027 - AEDs Versus Cardiac CT | ClearCardio and GoRescue

Most of these sudden cardiac events, not all of them, but most of them, are due to people who are unaware of the fact they have heart disease. They've got blockages and plaque. We're doing a really, really terrible job of diagnosing that presence of plaque early.

That's the reason Claire and I are here today, is because I've watched so many people go down with sudden cardiac arrest or having bypass surgery, stents.

In some people, all the numbers will look great, but the plaque is still growing. Well, hello everybody. We have the incredible opportunity to talk to a couple of our latest patients, Floyd and Claire. We'll talk about how they came to us, and particularly also too, Floyd has been involved in the world of cardiology for over 50 years.

Since 1977.

Since, okay, well, nearly 50 years. And he has a really very, very interesting story about His— the role that he's played in cardiology as well, literally a life-saving role. So we're gonna hear all about that. We'll talk about how they found us, and we'll talk about their concerns, you know, why they came all the way from Alabama to get their scan here at Clear Cardio in Carrollton, Texas. So with no further ado, Floyd and Claire, welcome to our podcast.

Thank you.

Floyd, I do want to hear how your story— I've just been dying all day to hear your story in the world of cardiology and what you've done.

Well, my world started back in 1977 when I started to work for a company called Physio-Control. They're out of Seattle, Washington, and they were starting to try to get defibrillation started in the United States, basically. It was pretty limited. Actually, I think—

And if you could, just, you know, some people know about defibrillation and all that. Just define that so that if someone's not coming at it from a medical aspect.

Well, what happens and when you need a defibrillator is when somebody goes into sudden cardiac arrest. That's the electrical side of the heart. And so what that means is you're clinically dead at that point. And so the heart has 4 chambers. One, the upper chambers are the atrial, and if they get out of electrical kilter, it's not exactly life-threatening at the time. But the lower chambers of the heart is ventricular, and that's what's actually pumping the blood to the body. And so the electrical system gets knocked out of—

Kilter.

out of sync for some reason, a variety of reasons, and the heart basically turns into a bowl of jelly. And so it's not pumping, and it's not sending any blood anywhere. And so just like lightning strikes, you fall over, and you're actually clinically dead. So at that point—

So you have zero blood pressure.

You are— you're gone. The only thing that's going to save you is to be lucky enough that you're witnessed, that somebody knows that you're down. Somebody starts an early CPR, and the CPR part of it is going to help you cut down on neurological damage, and it's going to keep some blood flow going to your different organs until you can get the heart restarted. So when the Defibrillator gets there, whether it's external or the smart AED, when it gets there, what its job is, is it's supposed— it will send an electrical shock across the heart. And basically, you can think of it like your computer. It's just rebooting the heart of the computer.

Mm-hmm.

So it hits the heart, starts back, and so then you're hoping that the heart's going to come back into a normal rhythm. sinus rhythm or normal rhythm. And so time is probably the most single determining factor of whether you survive that cardiac arrest or not. And so with each minute you're going down, your chances of survival are a whole lot less.

Hello everybody and welcome. This is Dr. John Osborne, the Chief Medical Officer of Clear Cardio, and I have something really exciting I want to share with you. We now have a newsletter. So this newsletter is all of the great science that I look at every day and read and scour the medical literature for. Important studies, important outcome studies, new tools, new drugs, new data on nutrition, all of the different things that I commit my life and have committed my life to and am passionate about. in helping me to further preventative cardiology, from new diagnostic tools to new blood tests to new medications to the latest on intermittent fasting and dietary approaches to help people live longer and better. So it will all be in our newsletter. It is great reading. The price is right too, 'cause it's free. So please subscribe to our newsletter. Go to clearcardio.com. Or you can click down below and get access to our newsletter, whether you're one of our patients or not, it's all good. But I love reading, I am a voracious reader, I love medicine, and I love finding all the little charms, little treasures out there that make me a better doc, that better inform me, and ultimately help people along the way. So please, please support my habit of finding new things. finding the greatest, newest, most important literature, and I'm delighted to share that with you. So please click below, subscribe, we'll get you on the newsletter list, and I think you'll really find it fascinating. So again, click below, join our newsletter, and we'll be really excited to help educate, or as, 'cause we're in Texas, I like to say edumacate you on preventative cardiology and what the latest and greatest tools, tricks, and treasures are. So thank you again. This is Dr. John Osborne, the Chief Medical Officer of Clear Cardio, and click below and get on that newsletter. I think I was taught that once you go into those lethal heart rhythms, ventricular fibrillation, the survival rate is you lose 10% per minute.

That's correct.

So 10% per minute?

That's correct. That's correct. So you want to have the defibrillator, you want to be able to have it accessed so that you can be there, hopefully within 3 minutes is the best, and 5 to 6 is, you know, getting out there. You do hear stories where people with good CPR are down longer, but— You don't want to bet on that.

Yeah, yeah, those are bad Vegas odds, right? I also remember, you know, in cardiology, we used to call the defibrillators— we called it Edison medicine.

Really?

Edison medicine. Right, right. So I think probably most of us probably had, uh, have a little bit of, of an idea at least what this is and, uh, the AEDs because of the, uh, the Buffalo's player. Was it, uh, Yes. Darren Hamlin?

Hamlin, yes, correct.

Who, you know, had a cardiac arrest, went into ventricular fibrillation. Obviously lots of medical personnel there. They had a defibrillator. They rapidly made the diagnosis and then used an AED there to shock him out of it. And of course, you know, because they had all the equipment, all the people right there, all the training, most importantly the Edison Medicine, the device there, literally, you know, he had a complete recovery and he's back playing That's correct. Football, which is exciting.

