch of blockages.
Right.
So it just seems so, like you're rolling the dice.
And your threshold for an abnormal stress test, right? A true abnormal.
Yeah.
Starts at 70% blockage.
Wow.
Okay, see that little narrowing there?
Yeah.
That's maybe 30%.
Okay.
You don't have an abnormal stress test till it's 70%.
Wow.
Okay, up until that point, your stress will be normal all day long.
Can you have a heart attack or stroke when it's 30% blockage?
The vast majority of heart attacks are from the 30s, 40s, 50% blockages.
Wow.
That will never be picked up with stress tests.
Anything you just mentioned and any of the stress tests. That will never be picked up with stress tests. Or even in a heart cath with a camera, you'd never see it.
No.
Wow. So it sounds to me, your statement at the beginning, that it's all pretty much useless.
Yeah. Listen. Wow.
Yeah. Is useless.
So as I tell my patients, because they go, What? Right. Okay. This is what I love to tell them. And it's both meant to be funny, but true. So I tell them, just remember, whatever I tell you is the truth. Whatever anyone else tells you, except for your wife, is opinion. As long as you understand that, we'll get along famously.
Okay.
So let's keep going.
Yeah, let's keep going.
Okay. This underscores why our current approach is so bad.
Okay. So let's just recap. So all of this stuff we talked about, about state of the care today, doesn't tell you if you have arteriosclerosis, heart disease.
Right.
It doesn't. It's just, there's high-level risk factors and could be improperly diagnosed both on the negative and on the positive side. And it doesn't tell you if you have plaque, where you have plaque, or how much plaque you have. Or what your risk is of actually having a heart attack or stroke.
I can understand your risk in someone who kind of sort of looks like you.
Fair enough. So it's a broad spectrum.
But who's not you.
Yeah, fair enough.
Right?
Okay. So, and we're learning that plaque is—
That's where risk factors come into play.
Correct.
Risk is risk.
Right.
It's not disease.
Fair enough. And so there's nothing definitive out there that you're talking about right now.
Right.
Okay. And then plaque, we understand, builds up on the outside of the wall. Of the artery, in the artery wall, not on the inside of the artery.
Grows outwards.
And grows outwards. And then what happens? It eventually just keeps growing.
It's like an iceberg.
Does it keep growing and growing?
Well, there is a limit, right? You see this, how far that's grown out?
Yeah.
Once the vessel, the channel plus the wall, once it's basically about doubled in size, then it'll start to grow inward.
Got it. Okay. So by the time you actually start Really seeing what you can't see unless you're doing something like this, but start restricting the arterial wall, you've got a lot of plaque going on there.
You've got a lot of disease. Yeah. By the time you have symptoms, chest pain, angina, flunk a stress test, you're in trouble. You don't have a little bit of disease. Think of it as cancer.
You're disease-ridden.
Imagine my cancer detecting tool could only detect metastatic cancer.
Yeah, no.
And anything less than that, it wasn't helpful.
Yeah.
In fact, will make it worse.
Yeah.
Any other tool other than my metastatic cancer detecting tool?
Yeah.
Any other tool?
Yeah.
Had a 25 to 30% false positive rate saying you have a cancer. Yeah.
You don't. Yeah.
And a 25 to 30 to 40% false negative rate saying you don't have cancer and you actually do.
Yeah, no, I get it. Okay. So, so pretty frightening. So that's pretty frightening. So what do the colors mean?
Okay, so plaque will always develop in a very predictable way.
Okay.
So the red plaque is your—
The lava.
The lava. In fact, this I'm going to, I'm going to really call out as the red hot lava right out of the volcano.
And that's really— that's more dangerous than the other stuff?
Yeah.
Okay.
It'll then cool, but it's still lava. Right? It's still flowing, but it's not erupting and going 30,000 feet in the air, but it's flowing down the sides.
Got it.
That's the yellow.
Got it.
Okay? So this is low-density, non-calcified plaque. This is non-calcified plaque.
But medium density.
Cool lava, medium density, but not quite as bad as this red stuff. Okay?
Got it.
And note in the middle, this is the cross-section, by the way. So there's the cross-section cutting right through that. Which we can do with our technology.
We can cut right through the vessel.
