023 - Heart Disease Kills 40% More Than All Cancers: How To See It Decades Early | ClearCardio
In this 45‑minute presentation Dr. John Osborne, Chief Medical Officer of Clear Cardio, argues that cardiovascular disease (CVD) is the leading cause of death in the United States—killing about 40 % more people each year than all cancers combined—and that the majority of these deaths are preventable. He explains why traditional diagnostic tools (stress tests, invasive coronary angiography, calcium scoring) have failed to identify the vulnerable patient because they only detect lumen narrowing after plaque has already caused a ≥70 % blockage. Osborne describes the biology of atherosclerosis: plaque grows outward in the arterial wall for decades, is largely asymptomatic, and most fatal events arise from soft, lipid‑rich (“lava”) plaques that often cause <50 % stenosis. He traces the evolution of imaging from invasive cath to 64‑slice and now 640‑slice cardiac CT, emphasizing that modern CT combined with AI acts as a “cardiac colonoscopy,” visualizing both calcified and non‑calcified plaque, quantifying volume to a tenth of a cubic millimeter, and enabling longitudinal tracking of disease progression or regression. He presents multiple real‑world cases (a 47‑year‑old nurse, a 40‑year‑old firefighter, a 55‑year‑old teacher, etc.) that illustrate how early detection, personalized lifestyle and medication regimens, and serial CT monitoring can shrink soft plaque and convert it to stable calcified plaque, thereby reducing the risk of heart attacks and strokes. Osborne also cites large randomized trials showing that adding revascularization (stents, bypass) to optimal medical therapy does not improve mortality, reinforcing that the true therapeutic lever is medical‑lifestyle management. Finally, he compares screening efficiency: about 30 people need cardiac CT‑AI screening to prevent one major adverse cardiac event, far more cost‑effective than mammography, colonoscopy, or low‑dose lung CT. He concludes with a call to adopt precision heart care to eliminate CVD in the 21st century.
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Many, many cancers are less lethal than cardiovascular disease. The wall of the vessel will literally grow outwards while the channel is completely normal. Only later does it begin to grow inward, and we will not have symptoms— chest pain, angina, flunk a stress test— till we already have a 70% blockage. This guy with this severe blockage is Bill Clinton. Really? Hi, everybody. This is Dr. John Osborne. I'm the Chief Medical Officer at Cleer Cardio, and I have some exciting stuff to share with you that really gives us a history of, really, cardiology, and really talks about where we've come from in cardiology diagnostically, how we historically have tried to identify people with heart disease, and we'll go back in the past, and then we're gonna bring it up to the current and the state of the art. As far as early detection of heart disease, and how ultimately why we want to detect heart disease and early detection of heart disease is so that ultimately we can stop cardiovascular events, strokes, heart attacks, balloons, stents, bypass surgery, and sudden cardiac death. So that's what we're going to talk about today. So let's jump into it. So this is what we're going to talk about. The scope of the problem. We'll talk about the vulnerable patient, what that means. Why we have failed in the past, the new approaches, how we can now deliver precision healthcare and heart care to you, and then we'll talk about some very fascinating cases that really illustrate the value of early detection, not just to detect disease early, but to make a difference. Because if we can't make a difference, why should we detect it early? But I'll show you how we can both detect disease early and importantly intervene upon it, not in a mechanical way, but in a medical way with diet, exercise, personalized medications to help us eliminate— help to eliminate the number one cause of death in the US, which has been the same cause of death, has been the leading cause of death for over 100 years in the US, We're really now close to being able to help to eliminate what causes about 45% of all the deaths in the United States. So with that, let's carry on. So here's the scope of the problem. It's a major issue. Of course, it's the leading cause of death in the United States. So just to put this in perspective, we actually, even during COVID We had 2 times more cardiovascular deaths even than COVID, even during the height of COVID It is silent. Over 120 million people of our approximately 350 million population have cardiovascular disease, with the vast majority of those having no symptoms whatsoever. It is tragic. The average age of a fatal heart attack is 50, literally decades' worth of earning power, time with friends, family, etc. All of the people are cut down really as they're only beginning