There were 2 lightning rods that I think of in all of my history of the AEDs, and one was— I was a part of, in that Lord Piers Wedgwood was in Birmingham, Alabama, and this was around 2000. He was in Birmingham working with Bromberg Jewelers because we had all the Wedgwood china and he was signing china. And so he went out with my friend Frank Bromberg and was playing golf, and he went down with a cardiac event.

Oh, wow.

And so he was saved. He went to UAB Hospital in Birmingham, and from there he recovered. And so he wanted to do something for the cardiovascular and really for the for the people, the surgeons, and everybody there at UAB for saving his life and his mind. And so I happened to get involved with that, luckily, and because Frank— I ran into Frank and he said, who at UA— who would be the person at UAB that would know the cardiologists and all of that, that we can form some kind of foundation or charity? Mm-hmm.

And I said, well, That'd be me.

Wow.

And so, 'cause I was, you know, I'd been working with them selling defibrillators, you know, everywhere. And so from there, they decided rather than just sending some cardiologists to New Orleans to a convention, this is where I brought the AEDs in, and this is when they were just getting started. The SMART. And so this— I was really just starting my business. The name of my business was Stop Heart Attack, which they really should be using now.

I like it.

They need to retire from—

it's more appropriate now. And so they decided that this was great technology and that it was to be something that we could measure. And that we would raise money, we'd put so many defibrillators out, and if we, as Lord Wedgwood says, if we can save one life, it'll all be worth it. Well, I don't know what the statistical odds of this happening is, but—

Well, you decided to put them in schools. That was the— that's where, you know, we started with the high schools, because they didn't have defibrillators at that time.

At that time, and so— We had a fundraiser. We raised $100,000. So this was in 2000. And so AEDs back at that time cost around $3,000 each. So we put out 33 AEDs in different schools. So the first one that we put out was not a successful story. The people didn't get the AED there to save the young man.

They didn't grab the— yeah.

But the second one, I don't guess I should call names or not, but anyway, she went down with sudden cardiac arrest playing basketball. And so the AED was there, saved her. And then her twin sister ran track, so she was tested and found that she had long QT. So we felt like we saved her.

That's a twofer.

Yep.

Okay.

So now we put out 33 AEDs.

This is the first 6 months.

And then in the—

Wow.

Just another month.

Wow.

We had another young lady that was sitting in math class, and she went down with cardiac arrest.

Wow.

They saved her with the AED.

Wow.

And now she lives actually here in Dallas, Texas. And she's got 3 kids.

Wow.

Wow. And so that was an exciting time. And one other, we had another save at Mortimer Jordan High School. So I don't know what the odds are of us putting out 33 AEDs, and in about 4 months, we saved 3 kids around 17 years of age.

Wow. Wow.

That was a lightning rod all across the country, 'cause that got everybody's attention that these things are needed. And that was where our charity was started to raise the awareness of AEDs and to save lives where we could. Wow.

Wow.

That was a lightning— one of the lightning rods that sticks out in my mind that was significant across the country. And then of course, millions of people watching that football game and seeing it actually go down, I think that You can talk about it till you're blue in the face, but when people actually witnessed it, it was another major second boost out here to placing AEDs, and everybody all of a sudden going to check their AEDs, because probably 1 in 5, the batteries are dead, or—

Or they can't find where they put the defibrillator. It could be on a—

Right. Yeah.

It got in the back storage room or—

Right, and so the AEDs have really, I don't know how many lives have been saved, but our company now, Go Rescue, which is part of a worldwide company, Safe Life, just this year, first 6 months, we've had 16 saves there, just around in the Birmingham area. That's what we know about.

That's just the area.

We don't even know how many that we don't know.

And that's the ones you've heard about. I mean, sometimes, yeah.

Wow.

That's right. We now have a wall of saves so we keep up with them all.

Wow.

Right. So those were the 2 big lightning rods that stand out to me over the time that made a huge difference.

I wanna hear, 'cause I think I'm— my joke is I always like to say when people ask what I do, I'm a general contractor. I do plumbing and electrical, haha. But, and, and today your experience is really much more on the plumbing side of things.

Um, right.

But being a preventative cardiologist, you know, it was pretty lonely for a lot of years, uh, and because I've been doing this for about 25 years, um, and, uh, I want to hear your experience because I know being, uh, a preventative cardiologist, uh, on the plumbing side was again pretty lonely when, when you start out and People are going to like, they don't get it, they don't understand it. But obviously you did it and you grasped it almost 50 years ago. I want to hear about the beginning and how that evolved. You said you worked for Physio-Control.

Right, right. And when I first started, of course, when I first started, I didn't even know what a defibrillator was. I just had to have a job and I was going to do something until I could find out what I really wanted to do. And here I am 30 years later still doing it.

It became his love.

I guess it was my calling, but when I first started, we were just trying to get defibrillators out on the wings of the hospitals. Basically, they were in maybe the emergency room and in the OR and intensive care. After that, if you were out there on the wing, your chances were not really good by the time they—

So in the wards and like the general wards and all that, they didn't even have defibrillators?

No, didn't have— out on the wings. So your response time was pretty slow, and then they really wasn't organized to have a code team, so to speak, code blue team. That was inside the hospital, but the most difficult area was the emergency medical side where that you had— we were trying to get defibrillators out there.

So they didn't have defibrillators in the ER?

No, in the emergency medical out here, in the ambulances.

Oh, oh, oh, right, right, okay. Your ambulances and—

So that was the most difficult because of just pure that you didn't have trained personnel out there to be able to read your EKG to decide which arrhythmia was shockable and what wasn't. So you can imagine the problem we had getting those trained, and then number 2, Until they could, they had to have a physician in the emergency room to give them the word to do it.