With CleerCardio's technology, yes. With CleerCardio's technology. We can cut right through the vessel virtually. And this is what it would take— look like, right? So there's the channel. And you see all this dark stuff here?
Yeah.
That's the lava. That's the low density. We also call it lipid-rich or cholesterol-rich plaque. Okay. But with AI, we can further differentiate it into the lava, And the really, really bad hot lava. Okay.
Yeah. And what's the blue?
Okay. So eventually this will cool off.
Yeah.
Right. And then you evolve to this.
Okay. Okay. Which is still dangerous.
All of these plaques can coexist. You can have an eruption, hot, hot eruption right here. You can have a volcano that erupted recently.
It kind of looks like it still has lava, actually. Yeah.
And note, There's all the black stuff here, right?
The dangerous stuff.
And then over time, the lava will cool off and it'll develop the cinder cone or become an extinct volcano. That blue is calcium. And you can see here, the calcium is bright white.
Is that why they do a calcium score?
Exactly. So the value of a calcium score is it will pick up the early stuff, certainly versus looking at risk. Versus looking at disease, calcium score is is a good test. However, it will only tell me about this. Can't tell me about if there's any blockage, right? So you could have a calcified plaque with a bad blockage or a calcified plaque where all the plaque is in the wall like this, right? So you can see it all. All the stuff is out in the wall. It's not causing any blockage here. But all of this, no idea. So you can see late plaque, you can see extinct volcanoes, you can see cinder cones, you can't actually see the lava.
So, so a calcium score, along with like, just like doing a stress test, just like doing the blood pressure, just like doing, you know, you know, the EKGs and all of those things, it's just a risk factor. And the calcium score indicates that you had plaque at some point.
Exactly.
But it doesn't tell you—
Active plaque.
You had active plaque, which is the dangerous stuff, the lava, which is the low density and the medium density, yellow and red. But it doesn't tell you if you have existing red or dangerous plaque, low density or medium density. It just said at some point you did. So you could have a calcium score and have no active plaque.
Yeah.
And you could have a zero calcium score And have all active plaque.
It could be all this, which would be invisible on a calcium score. None of it's calcified and your calcium score would be zero. And you go, this is great.
So the calcium score, like the EKG, looks at one little thing as an indicator, but really doesn't tell you much.
So the analogy I think of it is like an iceberg, right? So you could have a lot of ice under the water. Maybe none of that's even Going up above the water, right? That's all the lipid-rich plaque, right? That's right.
Yeah.
The calcium could be just the little bit that's sticking above, right? Or maybe most of that iceberg is all just under the water and you see nothing.
I have a friend who I've done some business with in the past. He came back. I was talking to him 3 or 4 months ago and And he actually said I could say something on this here. I'm not going to say his name, but he had a 2 calcium score. It was a 2 or 3 calcium score.
Okay.
And he's like, oh, JD, I'm great. And my blood pressure looks pretty decent. My cholesterol level was high. He mentioned he had high cholesterol. And so someone decided to put him on a statin or something like that, but it wasn't very tolerable because they didn't really look at it, for whatever reason. But he kept coming back to me about this calcium score, and I said, "Okay," and you'll know who this is. I referred him to you, and he came into Clear Cardio, and he was a skeptic. And I said, "Listen," I even bet him. I said, "Listen, if you don't have any, like if you don't have any plaque, like active plaque in your arteries, I'll pay for the whole program for you. It'll cost you nothing." And he we like to bet on the golf course and things like that. So he said. JD, done deal. It was the only thing I could get him to get in. Like, 'cause he's so busy, right? To get him in there. Turns out, and you'll know who this is, he had significant plaque, like significant plaque in a couple areas on his arteries. And he was flabbergasted. And he, I think he went back to his—
Placergasted.
He was placergasted. But he went back and he talked to his doctors and he, now you're his doctor, right? Because all these indicators showed him, and he actually had a family history. It was his brother who had a cardiac event, and his father died of a heart attack. But he was like, oh, well, whatever. And now we've got him back on track. I know he's scheduled to come back in, I think, next year or something like that. But it goes to show you that you could have a very low calcium score and not have a lot of the other risks.
Or even zero.
Or even zero. You could have a zero calcium score and have heart disease and be at risk and be at high risk for a heart attack.
Right. So the reason that we call these LAVA is they're very active.