to really hit their stride. That is the average age of our patients with sudden cardiac death. It is indiscriminate. It is an equal opportunity killer. In fact, women are 3 times more likely to die of a cardiovascular death, a stroke or heart attack, than die of breast cancer. In fact, in women diagnosed with breast cancer, more women diagnosed with breast cancer will die of a stroke or heart attack than the breast cancer itself. So startling numbers. It is rising. In fact, ever since 2011, uh, the rate of cardiovascular deaths, which have been falling since the 1960s— we did a great job of reducing them with better understanding of the disease, uh, better treatments for cholesterol, Quitting smoking, etc. It fell, fell, fell continuously every year from the '60s through 2011. 2011, with the advent of, frankly, diabetes, prediabetes, overweight, obesity, etc., amongst other things, lifestyle issues as well, that in 2011, every year there's been an increase in the risk of cardiovascular death. So we stomped it for decades, but it started coming back in 2011, unfortunately. And it is preventable. We estimate that over 90% of cardiovascular deaths are preventable, and that is the goal of Clear Cardio. Just to show you, this is the cardiovascular deaths from recent data. This is about nearly 800,000 cardiovascular deaths. Versus total deaths from cancer, so about 800,000 here, about 670,000 or 570,000 here. Cardiovascular death kills 40% more people than all cancers lumped together. Cardiovascular death is very, very treatable when detected early. Obviously, cancers can be quite different, but many, many cancers are less lethal than cardiovascular disease. Let's talk about the vulnerable patient. This is someone, no symptoms, I feel fine generally. Let's talk about this vulnerable patient and how we can identify them. And we'll talk about the history of how we tried to identify them in the past, and frankly, where we failed. So here, this is, if you've never seen one of these, this is a cardiac angiogram. This is an invasive cardiac angiogram, or cardiac catheterization as it's known. We used to do these, I used to do these regularly until 20 years ago, when the first of the 64-slice cardiac CT machines became available. Now, I call that the iPhone 1. Now we have the iPhone 16, I like to say. The state of the art is now 640-slice cardiac CT machines. That's what's evolved on the hardware side over the last 20 years. And of course, you can imagine on the software side, Dramatic improvements, just like the iPhone 1 to the iPhone 16, if you will. So this is the old-fashioned angiogram. Again, I stopped doing these 20 years ago because cardiac CT was better, more accurate, safer, cheaper, easier, and gave me data that I could not see from a heart catheterization, which we'll talk about. But this is an old-fashioned heart catheterization. Unfortunately, we still do a couple million of these every year in the US. This is a heart catheterization, again, putting a tube or catheter in the groin. Up into the heart. It's invasive, done in the hospital. Complications can ensue, such as bleeding, strokes, heart attacks, vascular injury, infection, etc. Costs about $20,000 to somebody, at least anyway. So this is a heart catheterization, and the fascinating thing is this is somebody with chest pain. You can see a vessel right there. There's a little bit of a narrowing right there that's causing Chest pain in this person. This is after symptoms and a positive stress test, but you can see how much the disease had progressed to cause a severe blockage. This is a 63-year-young guy. This is a 58-year-young guy. No symptoms, feels fine, normal stress test, no high-degree blockages. But with an angiogram, here's the key problem beyond the risk, the expense. Is we can only see the channel where the blood flows. We can't see the wall. The wall is the critical issue. That is always where plaque forms. That is where it starts. And early on, and literally for years to decades, the wall of the vessel will literally grow outwards while the channel is completely normal. So this guy has a severe blockage. This has been fermenting, if you will. Uh, for decades, finally got to a blockage. Uh, this guy also has heart disease, but you can't see it on an invasive heart catheterization, which again is why I stopped doing those 20 years ago. So which is sicker? Uh, as it turns out, this guy with this severe blockage is Bill Clinton. He, as you know, had bypass surgery. Because of these blockages. No symptoms, and after his bypass surgery, but he did have symptoms and had obviously severe blockages on his heart cath that literally transpired over decades of time. The next person is a guy named Tim Russert. Tim Russert, if you recall, 10-plus years ago, was a newsman for NBC. He ran Meet the Nation on Sundays. At the prime of his life, in his mid-50s, while at NBC Studios, had sudden fatal cardiac arrest. 