Right.

So you were having to put up cell towers, and you're talking on walkie-talkies, and I mean, it was just a mess to see how far that, you know, that comes— came, you know, over the years. And so then in the late '90s is when the smart AEDs that you see everywhere on the wall, where that they were able to put the algorithm in there to look for the one lethal rhythm, ventricular fibrillation. And so that opened up the whole world for defibrillation. And so I saw that coming, and I retired from Physio-Control and started my own company—

Oh, wow.

Where I represented all the manufacturers and put them out. Now, it was a pretty lonely world out there, because I started maybe a year too early, because when I would go into a business or to a school and say, we want you— I want you to, you know, respond to cardiac arrest and defibrillate somebody, and they'd go like, call security, we've got a guy in here that's, you know, on drugs. He's out of his mind if he thinks we're responding to a cardiac arrest. Defibrillating. I mean, this was completely foreign territory to them, you know. So the saves with the Lord Wedgwood Charity really got me off the ground, to be completely honest, because all of a sudden then everybody's like, wow, these things do work and we need them.

So in his particular case, was it a first responder that brought it, or did they have an AED there at the golf course?

No, they didn't.

They didn't have an AED at that time. They just called the fire department.

And he was lucky enough that they showed up.

He was lucky enough he got there.

Real fast and brought it.

A gentleman by the name of Joe Buffington was playing with him, and he started immediate CPR. Oh, wow.

That chain of survival, right?

Wow, wow. So, but he had the event, and I don't— I'm not sure whether they defibrillated him there or not, but he came back conscious. But they found out that he had cardiac disease in a big way.

Right, yeah.

And so it led to bypass.

Right, right, right.

And so the rest is kind of history from there.

Well, it is fascinating for me on the plumbing side because there is this relationship between plumbing and electrical. I always like to say they're kind of different, but that relationship— most of these sudden cardiac events, not all of them, but most of them, are due to people who are unaware of the fact they have heart disease. They've got blockages and plaque, and in about half of the people The first symptom of heart disease is you die from it.

That's right.

Right?

That's right.

So we create lots of widows and widowers.

Number one killer in the world.

Absolutely, right? 20 million people globally every year, year in, year out. Which is why, as a preventative cardiologist, someone, you know, I do both, take care of both things, but on the plumbing side, you know, there's a terrible We're doing a really, really terrible job of diagnosing that presence of plaque early because we have incredibly effective and proven tools, multitudes of incredibly effective and proven tools that work, that stop plaque, that can reverse plaque. Yes, you can stop and reverse plaque. Unfortunately, we just wait till the machine breaks.

Mm-hmm.

And sometimes that machine will never work again.

Yeah.

It's pretty terrible.

That's the reason Claire and I are here today is because I've watched so many people go down with sudden cardiac arrest or having bypass surgery, stents, or out here. And so I'm excited about this program is that it's a year program that will give us the opportunity with your new technology, with AI and the powerful supercomputer That we can go in and identify what soft plaque that I have, if I have it. I know I've got some that can identify that. And the most exciting thing is if I've got a problem, then we can work, or you can work your magic, and hopefully eliminate or reduce that plaque where that I have peace of mind that I'm not a time bomb out here waiting for something to happen.

You don't want to use your own product.

Right.

No.

Right.

And I always, you know, love to say that, you know, if you come to me breathing and with a pulse, got you covered, right? I mean, most everybody who has plaque, I would say if we detect it early, we can stop it, we can shut it down. Again, we have multiple tools, pharmacologic, non-pharmacologic, multiple tools to be able to address that plaque, get it to stop, reverse it, et cetera. The biggest problem has always been the diagnosis.

Right.

I mean, kind of like your problem with you, even when you had the machine, you needed to be able to read an EKG, do an EKG, read the EKG, say, yes, this is the shockable rhythm. And that massive advance when all of that came together with algorithms where you put the leads on, the machines went back, it just says, you know, stand back, and it does its thing. It's right.

That's the thing is that Everybody is, you know, is subject to this. Sudden cardiac arrest and heart attacks, they know no age, no color, no gender. It's everybody. And sudden cardiac arrest can happen to anybody, as I just went through earlier. Our first victims were all 17 years old and younger.

And younger.

And so on the plumbing side of it, That 99% of us over 40 years of age, we have plaque.

Yeah.

What we don't know, as I'm sitting here for today, and I'm about to find out more information here, is I know I got plaque, but how much soft plaque do I have, the lethal plaque?

Right.

And so, and now that we can, through medications and your Your counsel, we can hopefully eliminate that and give me peace of mind that we are not going to be victims of this.

Well, and I can relate. I think you probably feel, I suspect, you know, you have jobs and then you have jobs that are really, really important. And I think you have one of those jobs, right? And what you've done over your career, I mean, it literally saves lives. These people, you know, if that equipment was not there and all the different parts to it, getting it in all the right places and educating people and the device itself. But, you know, that must be extremely rewarding. I mean, all those lives saved ultimately kind of come down to you and your passion.

Well, I don't own but a speck of that dust, but it really does make you feel good.

Yeah, and I have the same passion for what we do at Clear Cardio.

I can't imagine— I think about that a lot— I can't imagine a Being an MD that really has the hands-on, or a surgeon that saves somebody's life, puts them back together from a car wreck or whatever. It's amazing.

Well, I like to say in what I do, we could either have trauma hospitals all along the Autobahn, or else we obey speed limits and have seatbelts and airbags. I'm more of the seatbelts and airbags kind of guy, right?

That's right.

That's right.