Okay.
What we didn't talk about is the final common pathway, and this occurs again with strokes or heart attacks. So you've got plaque, it's out here, it's in the wall, your channel's fine, you're not having symptoms. There's no ischemia. Your stress test was fine. Again, no symptoms to suggest a blockage because that doesn't start till 70% anyway. And in fact, you actually nailed it before. The final common pathway, what causes on that given day the catastrophic event that we call a heart attack or stroke that just comes out of the blue. I was fine yesterday.
That kills half the people.
I had a normal stress test last week, right? Is what we call plaque rupture. That is what causes, in the vast majority of people, the acute catastrophic event that we call heart attack or stroke.
Okay. So this is really important for our listeners, for sure. When we first started this—
We'll be right back.
After these commercials. No, we're just kidding. We're going to get to it right now. So when we started this particular discussion, it was what causes heart attack or stroke? What is a heart attack or stroke? And what are the dangers of a heart attack or stroke? Well, obviously death is part of the danger, but what actually causes a heart attack or stroke? And you're saying in most people, that kills you first symptom kind of thing.
Or you end up having a heart attack and suddenly you have to get a stent.
Or you have a stroke and you're paralyzed or whatever. It isn't it isn't necessarily the the the the the over twenty thirty years of growing and you're narrowing and narrowing narrowing and and into that kind of thing, which you know slowly happens like this, and then you catch it because you whatever reason, and they put a stent in and you move on, or they have a bypass or whatever.
Right.
It's it's it's the eighty percent or whatever it is, the ninety percent of the folks where. You may not know you have a 30% blockage at all.
You wouldn't.
You may have a zero calcium score.
Stress test is fine. EKG is great.
Right. And you have a zero calcium score or very low or whatever. And all of a sudden, this lava plaque, both yellow and red, it, what'd you say, bursts into the—
Well, we use the term rupture.
Ruptures. Okay.
However, if you want to think of it as it breaks down, flakes off, Pops like a pimple. I mean, all those analogies are perfectly fine. So what happens is this plaque out here, right? Again, growing outwards.
Yeah.
Hot lava here.
Yeah.
And again, this plaque has probably been there growing completely asymptomatic, fermenting, I like to think of it, right? For 20 to 30 years, right? So this has been detectable with our technology Literally for decades.
Today's technology now.
With our technology.
Yes. You couldn't do it 20 years ago because—
Well, we didn't exist then.
It didn't exist then.
Right.
But yeah.
But with our technology—
Going forward, that's—
We can now detect this plaque literally decades before you get in trouble, before you have symptoms, chest pain, heart stress test. And prevent it. And prevent it. We haven't even talked about prevention, but yeah. I mean, this is all preventable stuff. We can stop it, arrest it, reverse it.
Yeah.
So yeah.
We're going to do that in another podcast, by the way. Oh yeah, because it's— We'll talk about prevention. Yeah, yeah.
We'll get there.
Yeah.
So you've got this plaque, and generally the plaques that rupture aren't 80%, 90%, or even 100%. Those plaques can cause symptoms. They might make you flunk your stress test. They might cause you angina, as we call it, or angina, chest pain, things like that. But those plaques usually don't ever rupture. The plaques that do rupture Are your 20%, 30%, 40%, 50%.
The ones you don't even know are there. Again, that wouldn't cause symptoms.
EKG's normal, stress test normal. Those are the plaques that are going to rupture because they're full of lava.
And that's what's killing 50% of the people that have heart disease.
Exactly.
These people are just dropping dead.
I will find a cool video that actually shows this where you can see a plaque rupturing. It's really frightening, but instructive. As long as it's not your heart. But what happens is this plaque, again, been there for decades, growing slowly, growing outward, really a minimal narrowing, not enough to restrict blood flow, will suddenly rupture. And then what happens is the heart thinks that there's a hole in the blood vessel. It literally tears, rips open the vessel.
So that liquid plaque leaks into The artery.
Yep. And as it turns out, this stuff, I call it gruel, right? This gruel is what we call thrombogenic. That means very clot-forming. It really likes to— if your body sees this stuff, it's going to say, hey everybody, we got a hole in the vessel. We need to plug this hole.