6 weeks before his fatal cardiac arrest, he had a normal stress test. And his heart cath would have looked like this, that is not detecting any severe blockages, because it is not the severe blockages— That cause heart attacks. It's the plaque in the wall that suddenly ruptures, and you go from, I feel fine, normal stress test, to a clot that rapidly forms in seconds to minutes, which is the final common pathway to a heart attack, which half of the time will be— with the first symptom— will be a fatal event. Which is why tools like stress tests, EKGs, things that we've literally done for decades now, Are really completely inadequate, and we really have failed people using the wrong tools to detect plaque. So why have we failed? We're going to do a little history. So historically, we waited till you had symptoms. We call it angina or angina, but that already occurs when we have over a 70% blockage. So literally the decades That we marinated, if you will, that we fermented, if you will, in plaque. The plaque is slowly growing. It's a very slow glacial process. It always grows outwards into the doughnut itself, into the wall. Only later does it begin to grow inward, and we will not have symptoms— chest pain, angina, flunk a stress test— till we already have a 70% blockage. That is historically when we would pick it up. Stress tests, again, look for ischemia. That's a fancy word for saying reduced blood flow. Again, that does not occur until we already have at least a 70% blockage. Anything less than 70%, whether 10, 20, 30, 40, 50, up to 70%, will yield a normal stress test. Beyond that, and even scarier, when we do stress tests, they do not visualize the blood vessels of the heart. They only look for blood flow problems, which only occur at a 70-plus percent blockage. So you could have someone with multiple plaques, multiple narrowings, none worse than 70%, have a completely normal stress test. Plus, because stress tests don't look at the blood vessels, we have about a 25 to 40% false negative rate where there are severe blockages, And the stress test still looks fine, which is really, really scary. We also have a 25% to 40% false positive rate where the stress test looks funky, and in the old days, those poor people then go for the invasive $20,000 heart cath only to find out they're fine. But again, all I can see is the doughnut hole. I can't see what's happening in the actual doughnut, which is what really matters. Invasive angiograms, again, can find blockages. But they cannot see the doughnut itself. They can't see into the wall of the vessel and really are only useful for finding severe blockages. And again, cannot— the wall of the vessel, the doughnut as I call it, is completely invisible on an angiogram or heart cath, despite the cost and risk and the expense. So that's where we've gone over the last 50 years. In fact, by the way, When we look at mechanical approaches to treat heart disease, when I say mechanical, I put that into the into the the category of balloons, stents, and bypass surgery. All the things that you want to avoid. And again, we only do these on people who are alive. If your first symptom is a fatal heart attack or a fatal stroke, well, you don't get any mechanical fixes because you're dead. That'll be half of the cases. The top half of the class, as I like to say. They get— they have symptoms, they flunk a stress test, we do an angiogram, we find blockages, we then get stents or balloons or surgery. We really don't do balloons anymore, but stents and surgery— costly, expensive, risky. None of those mechanical approaches, and this is extremely important, none of those mechanical approaches makes you live longer or prevents a heart attack. None of them. These are 4 critical large studies that we've done over 30 years that shows the same exact result every time we add on top of what we call optimal medical therapy, which is diet, exercise, medications targeted to plaque, plus optimal medical therapy with what we call revascularization. That's the fancy term for balloon stent or bypass surgery. Every time we do these studies, and we've done them multiple times, and I'll tell you why we've done them multiple times, because we always end up with the same answer. We've done these multiple times, and every time we find out there is no difference in cardiovascular death or heart attacks in people who get balloon stents and bypass surgery with optimal medical therapy or just optimal medical therapy So the solution for heart disease is actually medical therapy, diet, exercise, lifestyle changes, etc. It's not stents, balloons, or bypass surgery. The value of stents, balloons, and bypass surgery is they're good to treat symptoms. I call that the knee replacement of heart disease. If you have a bad knee, you get a knee replacement. You're willing to put up with the cost, the rehabilitation, the pain to get to the other side of that so you can walk with less pain