But I don't know, I guess that— I think about it sometimes, and I guess that was my calling, was to be the defibrillator salesman and be that part of it.

Right.

And that's another reason I'm here today, that, you know, I kind of feel like I was on the start of saving lives with defibrillators. And then we had one of the first test studies in the whole AED world was actually in Anniston, Alabama. And oddly enough, one of the saves was not from a cardiac. Actually, the person was electrocuted on the job.

Oh, wow.

And it knocked his heart into cardiac arrest, you know.

Right, wow.

So I felt like that from start to finish—

Fight fire with fire.

I was out trying to get the defibrillators in the hospitals, and then I was trying to get them into schools and get them everywhere on the wall. And today, this is such exciting technology that we have here. And I think back in the late '80s, I had a friend that I was explaining about the defibrillators, and he's going like, well, it looked like they would have something like Drano that we could drink and just kill all of our— clean out our arteries.

Right.

And I laughed, and I think about that, and I'm going like, you know what, I wish he was alive today that I could of telling, we got something better than that. So this, I'm enjoying being on the, you know, front of getting my friends and people I don't know that we can get them into preventive cardiac medicine.

Well, yeah, because it's the burden, right? The heart attacks, even if you survive, the sudden cardiac death, even if you survive, you know, is a massive burden. The mortality, again, 45% of us roughly will die of a plaque event, right?

That's right.

Is massive. And we just have sort of sat back and just let it happen for decades.

Yeah.

It's been complacent.

Yeah, right? And I'm sure, you know, when that light bulb went on in your head on the electrical side 50 years ago, you're like, but why aren't these everywhere?

Right.

Right? How many people are keeling over dead and having sudden cardiac arrest? And, you know, it's a massive tribute to you And your passion and resilience and stick-with-it-ness to see what— how all this ended up evolving.

Well, this is fun to me because I'm getting to explain something, and you know, it's easy to explain if you can get people to listen.

Yeah, you're right.

But they're— because I'm so, I guess, well known for the defibrillator world and heart attacks, people tend to listen to me when I talk to them, you know what I mean?

You put in the time.

So it's— I'm pretty much retired right now, and so it's given me a— I'm still involved in the company world, but this is really my new passion. As the CEO of Go Rescue said, I hadn't seen Floyd this excited in a long time. But it's a lot to be excited about because we can make a difference in people's lives and maybe give them even a better quality of life along with saving the life.

Right, right. So I also want to— I know— Well, Claire has a great story as well. She had her scan today, and it looked perfect. I now have to say, have to qualify that because my eyes—I didn't see any plaque there. AI is better than mine, so we're still waiting for the AI.

Waiting for the AI. Yeah, hope you are.

I hope so too. I didn't see any plaque in hers. I saw a little bit in yours that we could take care of. The other thing I was going to say is, you know, there's there's a couple of major. transformations that have occurred. Now we have the scanners, the ability to see stuff that would have required an autopsy before, now layering on the AI to be able to see things that I can't see, nobody can see, uh, to extract that data, uh, that, that even in vessels that look perfect, there can still be plaque. And then the last bit is the ability to quantify it, right? So the ability to quantify it Is massive because we know the more plaque you have, the more likely you are to have events down, down the road. The other thing is, and we could never do this until we had the AI to be able to see plaque that we couldn't see, but also equally important to quantify it.

Right.

Because down the road, right, we'll do our magic together working as a partnership. We're gonna stop that plaque, we're gonna reverse it. But now with the ability to quantify plaque very precisely down to a 10th of a cubic millimeter, which is, you know, far smaller than a period at the end of a sentence, that if we want to, we can put you back in the machine after we do our preventative magic and go not only cholesterol's better, blood pressure's better, whatever targets we, you know, and this is where the prevention is always personalized, right? It always depends upon the person. And in fact, one of the things we do beyond the scan— I always like to say the scan is the Ghost of Christmas Past. That will tell us exactly all the impacts over the last— you're 39? Yes.

Yeah.

Over the last— your third— last 39 years, good habits, bad habits, but also throwing in genetics, DNA, and ancestry. The scan and the AI will tell us exactly the net impact on all of those different factors, right? So that is the Ghost of Christmas Past. The labs are the Ghost of Christmas Future, right? That's going to tell us where our trajectory is. Maybe that trajectory is great, no problem, right? We'll put you in the scanner a few years, make sure the plaque is better, right? Not that just the numbers are better, but is the plaque better? And we can never do that without the ability to quantify it very, very accurately. Um, so the quantification is really is transformative as far as the ability to not just detect it but also manage it. Because we can say down the road, we got all the numbers great and the plaque is better. Yahoo! However, I will tell you, sometimes what happens is in some people all the numbers will look great but the plaque is still growing, and you would never know that unless we had a baseline and then to be able to look at it in the future. It is possible. Most— in most people, we get the numbers better and the plaque is better, but we don't have to risk your life on assuming that the numbers mean the risk is over, right? We could put you back in the machine down the road. So that's another huge advantage of the AI, the ability to very accurately measure it so we can manage it.

Right.

And not manage numbers— we'll manage numbers in the meantime, But actually manage the disease and prove, yes, all the stuff we're doing is having the effect we want. And it's really fantastic to work with somebody, we put them back in the scanner a few years down the road and go, you have less plaque now than you had when we started. And I mean, that's just incredibly exciting for me and reassuring.

Do you have anybody that comes to mind that, that you reduced plaque over a year?

Oh yeah.

2 years that you can maybe give me?

Yeah, yeah. So I'll give you some examples. One guy, early 50s, bad family history of heart disease, works out 6 days a week, never smoked, perfect blood pressure, no diabetes, no body fat, right? I mean, he's stellar shape, but he had a bad family history. So interestingly, and we'll explore this with Claire, he had a calcium score, it was zero.