So it sends a signal. So when this— so when that, which undetectable, unless you, unless you do something like what we do here at Clear Cardio, right? It's undetectable and you wouldn't have any symptom. You could have a zero calcium score. Everything could be great. And this little plaque that builds up could pop into your artery, burst into— you could be doing strenuous exercise, you could be sitting down, it doesn't matter.
Or maybe it's in the morning where your blood pressure is the highest it's going to be.
Okay. So blood pressure has an effect on it. Okay. Got it. Or age, because the vessel's walls are thinner.
Or you smoked that cigarette.
You smoked that cigarette or you had way too much whiskey last night.
Or whatever.
I'm not talking about myself, of course. But as long as it's under the supervision of a physician. Fair enough. We'll have to drink whiskey together then, right? Then it's okay. Okay, you heard that, guys. If you're gonna drink, drink with your physician.
Yeah, that's a whole nother—
drink with your cardiologist.
Yeah, we'll talk about alcohol in the future.
Yeah, fair enough. Yeah, we'll have all—
we'll keep you coming back.
Yeah, but so what happens is that, that lava leaks through in, like just pops.
Yeah.
And then your body goes, whoa, something's going on, right? You have no blockages anywhere, but that leaks in And it clots.
Yep.
And it's that clot that kills you?
So you go from that 30% narrowing, more than adequate to carry down the blood flow, no symptoms, blah, blah, blah. Within seconds to minutes, it recruits a clot, a thrombus, a clot, and now can either incompletely block off the vessel. So now you were at 30%, the next moment you're at 70 or 80. So now you start having chest pain or angina. Or if you're—
is that the silent heart attack kind of thing?
No, no. So angina is that feeling, that chest pain, heaviness, all that stuff that can be a heart attack. So it may not completely block off the vessel, but enough that you start having symptoms, or it can completely block off the vessel. Now there is no blood flow down that vessel. So that entire vessel, the rest of that vessel that now is blocked off by a blood clot that should be supplying oxygen, nutrients, et cetera, To the heart muscle.
Or to the brain.
Or to the brain. Heart attack, brain attack, same thing, is no longer doing that. And then you can have symptoms or not. And also too, in the people that die suddenly from this, that thrombus, that clot causes downstream from where the clot is electrical instability of the heart, which can then put you into lethal heart rhythms, Who are lethal to the point where the mortality rate from certain of these heart rhythm issues, arrhythmias, particularly stuff like ventricular fibrillation, which is pretty much 100% lethal if not corrected quickly, the mortality rate from V-fib is 10% per minute.
Wow.
So it's not detected and corrected within 10 minutes, you're dead.
Wow. So if you don't know what this plaque is, really nasty stuff. Yeah. So, so plaque is the cause of death. Yeah, it is a cause of heart disease.
So if you're lucky, you just block off that vessel, they get you to the— you start having symptoms, they get you to the hospital, they make the diagnosis, they rush you off to the cath lab, they spend $50,000-$60,000 to do all that stuff. You'll be in the hospital longer. So probably $100K by the time you're done. And all of that could have been prevented. The other half of the class will go into these lethal arrhythmias and just die. So again, if you're half— if you're the top half of the class, you survived it.
Or a bypass surgery, which is a half a million dollars, which is crazy. And just, I've seen guys who have the— they call it the zipper.
Nothing pleasant.
They call it the zipper.
Nothing pleasant.
I know my uncle had one of those. So that was pretty intense. So I just find this absolutely fascinating. Why isn't everybody talking about plaque? Why isn't everybody— why isn't that the discussion? And why is that equally as important, if not more important, than colonoscopies? Why aren't we addressing that situation right now?
A lot of times, as I explain this concept to my patients, is I'll call what we do, our CleerCardio process with cardiac CT and AI, is I'll call it, think of it analogous to a cardiac colonoscopy, right? Because I want to find your polyps long before you get cancer.
Yeah, exactly. So let's talk about that.
And I'll also point out though, along the same concept, that in my world of treating plaque, if we can detect it early, we have incredibly effective tools to stop it, reverse it, prevent it from rupturing, all those things.
Let's talk about that.
Unlike colonoscopy that kills 2% of us, this only kills 40% of us.
That sarcasm there, by the way, guys.
Yeah, that's my sarcasm. Sorry. I told JD I'd stop doing that. That was a joke. The applause, the joke light is not working.