and disability. But no orthopod is ever going to say, if we don't fix that knee, you're going to die. But I can tell you, tens of thousands, hundreds of thousands of people in the US, they see a blockage, they say, if we don't fix that, you're going to die, you're going to have a heart attack. That is not the truth. When we look at the science, there is no data that mechanical approaches make you live longer or prevent heart attacks. It is the medical approach. Diet, exercise, lifestyle, precision medications that do deliver the goods with respect to treating plaque, stopping plaque, reversing plaque, and ultimately preventing the strokes and heart attacks that we see and manifest as the manifestations of plaque. Next slide. So, and I mentioned this earlier, but when we look at the plaques that rupture, the plaques that kill you, Or potentially kill you, or that you now show up needing a stent or balloon or bypass surgery. They are not severe blockages. Almost 70% of those plaques that rupture, that pop, flake off, break off, are causing less than 50% blockage, which will not cause symptoms, which will not be picked up with a stress test. About 20% are in the intermediate range between 50 to 70%, Doubtful they'd cause symptoms or cause you to flunk a stress test. Less than 15% of the plaques that rupture, that cause the heart attack out of the blue, the sudden catastrophic event that we call a heart attack, or again, this could be a vessel in the neck causing a stroke, less than 15% are blockages greater than 70%. And even those generally don't have symptoms. Many of them can be missed by stress testing because the heart, being smart, builds up other vessels that go around that blockage so that we don't have what we call ischemia, that is reduced blood flow in that vessel. So you could certainly have no symptoms, you could certainly have a normal stress test even with having blockages above 70%, but again, that is a very small minority. Of the plaques that actually rupture and cause heart attacks as well. So this just shows the slow glacial process of what occurs over decades in our blood vessels. So we all start out with normal, and by the way, plaque is a 100% completely acquired disease, right? No one starts with plaque. It is not congenital, you're not born with it. It is 100% acquired over the course of our life, depending upon, as I like to say, what ancestry you chose, right? I tell people many times they chose the wrong ancestors. But also genes, genetics, DNA, very important. But also, of course, diet, exercise, lifestyle, high blood pressure, diabetes, cholesterol, all those factors that can both be addressed either with— that can be addressed with medications or with diet, exercise, lifestyle. changes as well. So there's an incredible array of things that cause plaque, but I will say that plaque is something we understand very, very well, such that we have a variety of highly effective tools to both stop and reverse plaque. But this is how it develops over decades. Importantly, will not cause— will not have symptoms, chest pain, angina, till we're here. But the plaque has been slowly growing, no symptoms, no chest pain, no angina, normal stress tests, literally for decades up until we get to this point. And again, by the time we get to this point, the solutions may be mechanical to treat symptoms, but the mechanical solutions, the balloons, the bypass surgery, and the heart— and the balloons, stents, and bypass surgery, Do not change the trajectory of disease. They improve symptoms if you had bad angina, but they do not treat the disease. At Clear Cardio, we're all about early detection and treating the underlying disease, which is plaque itself, so that we can stop it and reverse it. That is ultimately how we will end up eliminating or dramatically reducing the risk of heart disease, which again, over the last several years, is actually going back up. As far as cardiovascular. With cardiac CT, we can see if you have completely normal vessels, which I love to see. I will say though, using the microscope of CT with AI, only 1% of us have completely normal vessels after looking at tens of thousands of people. In fact, when we put it into a framework of stages, Yeah. Zero meaning no plaque, that's only 1% of us. So 99% of us have plaque, which is startling. Of the 99% of us, a third of us will actually show up when we do their first scan, no symptoms, no chest pain, no angina, normal stress test last week, a third of us will actually have stage 3 severe atherosclerosis or plaque without any symptoms, any awareness. So that is why it's critical for early detection. But we can see if you're normal, and we can detect anywhere along this pathway with using cardiac CT with the microscope of quantitative AI. So historically, we looked for ischemia, that is chest pain, angina, flunk your stress test, caused by a blockage. caused by atherosclerosis. It's exactly the wrong