Okay.

So, he's going, okay, that's good. But I said, you know, knowing that 10 to 30% of people with a zero calcium score can have plaque, and that plaque is the active lava, right? The calcium score is the cinder cone, the lava is the stuff that can kill you and rupture and cause sudden cardiac death. So, I said, I'm glad your calcium score was zero, but I'm just not going to trust it. So, we went ahead and did his cardiac CT. So when we do cardiac CT, we have 4 stages. We have stage 0, nothing at all. By the way, that's only 1%.

Right.

So that's like scoring 1600 on your SAT. It exists, but it's pretty rare, right? So 1% of us will have no detectable plaque with AI. The other 99% of us will either be stage 1, mild, stage 2, moderate, or stage 3, severe. In fact, now having hundreds of thousands of these AI exams, cardiac AI exams performed, we know now that 1% would be zero across the board. Yahoo, eat right, exercise, don't start smoking, and you'll be great heart-wise. But a third of our patients coming into the scanner, no symptoms, feel fine, normal stress test last week, I like to say, will have stage 3 severe disease.

Wow.

So here's the numbers, by the way. 1 to 250 cubic millimeters, this is whole heart plaque, is stage 1. So 1 to 250. Stage 2 is 251 to 750, and stage 3 is above 750 cubic millimeters.

Right.

Okay, so a third of our patients will be stage 3 with more than 750.

Total throughout the heart.

Wow.

That's a stack.

Total whole heart plaque, right? So this guy told you zero calcium score, We put him in the machine. His score was 400. Wow! All of it lipid-rich, all lava, all active, right? Soft, soft lava. And I'm gonna tell you, when I looked at his scan, right, when I looked at his vessels, they looked fine. Yeah. Okay. The AI, and when we do the AI, it literally will light up the vessels, right? You're not preparing me for anything, are you?

It's very rare. We still got it. Very rare for me.

But when I turned on the AI, so we go from the pictures we looked at, I hit the button, I turned on the AI, his vessels just lit up.

Wow.

And he had 400 cubic millimeters. He was already stage 2, 400 cubic millimeters. And when you look at those vessels, I'm telling you, having done this for 25 years, they look fine.

Yeah.

So, but I have more good news. So we did all the right stuff. And I will tell you, his cholesterol looked fine, right?

Mm-hmm.

It, it nothing. It looked fine, right? Anyway, we did all the right stuff. We put him back in the scanner. So by the way, because we now have staging like oncology, right? The staging is helpful for both what we do. Stage 1 is different than stage 2, stage 3, as far as therapies and things we do. And number 2, it also predicts when we look again. So if you're stage Stage 1, we're going to give you 3 years. If you're stage 2, 2 years. If you're stage 3, you got lots of plaque, we're going to do our magic and get you back on that scanner in a year because we want to make sure that we're making an impact upon that plaque. So we scanned him 2 years later. So he started out at 400, 2 years later he was 200.

Wow.

Wow. So you cut it in half.

And what's interesting is on the second scan, and all that was the lipid-rich plaque, the lava, right?

Yeah.

Being reversed. On the second scan, even with the AI, he had no calcium, not at all, not a speck. On the second scan, of that 200, 1.5 cubic millimeters was now calcified. So what we're showing is we were converting, not only reducing the total plaque dramatically and the LAVA, which is, you know, the soft lipid-rich plaque, the most dangerous stuff, but also as we did that, we were converting some of that soft plaque into the harmless calcified plaque. So it was really phenomenal.

So you're either converting it to the calcified, or if you eliminate it, where does it go? It just dissolves?

So we can— we have mechanisms of reverse cholesterol transport, so we can literally go from depositing the plaque to not just stopping it, right? Then his score would have been 400 years later, 2 years later. But we can actually, if you If you use all the tools we have available now, you can actually get that cholesterol to come back out of the plaque.

Okay.

And then, so 2 things, either it comes out and/or it gets converted into the hard calcified plaque, the cinder cones I call it, the extinct volcanoes, which at that point don't rupture, aren't active, right? The lipid-rich plaque, the soft cholesterol-rich plaque, that is the active plaque, the growing plaque, the plaque that ruptures and causes sudden cardiac death, and that's why I call it the lava. Once we get it into the calcified form, the hard calcified plaque, it's just sitting there. It's a scar. It's not going anywhere. But yeah, we can do both of those. But it was interesting, there's one case, another case I just saw recently, had a guy with a really nasty looking, all lipid-rich plaque in the proximal LAD. We call that the widowmaker, which I don't like that term because I think it's a little hyperbolic.

No.

Plus, if it's a woman, it'd be a widowmaker. So it's sexist. But anyway, a lot of my colleagues call it the widowmaker, right? Yeah, that's how a lot of your patients end up needing your device.

Yeah, they call it that.

Yeah, but anyway, he said a big nasty lipid-rich plaque, no calcium, lipid-rich plaque in his proximal LAD, got treated very aggressively, and we want to know, is that plaque behaving? We didn't wait a year, 6 months, and you saw substantial reduction.

Wow.

Even in 6 months of that plaque. So, it— and the ability then to quantify it, because, you know, in the old days before we had AI, up until about 4 years ago, I could look at the plaques and I could see, you know, is there more calcium in a qualitative way? I could see, you know, look at the 2 images side by side and say, yeah, it looks like there's less lipid, right? But that was purely just a, you know, just, you know, just purely qualitative. The ability to monitor that and measure it very, very precisely, you know, you can see it. And then we actually have a compare function with the AI. There's a whole other aspect of it. I'll show you. You hit the button, and if you have an old study, we can integrate that in, and it will literally compare whole heart per vessel per segment and then give you all the math, right? Uh, you, you know, X percent increase reduction in calcium or lipid-rich plaque and all that, and it does that all automatically.