40%. That's a lot of people. Yeah.
And so to hopefully detect the 2% of people that die of colon cancer, everybody should get a colonoscopy for all the issues we talked about. Expense, cost.
Well, ClearCard does do the colonoscopy of the cardiovascular system.
So this is the cardiac colonoscopy.
Yeah. So let's explain to our viewers what that is. Tell them, let's understand what's the difference between what we just talked about, which is the current standard of care. Well, was the standard of care for 30, 40, 50, whatever years, right? Your entire career up until— The last, say, 3, 4, 5 years, 6 years, whatever it is now that we've been working on this, and Clear Cardio now within the last year specifically, you're the chief medical officer there, the brains behind it all. Explain to our audience, what is it now that we are driving to be the standard of care? How does it change?
Yeah, so I think if you followed this at all, you'd say, well, let's detect those Polyps before you get the cancer.
The plaque in our case.
Yeah.
Right?
Polyps. Cancer being the heart attack, right? So we clearly illustrated blood testing, not going to tell you. It might give you an idea of risk, but risk is not disease. EKGs, pretty much useless. Stress tests, pretty useless. In fact, can miss stuff and overcall stuff. And even the gold standard heart catheterization that's been around for 70 years. So how many people use a rotary phone these days?
Nobody I know of.
Punch phone?
Nobody I know of.
Yeah. Well, we're still using rotary phones in the world of cardiology.
Interesting correlation.
Right? So we don't use 1950s technology on a routine basis. Right? I mean, no one would put up for it.
We being society. I get it. Yes. Yes.
Yet for the things that we've been talking about, stress tests, heart cath, EKGs, they're all mid-century, 20th century technology. So with tools that we use now, cardiac CT and the AI analysis that generates all of this analysis, And this is just, again, the tip of the iceberg. We can quantify this. We can measure exactly how much plaque. We can monitor it. We'll get into all that later. This is the standard of care.
All right. So—
My standard of care.
Our standard of care. Yeah. One of our viewers comes in and says, hey, Dr. Osborne, I want to come in and I want the new standard of care. I want the Clear Cardio standard of care. What are you going to tell him? What are you going to tell me? What is it that we do? I walk in, shake your hand. What happens next? What's the process?
So the critical leverage of our technology is something that's been around, admittedly. And I started doing this almost 25 years ago now. And it really— Oh, wow.
It's been a while.
Yeah. So it was cardiac CT.
But you were the only one doing it, right? Yeah.
I mean, I had to change—
You and 3 other people.
Yeah. So, yeah, I mean, Somebody's got to—
Start, right?
Start it, right? So I had the concept of what we could do. Technology evolved to the point where we had very crude machines to do what we call cardiac CT. So by the way, when I say cardiac CT, a CT scanner, computed tomography scanner, is what probably most of you may have heard, or many of you may have had one, maybe not necessarily for the heart, But it's just a big donut that we can put you in the middle of it. I want to differentiate that it is not an MRI. So MRI is more the coffin, right? I'm going to stick you in this thing and it's going to completely surround you and it's pretty claustrophobic. A CAT scanner—
I hate those because you get claustrophobic.
Exactly.
This far away from your face.
CAT scanner's quite open. It's a big donut, but it's open. You can see out the other side and all that stuff. But what the CAT scanner does is basically, particularly the latest versions of those, of which we have the incredible luxury and fortune to be able to use just cutting-edge cardiac CT that has evolved just like our iPhones from iPhone 1 20 years ago to iPhone 16 nowadays.
I think they have 17 out there now.
Yeah, yeah, it's coming.
Coming.
Yeah. Yep. So we do it with a CAT scanner. We put an IV in the arm. We give you—
So pretty non-invasive stuff.
Pretty non-invasive, right?
I've had IVs just because I had too much to drink the night before and I want to feel better and get the glutathione and all the vitamin B12.
Yeah, for a few extra bucks we'll do that.
Yeah, on vacation or something like that. Yeah, they come right to your hotel.
So we put an IV in the arm, in the vein. And then we walk you down to the CAT scanner. You get in the CAT scanner. We position you in the CAT scanner.
How much does it take?
I would say from the time you're on the table to done, maybe 10 minutes.
Oh boy.