paradigm. Instead, we need to look for atherosclerosis. This is the disease, this is the process that can, if it is undetected and if it progresses, lead to a blockage, that's stenosis, and then ultimately that can cause ischemia. Historically, we only diagnosed people here, we never diagnosed people here. Except on an autopsy, so you can see historically how we thought about detected looked for diagnosed heart disease was completely as I like to say bass-ackwards. So here's the new approach. So just as we do breast exams and mammograms to identify breast cancer. We do fecal occult blood testing. Now we have tools that use immunofluorescence like Cologuard to detect cancers. Of course, we do colonoscopies as well. And historically, we tried to use chest X-rays to identify lung cancer. As it turns out, that was not successful. They were not sensitive enough. Instead, we can use chest CT scans in smokers and former smokers to identify lung cancer and literally save lives. So in the world of oncology, we have a variety of strategies, motifs, that allow us to detect the disease early, long before symptoms. However, in the world of heart disease, we have looked at risk factors. Now remember, risk factors are important. That might give us an insight how we treat plaque, but risk factors do not mean you have plaque. I can't tell you how many people I've seen Whose cholesterol numbers look fine, not on cholesterol medicines or anything, nothing was done about that, who have extensive plaque. Conversely, I can show you people, and we see this all the time, whose cholesterol is high, whose bad cholesterol is high, and they have zero to minimal plaque. So risk factors are not the disease. Historically, we said we look for risk factors, assume you have disease and then start treating you, which many people are being overtreated with medications because they don't have the disease, as it turns out, even though they may have risk factors. And then conversely, there are a number of people who have extensive disease, but their numbers look fine, that we're not treating, and that is a very, very dangerous proposition. Signs, again, only occur with extensive severe disease that literally has been there decades, And again, the sequela, 75% of the plaques and the blockages that cause heart attacks are going to be missed with stress testing. So the motif, the idea that started a number of years ago— this actually goes back to the '80s, so we'll do a little bit of a history exam— was to look for calcium in the blood vessels. So lipid or cholesterol is what's first deposited, that is the active growing plaque, I call that the lava. That is the stuff that ruptures. With enough time or with treatment, we can convert the lipid plaque, the soft plaque, the lava, into calcified plaque. So back in the '80s, someone said, well, let's do a CAT scan. Let's see if we can find this calcified plaque that we knew was part of plaque, although it is only the stable plaque. That is the plaque that does not rupture. That is the plaque that really doesn't harm you. But at least with using a CAT scanner, we can detect some degree of plaque, although it's not the dangerous plaque. So we began back in the '80s to do calcium scoring, and you can see here's a normal scan. We're looking for the white stuff. Here's a little scan with a few patches of white in it. That's the calcium. That's the hard plaque. I call it the extinct volcano, the cinder cone. This is moderate. We can see much more of that calcium. And then this is severe, where you can see really a massive chunk of calcium in that blood vessel. The value of a calcium score, that the only normal score should be 0. Anything that's not 0 says you have plaque. However, here's the limitation. I'm only seeing the hard plaque, the secondary plaque. It's already been through the lava stage. Now it is the hard plaque, the calcified plaque. The extinct volcano, the cinder cone. I can't see the actual plaque that matters, the lipid-rich plaque, the soft plaque, the cholesterol-rich plaque, the lava. That is invisible on a calcium score. Plus, in the calcium score, I can't detect if there are blockages. Plus, if you look at this person with a 0 calcium score, no calcium whatsoever, because lipid soft plaque always comes first, 10 up to 30% of people With plaque that's all lipid-rich, that's invisible on a calcium score, 10% to 30% of people with a zero score will actually have detectable plaque when we do cardiac CT and AI as well. We then, back in 2005, and this is when I stopped doing heart catheterizations because we could do it better with cardiac CT, faster, cheaper, safer, simpler, easier, no risk of complications from a cardiac CT. This is the angiogram. This is what we could do with cardiac CT. This is before AI, but here I could get all of the detail from an angiogram. I could see the channel. I could see the doughnut hole. But more importantly, we could see