Wow. Which is Really cool.

And, and so what I was going to say before is up until we had AI and the ability to say precisely how much plaque you have now, how much plaque you have down the road, if you had a stent or bypass surgery or sudden cardiac death or plaque, right, that was discovered somehow, we would do all the right things, right? You know, we want to save your life and make sure the plaque is better. But if you asked me before we had AI, well, Dr. Osborne, is my plaque better? I can say, well, your cholesterol's better, your blood pressure's better, your blood sugar's better, you quit smoking, you lost weight, you know, whatever. But I could not look you in the eye and say, is my plaque better? It was impossible to be able to do that.

Right.

We now can do that. So we can say, not only we know all the good stuff, but sometimes the good stuff doesn't work as well as we might think. And sometimes we have to— but we'd never know that unless we knew precisely how much plaque you had, and then be able to compare it down the road to make sure that not only are all the gauges in the green, but is the plaque better? And that was impossible up until we had the advent of AI. I, I want to hear, hear your story, and I'll tell you another story, just a little anecdote. Claire's going to back me up on this as well. Uh, one of our first people that came through Cleer Cardio, uh, was an executive at Toyota here based in Dallas. And he and his wife worked out all the time, ate clean. I remember her saying that they would eat meat 4 times a year, right?

Mm-hmm.

I mean, they were hardcore, doing all the right stuff on, you know, diet, exercise, working out all the time. He was a tremendous specimen. I think he was about 58, I think, but had a bad family history. So we put him in The machine, no symptoms, felt fine, whatever. Now, he did have a calcium score and was high. So, already there was like, okay, something's going on, right? Calcium scores, the mammogram, he needed the biopsy, right? So, we put him in the machine, we did cardiac CT with AI. His total plaque volume, I think, was 1,500.

Wow.

Yeah, right? No symptoms, feel fine. He'd had multiple stress tests because he's an executive, right? Gets the executive physicals, all the stress tests were Phenomenal. Um, and, uh, it was, it was remarkable, right? And so we, we got him taken care of and squared away. His wife, who again, I mean, probably 110 pounds wet, works out, exercises, eats right, does all the right stuff, no bad habits, um, had been haunted. So she was, I think, 58 or so at that time and had been haunted for 30 years because In her 20s, her dad had sudden cardiac death and died in her arms. Wow! Oh wow! So literally since that time, over 30 years prior, she probably didn't spend a day where she didn't think, "Am I going to be like Dad?" Yes. And Dad, I think, was 58 when he passed. Wow! Right? So we put her in the machine. Right? She was zero. 100% absolute zero. So, I mean, she literally started crying because all of that worry, that concern, the unknown— do I have it? Did I get what Dad had? Right?

The only way to know is to go into the scan room.

Gone. Just gone. Yeah. I like to say, look under the hood, right?

Yep.

I mean, you know, you don't diagnose an engine problem by walking around the car.

Right.

Right? You got to look under the hood.

Right.

Right? Or now, plug your USB into the little electronics thing and it gives you the diagnostics. But in the past, we were just kind of walking around and go, I don't know.

It looks good to me.

Looks good to me.

Yeah.

Right? That's a stress test.

Yeah.

Right?

Right. And we've all done those.

Yeah. Right? Yeah. We do 10 million nuclear cardiology exams, stress tests, a year in the US. They're about $2,000 to $3,000. Somebody pays, even if you have insurance. Lots of radiation. In fact, 10 times more radiation or more than the CT scans we do. The sensitivity— you only see plaque or detect plaque, right, when it's causing a 70% blockage.

That's amazing.

And because we're not actually seeing the vessels themselves, we're really looking for blood flow, right? Blood flow will not become abnormal, disrupted, Until you have a 70% blockage. Up until that point, stress test is perfect. Because also too, we're not seeing or looking at the vessels themselves, we're looking at blood flow. We have about a 25 to 40% false negative rate where the stress test looks great. I pat Floyd on the back and say, you look great, you got the heart of an 18-year-old. And then next week, next month, next year, right?

Yeah.

He's using his devices, or someone's using them on you.

That's right.

And then a 25 to 40% chance of false positive, where the stress test looks funny because we're not seeing the blood vessels. That usually is followed by a heart cath, a $20,000 invasive procedure going through the groin. The only big advance in the last 20 years is now we go through the wrist, and that's $20,000. Risk of complications: heart attacks, strokes, kidney failure, infection, bleeding, etc. And then we find out, oh, you're fine. Stress test looked funky. But the $20,000 diagnostic test with risks looks fine. And even then, on a heart cath, an angiogram, as I love to say, if you think of the vessel as a donut and a donut hole, on a heart cath, all I'm seeing is the donut hole. Can't see what's happening in the wall. And that's always where plaque starts. And you could have a completely normal heart cath and still have substantial plaque.

Right.

And no blockages, right? And it's all happening out in the donut.

On the outside.

On the outside, in the wall, right? In the donut, not the donut hole. And the vessel actually can expand to about twofold, right? The whole vessel, right? Usually the wall's pretty thin. It'll grow outwards. It'll warehouse the plaque, so to speak, right, for years to decades. Once that vessel roughly doubles in size, because that's how much plaque is in there, Then it begins to grow inward. Starts fading in. Right. Yeah, and, and, but we won't have symptoms or flunk a stress test till you already have a 70% blockage of the channel.

Right.