Okay.
That's nothing. That's fast.
And we put some EKGs on your chest. And then we position you properly in the CAT scanner.
So this is exactly what I did.
Exactly.
Yeah.
So the scan that we do to actually get the data here literally takes 1 second.
Wow.
1 second.
Wow. That's awesome.
And then we get— well, we get—
And then you put— and there's an AI— Yeah.
And then there's an AI part of that.
Imaging assessment and all that stuff, which is amazing. But because the eye can only see so many colors, like, as I understand it, right?
So when we do— and we'll kind of get into the AI later.
That's—
it's really absolutely fascinating. And that's really absolutely cutting edge.
Right.
But when we obtain these images, we call this grayscale, right?
Yeah.
That's gray. That's black, right?
Right.
All the colors are put on with the AI.
Okay.
So that when we get this, it just looks grays and blacks and whites. When we do the scan, we do this high-resolution scan, we're literally going to get millions of pixels.
Yeah.
Voxels, actually, of data coming out of the machine that basically takes this high-resolution 3-dimensional image of everything basically kind of below the collarbones down to the diaphragm or the liver. Okay? Of course, the heart is in the middle of that. So we have millions of pixels. And when we look at grayscale, The stuff that we can see with our eyes, we can delineate or define about 50 to 100 shades of gray with our eyes.
50 Shades of Gray.
50 Shades of Gray.
Good movie.
Exactly. Yeah. Watch out for the red room.
Yes.
So however, in each of these millions of pixels that make up that scan.
Yeah.
And by the way, these scan, the size of these scans are in the gigabyte range. All that is obtained in 1 second. Got it. Okay.
Yeah.
In all those millions of pixels, if you break it down, or voxels actually, if you break the pixels down at the computer level, there's not 50 or 100 shades of gray per voxel or pixel.
It's a lot more than that.
There's over 2,000 shades of gray that are invisible to our eye. So by using AI, it will analyze across this entire area, All the— every single one of the millions of pixels and do it not across 50 or 100 shades of gray, but over 2,000 shades of gray. And then we'll output these images.
Okay, so why do we care about that?
Right. It'll output these images, which are great because we can see and visualize this. But as important, maybe if not even more important, it will literally measure exactly how much plaque there is, down to a cubic millimeter, and break it up into The red plaque.
That's right.
The yellow plaque.
I remember seeing my report last year. It's coming back. And I remember there was a total plaque burden. It was said, okay, so for the first time ever, of all the times that I've gone to see doctors and I went to the clinics and I had all of the bells and whistles and risks and I ran on the treadmill and all the things we discussed about earlier, It was the first time anybody sat in front of me, which you did, and you said, JD, you have heart disease. You have arteriosclerosis, and here's where it is. You showed me a— you called it a living autopsy.
Yeah.
Again— Which is just scary as hell, but you're alive.
The joke sign needs to go on, but I call it the virtual autopsy.
A virtual autopsy. Okay. Yeah. Virtual autopsy.
Emphasis on the virtual, as always. The virtual autopsy. But this one you get to walk away with, right?
I get to walk away with it. Yes, that's right.
With knowledge.
Yes. And you showed me my own heart.
It's like the Ghost of Christmas Future.
Yes.
If I stay on this pathway, it's not going to be good.
That's right.
So I'll show you what the future looks like, and then we'll talk about how to fix that.
But if you don't see it, it really woke me up, right? Because for years and years, and you can ask my wife this, I would come home from the clinic after spending 12 hours there and 10,000, and they would be like, you know, these— yeah, you got some risk here. Cholesterol's a little high, but yeah, you're pretty good. I don't think you're— you know, just don't drink as much whiskey and don't eat red meat. Like, okay. And I was like, I'm out there doing my thing and I just forget about it. Seeing it, like really knowing there's nothing— and I had anxiety. Like I got anxiety because I didn't know, like, am I going to die of a heart attack tomorrow? Because nothing they told me really made me feel warm and fuzzy. But when I sat in front of you, and this is not meant to be a commercial, guys, this is just the facts. This is how I felt personally. And I wasn't happy to know that I had plaque in, I think it was, I know you don't like to hear this, but the widowmaker area, which is where it was for me, guys. And luckily it wasn't a whole lot. It was manageable. I think you say it's all manageable, which is great. And I believe you now, a year later. No, really. But I saw it and I could show my wife it and it was no arguing with it. It was 100%.