the plaque in the wall of the vessel. And note, it does grow outwards. A little bit of calcification here, but all this black stuff here is all lipid, all soft plaque, plaque that is rupture-prone. This is vulnerable plaque. Growing in the wall of the vessel, and that person's angiogram shown here is completely normal. So when we got the first of the commercially available 64-slice machines— state-of-the-art is now 640-slice, which is what we use at Clear Cardio— but even the first of these 64-slice machines were so enlightening, so impressive with what they could show us and detect, that that is the year, 2005, when we got our first CT machine. Even without AI, that I knew it was so good that I didn't have to cath people and save $20,000 plus the risk of a complication and actually get better data, not less data, with a cardiac CT than a heart cath. Dramatically lower cost, radiation dose is much less. It is, by the way, cardiac CT now, as of 2021, is now endorsed as the first-line treatment First-line therapy, diagnostic rather, for evaluating people with chest pain. This is called a Class Ia indication. What that means is cardiac CT is now the standard of care to diagnose heart disease and blockages. That's been ever since 2021. Stress tests are not Class Ia. Unfortunately, we still do about 10 million stress tests a year in the US. We still do a couple million cardiac catheterizations. Which is probably about 10 million and 2 million too much in the presence of highly effective, highly sensitive cardiac CT, but now coupled with AI. Very quick. This is a 1-second scan. And again, highly effective to detect the early disease plaque, or as I call it, cardiac CT is the cardiac colonoscopy. Let's find the polyps, take care of the polyps. We don't get the colon cancer, correct? We understand with colonoscopy, No reason we can't duplicate that with cardiac CT and AI. So this is what we can now see. We can see really— I tell people, even with a heart cath, that's a telescope. This is a microscope. We can determine where the plaque is located. Are there narrowings? Plus, we can see what kinds of plaque. Is it calcified? Is it non-calcified? We can see all of those different vessels. By the way, we can also see We can see the bypass grafts, which is what is located here, as well as the native vessels with cardiac CT as well. So this is now the state of the art. This is an example of the data we get back from cardiac CT. We take the images, high-resolution, 3-dimensional images. We then upload that to the cloud. We then very quickly— the AI will analyze every single one of the millions of pixels. It will do that across not 50 shades of gray that I can see with my eyes, but across 2,000 shades of gray, give us very accurate understanding of exactly where the plaque is located, where it's located, what vessel, and adds on quantification. We can now exactly determine exactly how much plaque you have at any given time, which then means down the road, if we want to see, is the plaque better, and we could never do this before with cardiac— with— Without cardiac CT and AI, we can now tell people, you had X amount of plaque at time A, we did the right things for you, precision medicine, we treated the plaque, and we can now show the plaque is being reversed. That was impossible up until just a few years ago, and that is what cardiac CT with AI now allows us to do. This is what it looks like. You can see the donut hole, so no significant narrowing. We used to call this lumpy bumpy. Stuff on a heart cath. However, all of the action is occurring in the wall of the vessel, and then we can then delineate what kinds of plaque there are. This is very important. These are the rupture-prone plaque. This is the active plaque, the lipid-rich plaque, the soft plaque, the lava, as I call it. This is the hard plaque, the calcified plaque. All of this is occurring out in the wall of the vessel, and then in addition, we can now quantify exactly how much plaque we have. Down to a 10th of a cubic millimeter. And then from this, determine a highly personalized approach for you, depending upon your medical issues, to be able to stop and reverse that plaque and ultimately begin to lower the risk of cardiovascular events. The end— the beginning of the end of cardiovascular disease is here, and that's what we're doing at Clear Cardio. So delivering precision heart care. Now we can use this technology to evaluate and detect. Remember, 99% of us have detectable plaque when you use the microscope of cardiac CT and AI. It empowers us. It's amazing when people look at their vessels and I walk them through their heart. It's amazing how much they go from, I feel fine, I got no problems, had a normal stress test last week, to, Oh, now I get it. Okay, very similar. You go get your colonoscopy, they show you the polyps, right? Well, now I can show people the early baby plaque, and no better tool for me to convince them, to