So, you know, I think you told me your cardiologist, rightfully so, says—

Right, right, because I, and I just did this like a month ago.

Right, so tell me your story.

Well, you know, I did need to go to the cardiologist, and I went about a month ago, and But, and like you said, I mean, he said, we don't— I don't do stress tests anymore.

Which I'm gonna say, yahoo! That's— he's really progressive.

I'm anxious for him to see, you know, all of this. You know, basically, I mean, heart disease— my uncle passed away from— or great-uncle passed away from heart disease. My mother, at about my age, had a triple bypass, and I don't remember any symptoms. I'm not so sure she wasn't just having a— I think she might have been having a stress test, and it didn't look right, and then I think they put a dye, and from there she had a— went in and had a triple bypass. I think her symptoms came after that.

Mm-hmm.

But then actually Floyd, you know, through talking to some of the people he knew when he decided to come, that's kind of when I got on board. But I mean, I think it's amazing, you know, and that's what we were talking about. I'm like, okay, you just go through my neighborhood. This gentleman has a stent. This gentleman has a stent, doesn't want anyone to know about it, but, you know, he keeps it secret, but he's got a stent. This one had a heart attack. He's okay now. And it's just the number of men that we went through.

Mm-hmm.

And a lot of them were very healthy, very healthy. We would see them running every day around the neighborhood.

You feel great until you don't.

Feel great. And they actually had gone to their heart doctor, everything was fine until it wasn't.

Right.

So, but, and like we were talking earlier also, they had the bypass or the stent, and then they're like, okay, I'm cured, everything's fine.

I'm fixed.

And Right.

And you want to think that way too.

Sure. The way you've explained it, you know, to us, I never looked at it that way. Never. Never understood plaque or how it built or how it hid. Like you said, it's really just kind of hiding over in this chamber that—

No symptoms, feels fine.

No symptoms. You don't even know. It's been segregated. It's not showing up at all. Not showing up at all. So, and I never knew you could, the difference in hard plaque and soft plaque. Or that you could dissolve the solid plaque. I mean, I never knew that until this.

You know, one of the things that we love, and I think it makes what we do different, right? We have incredible technology, the nut behind the wheel that can read all of that stuff and put it all together, but it's also education.

Yes.

We have plenty of time, which pretty much nobody else has, to sit down with our patients and walk them through the whole story, what all of this is, what it means, And my ultimate goal is, you know, I've been doing this for 28 years, 15 years of training to be able to do the last 28 years, you know, so a lot of training. So I love to hopefully every day create more junior cardiologists.

Let me ask this question on that because—

So that you so well understand this that anything we do from here, you go, well, of course that's what we do. We can explain it. And we have the— we at Clear Cardio, we take the time it takes to educate you. And I think that's a critical thing that doesn't happen nowadays. Right. There's no way you can see 5 people an hour, diagnose them, figure out what's going on, educate them so that everyone is thinking, got it, I understand what's happening.

Right. We've been here since 8 o'clock this morning. We've got a lot of education. But, you know, and like, I can think years ago, and I knew nothing about defibrillators until Floyd. And then several years back, and this was a heart I'm amazed at how many defibrillators are not in a heart doctor's office. So he had— there was a heart doctor.

I guess they're pretty bold and—

I don't know, but you start looking around, they're not there. But there was a heart doctor in Birmingham, and he decided to get a defibrillator simply because he didn't have one. And after hours, you would have to go out of his facility, try to go around, make it to the main hospital that he was even, I think, part of. Well, he got the defibrillator. It was one of his employees that went down, what, just a few weeks later?

Yeah. Wow.

And they had a save.

Wow.

And the employee, along with the doctor, had been supporting Wedgwood.

Actually, he was. Oh, wow.

And this was a big time. But so people started looking and asking there. So, you know, when you, when you think about that, and like in your field, And so now I'm wondering, when I go to my heart doctor and they give me a clean bill of health, are they aware that you don't get a clean bill of health until you're 70%—

In fairness to them, that's not a good point.

In fairness to them, do they really—

Yeah, we know.

Or do they kind of have to know?

In the world of cardiology, we know the limitations of stress tests. And your doctor, I fully support that, doesn't do them.

Yeah.

Why do I not do them?

But even take the stress test.

Do they generate revenue?

Yeah, they generate revenue.

Very nicely. It's great for the next Ferrari, Lamborghini, Cessna, mountain home, lake home. But as a clinical tool, pretty worthless. So he has surveyed the literature and said—

But in taking the stress test out, did they— because I don't think the lay public, my friends, I mean, and I'm thinking of all the people with the stents and all my friends. I mean, a woman, a friend of mine had a A heart attack, female, and it was silent. You know, it's a silent heart attack. So, but are they aware that you're not gonna feel any symptom until you're 70% blocked? Yeah, they know it. But they— the machines don't pick up on it?

Well, it's probably a lot of this.

But he said the machines don't—

Cardiologists out there today, they are probably aware of their limitations, a lot of them. or not have the availability. I understand there's like 4 of these supercomputers in the country.

Seriously, 4 in the country?

Yeah, so you don't tend to talk about stuff that you don't have available to you, in fairness to them. Right, right.

You say, I don't know it, I don't understand it, we don't offer it, right?

This guy's probably, if he kind of knows or heard about it, he's probably going to say, now, Clara, you need to fly to Dallas, Texas, And have this scan.

Right.

So it'll evolve.

It will, right? I will say I'm very proud of this. So as I was talking to you guys earlier, the first machine that was first commercially available machine was called a 64-slice machine, right? So how many slices it gets. With yours, we do about 2,000 slices in 1 second with our machine. So what's happened, just like iPhones, that was the iPhone 1, 64 slices. The machine that you guys were in is a 640-slice machine. So that's what's happened over the last 20 years. We were the very first install of this machine in North America.