Right.
And I looked at it and I went, okay, I know where it is. I know how much it is. I know what kind it is. And now I know, because then you said, but that's not enough. I know how to fix that. We can take it from the dangerous stuff, the liquid plaque, that lava, yellow and red stuff, and we can turn it blue. And it's the blue stuff that can't kill you.
Right.
Right? So let's get that going. And then you combined it with, hey, and you should probably make some lifestyle changes. You should lose some weight because these things contribute to the stickiness in your arteries. Age, genetics, blood pressure, all of those things. Let's get—
You need to start dressing better. And hey, Exactly. Yeah. Joke light.
Yeah. Yeah. Joke light. That's what I love about you. But because we could talk about serious things, and these are very serious things that affect—
It's as serious as heart attack.
Millions of people every day and their families, right? Who are impacted. Like whether it's a husband or a wife who has a heart attack or stroke, whether they survive or not, it's a major big deal. I mean, when they pass away, obviously that's a tragedy, Because that affects them for the rest of their lives in a very, very definitive, fast, quick way. Most people are not prepared for that.
Right.
And then if they do survive, then all of a sudden it's the expenses and the costs, and some people never really truly recover and all those things. So it's a very serious issue, but you're so good at injecting humor when it's an uncomfortable conversation, because you have to have those conversations. And for me, that was definitive. So this is extremely helpful in that process, and and I and I highly recommend. And again, this is not meant to be an infomercial by any means. This is meant to be an informative discussion with one of the premier preventive cardiologists on the planet, Dr. John Osborne. But I highly recommend you know you check us out, whether it's us or somebody else. I don't know how many other people are doing something like this. I'm only focused on what we are doing here, but not many, unfortunately. We're looking to change that, you and I, and the folks that— and our patients who are yelping from the rooftops about how important this is. So folks, feel free to reach out to us at Clear Cardio and Dr. Osborne to get answers, or if you have any more questions, please comment below here if you have any questions or other types of podcasts you'd like us to, to, to go through and, and, and to, to, to discuss about health and concerns, not only in cardiology, but in general, because we're going to be covering a lot of different, um, topics here specifically around healthcare, um, or the lack thereof, um, the issues with, um, you know, insurance coverages or lack thereof, Medicare, Medicaid, um, companies like, you know, You know, United Healthcare in the recent issue. We just did a recent podcast exposé, controversial podcast. I mentioned that in the beginning of this. But with that said, I think we've covered a lot of data here. Thank you so much, Dr. Osborne, for such an enlightened discussion. I know I've learned a lot over the last year and a half that you've been my My physician. I know, thank you for that. She's going to change it back to our Clear Cardio logo here. But any last things you'd like to tell our audience before we sign off here?
We kind of went into a deep dive about the disease, how we detect it historically, which wasn't very good, how we can detect it now. And we didn't even get into some of the— even there's a lot more we can talk about AI, and we will. The ability to quantify this plaque, know exactly where you stand. And with AI, the other fascinating thing is, which we really need to talk about this and we will, is I can scan you at one point, tell you exactly where you stand, how much plaque, where it's located, where the blockages are, how much plaque there is in the whole heart, in each vessel, in each segment, how much soft plaque is, hard plaque, right? Then we can treat you, do whatever we need to think would be appropriate for you. And this is where the personalization comes into play. Right? Everybody's going to be different how we attack the plaque and stop the plaque and reverse the plaque. Then we can, down the road, do another scan and see not only are the numbers better, my cholesterol's better, I'm feeling better, my exercise capacity is better, my blood pressure's better. Oh, that's great. But we can now see the first libido. Yeah.
I saw an improvement there.
Yeah. Well, and honest too, Remember, blood vessels go to lots of places, not just the heart.
Yeah.
Right?
That's right.
Yeah. So ED in guys is a vascular disease.
Yeah. Yeah. People don't realize that.
This'll be a whole nother podcast.