motivate them for change, to eat better, exercise, quit smoking, whatever we need to do. And again, this is the personalized approach that we focus on at Clear Cardio to stop and reverse this plaque. We can educate them better because we're actually showing them their blood vessels, not a theory, not a hypothesis, not a could be, maybe. There are no mights. There is only have and don't have at this point. We can then treat them. We can then track that as well because now we can quantify plaque, see how it evolves over time, and make sure that that particular precision pathway that we determined for you is not only giving us better numbers and blood pressure and cholesterol and weight, et cetera, But actually is stopping and reversing the plaque. That is something we cannot do without the Cleer Cardio approach. And ultimately, that will prevent our terrible epidemic of cardiovascular disease that has been the leading killer for over 100 years in the US and now is the leading killer globally as well. This is what it looks like. We get very accurate, highly detailed reports that we share with all of our patients. So that it is very transparent what is going on, where we're at, and then what we're going to do about it as well. And we do have, based on the stage, we do have a variety of strategies. The higher the stage you are, obviously the more aggressive we're going to be. All this is based on evidence-based approaches that stop and reverse plaque across stage 1 or stage 0, stage 1, stage 3, etc. This also dictates when we're going to look under the hood again. If you have stage 1, we'll look in 3 years. Stage 2, moderate, would be 2 years. And stage 3, which are a third of our patients that are coming in, I feel fine, no symptoms, normal stress test, a third of our patients are actually stage 3. We're going to look at them in 1 year to make sure that the tools, the precision tools that we determined that are right for them, are actually working not to treat a number, but to actually treat the disease, which is plaque. So all-in-one approach to heart attack prevention. Again, we do mammograms. If we do 1,000 mammograms over 15 years, the number needed to screen to detect a fatal breast cancer is 570 women to detect a potentially fatal breast cancer. With colonoscopies, To save a life from colon cancer, you have to do 1,250 people to save a life from colon cancer. Low-dose CT scanning for lung cancer screening, you have to screen 323 individuals with a prior history of smoking or current smokers to save a life from lung cancer. And we should do all of these. These are in our guidelines. This is standard of care. However, to prevent a major adverse cardiac event, a fatal heart attack or stroke, or a non-fatal heart attack or non-fatal stroke, we screen 30 individuals, put them on a precision-guided pathway based on the CT and AI, 30 individuals to prevent one major adverse cardiac event, a fatal cardiovascular event, or a non-fatal heart attack or non-fatal stroke. It's amazing to me to think that this is not standard care for the leading cause of death in the US, but here are the numbers. And I think it's very, very clear what we should be doing. So I'll share with you just a few other individual cases. I think this is really showing you the application of real people, of what this looks like. So we get all of this data. And the other thing that we can now do, and that's what this shows, is We can look at your scans in the past and literally compare them whole heart, per vessel, per segment. How is the plaque doing? How is the hard plaque doing? How is the soft plaque doing? Are we literally making a difference on plaque with your personalized preventative plan? I'll show you a few examples of this. So this is actually heart attack prevention in practice. This is what we do every single day. At Clear Cardio. This is a 47-year-young female nurse, mildly elevated cholesterol, normal blood pressure, mild obesity, no diabetes, no smoking. She has extensive plaque. Most of it— her total plaque volume, which puts her at stage 2, is 440.5 cubic millimeters. The only normal score is 0. Most all that plaque, the vast majority— Is in the left main artery. Is all lipid-rich, soft, active, rupture-prone, deadly plaque. Very small amount is calcified, probably not even enough to yield an abnormal calcium score. But what we showed is looking over time, 24 months later, with the right personalized approach for her, we were able to shrink her non-calcified plaque by 33% to 52%. And increase the calcified plaque, the inactive plaque, the extinct volcanoes, the cinder cones by 500%. This is illustrating that we've stopped the active growing plaque, the lava. We've converted to the inactive hard plaque. This is the stuff we detect on calcium scores. This stuff is completely invisible. But this is what we do every day at Clear Cardio: early detection. Coming up with a personalized plan for you, and then showing not just are the numbers better, but is the plaque better as well. This is how we're going to eliminate heart disease as we know it. Another case, 40-year-old male firefighter. By the way, firefighters actually have much higher rates of cardiovascular events than the average population. So no heart disease risk factors at all. He's 40, no heart disease risk factors. We did his scan. You can see all this lumpy, bumpy stuff. Lots of yellow, which is the lava, even some red stuff, which is the red-hot lava. Very, very rupture-prone active plaque. His total plaque volume was 1,268. That puts him well into stage 3 plaque in a 40-year-old firefighter with no traditional risk factors. This is the kind of patients that we are going to save with our CleerCardio approach. Next slide. So, here's an example of a 55-year-old female schoolteacher, 5 years into menopause, no symptoms, no chest pain, normal stress test. This is her baseline. You can see a little tiny bit of plaque here. Remember, 99% of us will have detectable plaque when we use the microscope of the Cleer Cardio approach. Now, in this case, because nothing was done, they repeated the scan 5 years down the road. There was no plan. There's no plan to treat this baby plaque, as I call it, or the polyps. There was no plan. So we call this in medicine where we don't do anything, that is the natural history. So we followed the natural history of plaque with no intervention, no personalized plan to stop it and reverse it. 5 years later, her plaque volume went from 64 to 195. Furthermore, the dangerous plaque The lipid-rich plaque, the plaque that kills you, the plaque that ruptures, increased by 3,800% over the next 5 years. So this is the promise, the early detection, then deriving a personalized approach just for you so that we can prevent this progression of the disease. Another guy, 53-year-old male accountant, had a normal stress test. So this is a nuclear stress test. You wouldn't know what this means. But basically, this shows normal blood flow to the heart. So this would be a normal stress test. When we actually did his cardiac CT, fortunately, we showed extensive plaque, lots of calcified plaque, the blue stuff, lots of lipid-rich plaque, the yellow stuff. So lots of LAVA as well. His total plaque volume was 944. This put him well into stage 3 severe atherosclerosis. With a completely normal stress test. And this kind of thing we see all the time at Cleer Cardio as well. Stress testing has had its day. It should be retired. It's no longer adequate. Cardiac CT with AI, the Cleer Cardio approach, is the dominant approach for the early detection and accurate detection of cardiovascular disease. And then lastly, 56-year-old male football coach, Mildly elevated cholesterol, initially treated with statins. Here we can see what happened though is his LDL was 143. We got it down to 82. But here's the problem. His total plaque, non-calcified plaque, the active plaque, the lava plaque, even being on a statin, even with an LDL of 82, over the next 24 months, 2 years, Actually increased despite having what looks like— clearly was a lower LDL, but for him it was not low enough. This is why a personalized approach, actually tracking the disease, not the numbers, is what's called for if we have hope of eradicating cardiovascular disease. So 2 years later, his plaque was progressing despite being on a statin, despite having an LDL of 82. It was 143. We definitely reduced the fertilizer, but we did not turn off the fertilizer. We turned off— we reduced the flow in the faucet, but the faucet was still on. Then when we got more aggressive, another 2 years down the road, now his LDL is 53. Here we actually got him back to where he was 4 years prior. His plaque now was reversing as we'd expected, but it required And required the tracking of plaque to know that that initial LDL was a good start, but was not adequate to actually stop the plaque. This is the state of the art of cardiac imaging with cardiac CT and AI. This is the promise. Frankly, beyond the promise, this is the future of cardiovascular diagnosis, of treating plaque, of early detection. This is how we will work to eliminate heart disease together as well. That is the Cleer Cardio message. Again, this is Dr. John Osborne, the Chief Medical Officer of Cleer Cardio. I hope this was a meaningful illustration of the state of the art, where we were, where we have failed, but where we are now as far as the state of the art of atherosclerosis and plaque detection. I encourage all of you— 99% of us have plaque. All of you, if you're above 40, please look under the hood. We can either reassure you and say you're fine, which is fantastic, or we can say we need some work. But that is the way that we will help to eliminate cardiovascular disease in the 21st century. So I want all of you to be part of that elimination of cardiovascular disease with us at Clear Cardio.