Yeah. That's a good point. We should do that. I think for me, Dr. Osborne, the anxiety of not knowing was really stressful and caused unnecessary anxiety because I really wasn't getting the answers. And it wasn't until I went through this process of knowing. And again, like I mentioned, I wasn't happy to hear that I had heart disease, arteriosclerosis. But what gave me the strength and made me relax a lot, like, oh, kind of like just slumped over. I remember just I actually cried a little bit when I came home to my wife and I was showing her. But I was so relieved to know one way or the other. But then you told me there's a way to reverse it. It wasn't hopeless. There's a cure and we can get it no matter how far along you are.
Mm-hmm.
Once you know where, how much, what kind, and it's personalized to you, it's not that broad stroke, For me, that was kind of like, and I'm getting a little emotional right now, that was the process from which I could start on. It wasn't hopeless. And so thank you for that, Dr. Osborne.
And that's why I do what I do.
Yeah.
Right? To make a difference.
That's right.
Hopefully to eliminate, I like to say, the number one killer of humans across the world. And the flip side of what you talk about, you found out, yeah, you got some. Nobody wants to, but We can, we have tools to stop it and reverse it. But also the flip side of that, people who are absolutely deathly afraid, they've seen it in their parents, mom, dad, brothers, sisters, right? Friends of theirs die on the golf course or whatever, thinking, is today my day? Right? It can be absolutely stultifying and frightening. And just stop you from living life normally. I've seen that. In fact, one of our first patients, Clear Cardio patients, was a woman, 58. And she said this repeatedly, that her dad, when she was 20, died in her arms—
I remember this.
Of a heart attack.
I remember this.
And she was crying, sobbing. Crying is not a strong enough word. She was sobbing. Relating this, and ever since then, in the back of her head was, "Will I be next?" When do I drop dead? So she did everything one would ask, right? Eat right, exercise, height weight proportionate, works out, never smoked, everything perfect. Everything that I would ask anyone to do to you know stay away from me, which is kind of my goal, right? Yeah.
Is you know stay away from you.
Yeah. I mean you don't we should have her on this podcast.
I remember her. She's amazing and. And her husband was a patient as well.
Yeah. That's a whole nother story, which we'll go into. But for our purposes, you found some stuff that we needed to work on that was actionable. And we did so. In her case, we scanned her and there was not a speck of plaque.
Yeah.
I remember that. Nothing at all.
Yeah. Although her father dropped dead in the hospital.
Exactly. So the degree of just relief that we could give to her. It's saying black and white, not a risk, not, yeah, your risk factors look controlled. You're probably okay. There's a percentage, 7.5%, 10%. Whatever. You're at low risk of dying.
Yeah.
How about no risk of dying from heart disease? How about zero? Right? So we could look it in the eye and say, there is no plaque. 100%. End of story. So whatever genetics dad had, you didn't get. And all of your good work on diet, exercise, lifestyle, It all paid off and you're going to be fine. And this is just not an issue that—
Peace of mind, right? Yeah.
So whichever we come up with, and I always love to say, no matter what we find, right? If you come to us, Clear Cardio, breathing and with a pulse, 100% of our patients have left the CAT scanner breathing and with a pulse. No matter what we find, if there's nothing, yahoo, we'll celebrate. It's awesome. I love it. And if it's not, if we do find something, it's okay too, because it's all treatable. And that's really the promise and the excitement of preventative cardiology.
Listen, it was an inspiration to me. It changed my life, which is why Clear Cardio. And I'll be talking about this in another podcast about why I did this, right? Work together with you to co-found Clear Cardio. But I'll tell you, and it's not that expensive, which is remarkable. One of our other podcasts was talking about the expense of healthcare and insurance companies and all that, and what kind of care do you really get? Because I know Clear Cardio is concierge, right? So it could seem like it might be expensive, but it's really not in the grand scheme of things. Especially for the peace of mind and knowing, and then knowing that you can treat that and not worry about having a heart attack or stroke, dying at least from it. So, well, thank you very much, Dr. Osborne.
Always a pleasure, JD.
Thank you.
We'll continue to explore and we've got a lot of ground to cover still.
Yes, we do. We do. And for those of you who stuck with us through this podcast, thank you for staying and hanging out with Dr. Osborne and myself, JD Enright, CEO of Clear Cardio. Feel free and please join us on future podcasts here at Clear Cardio Podcasts. And we'll see you shortly. Cheers. Bye, guys.
Till next time.
See ya. Thank you.