Wow.

Wow.

So now there's one up in Manhattan, there's a couple more, but we were the very first install of this particular machine, which is called an Atlas 960 in the US. Actually North America, technically.

Changing, maybe going down a different road. You mentioned you have somebody, say, that's in stage 1, stage 2, or stage 3, say that they have a score of 200. 70, around 70% of the cardiac arrests in America occur at the home. So if you're in here and you have a pretty sizable amount of soft plaque identified, shouldn't you have an AED in your home?

Yeah, no, I certainly, you know, there are certain people that are at such high risk And you can tell by how much plaque they have that that's part of the whole program, right? Eat right, exercise, don't smoke, we'll take care of this, this, and this. But part of that is in the hopefully unlikely event that that does occur, right?

Yes.

I want to make sure we've created an environment where we have all of those things in system.

Yeah, I think that should be recommended, you know, if I was sitting in your chair. So, you know, I'm not scared of you, but it might not be you, it might be a visitor at your house, it might be anywhere. But you should have You should have those available at your home.

Yeah, no, I completely agree.

We do. Going in from the garage.

So tell me the name of your foundation again?

It's the Lord Wedgwood Charity.

Got it. Wedgwood as in the china?

Yeah, he was Lord Wedgwood in England. He was a dual citizen here and just one of my best friends to this day.

Wow, that's amazing. And so that's still ongoing, right?

Yes. It is.

Wow. Right.

And do you have a website?

We'll have a fundraiser in October, and we'll, you know, we'll raise funds for that, you know, to put AEDs. We've put— we've saved a lot of lives.

And fortunately now in Alabama, schools have them. Back then, I mean, it was— they didn't even— I mean, it's like a defibrillator. Right, right.

Is that like some kind of lie-detecting device?

Yeah, yeah. But now almost all the Schools, middle school, high school, private schools. Yeah.

So do you have a website?

Yes. Lord Wedgwood Charity.

LordWedgwood.org.

LWC.org.

Got it. Got it. Okay.

Yeah. Or you can Google it.

Yeah. Well, we certainly encourage everybody check that out. What a fantastic way to— it's a force multiplier, right? A little bit of money there.

Mm-hmm.

Can save a lot, a lot of lives.

And defibrillators have come down, you know, quite a bit, honestly.

And actually, we have now, they're down probably, well, they just went up, but they're probably $1,500 to $1,800. But now we get so many AEDs back in after 3 or 4 years, they're on programs to swap them out. They've just been sitting in a cabinet Right. So we can refurb those and put fresh batteries in the pad. As long as they're testing, you know, fine, you're good. So we can put those in the homes for around $800 or something like that.

Wow.

So they get there very afford— affordable.

Right, right. You know, is your life worth $800?

Yes.

And in fact, I mean, how long do batteries last on average, would you say?

The batteries?

How long do the batteries last?

Well, probably on average about 4 years.

So I wouldn't say it's, it's $800, it's $200 a year.

There you go.

Right? I mean, if it's gonna last 4 years, right, then that's right. I mean, yeah, yeah, yeah. That could be a dinner these days, right?

Exactly. Yeah, depending on who you go with.

It could be a bottle of wine if you're dining with Lord Wedgwood. So I'm gonna ask you a question and tell me if this is correct or not.

Okay.

Okay? So I'd heard that the place where defibrillators are most commonly used—

Most commonly used?

Yes.

I would say in the lay public, we get more in gyms, places like that. In high schools and the overall biggest places where athletics are involved.

Well, I'd heard, like, as far as the most common location where defibrillators are used out in the public are casinos.

Oh yeah, I mean, you hadn't gone there yet. Forgot about that one yet.

And then when you think about it, they're not used, but the cardiac arrest, the biggest is home because you're at home.

Right, right, right, sure, sure.

But really, that was one of the concerns You did a lot of casinos. But one that just got started really was one of the jump starts when they put them in, because people are out there, they're overindulging, and they're not sleeping right, they're eating too much.

Right, it's the perfect storm. I think you're right on that. A lot of, uh, a lot of population. That's what I've heard.

And then sometimes, uh, their unlucky night and maybe their blood pressure's going up, they're losing a little more than they should.

Exactly right.

Yeah.

Yeah.

But we have had a video.

So don't gamble, it'll kill you.

Yeah.

We've had a video, and actually they're all playing cards, and so the person went down with cardiac arrest, and so they responded to the thing, and they actually didn't even stop the card game while— I mean, true story, you look at that. These people are intense.

They're intense.

We'll get to him later. You know, I had a friend who I had a friend whose son, an attorney in our area, gosh, I guess he was closing in on 50 or maybe 50, that, you know, and he died in his sleep last week.

Oh, wow.

So as a matter of fact, yeah, funeral's coming up. I mean, and everyone has— everyone knows someone.

Right, right.

Should have come in and taken care of this.

Yeah, well, I'll go, I'll tell everybody all the time, I said, Well, I'm out here fighting cardiac arrest and all of that, but when it's my time, that's the way I want to go.

Agreed, right? It goes to sleep, it's painless. And honestly, I tell people that too, right? I can't make you immortal. Yeah, it's not going to happen. But I just want to get rid of the 45% of death that we can predict and prevent. Yeah, right. And again, you know, you get to be 120. Yeah, I tell people at 120 you're a super centenarian, right? At age 120, when my patients make it to 120, I tell them, okay, everything I've told you, you got to stop doing. I want you to buy a motorcycle, do not wear a helmet, which you can do in Texas. I want you to start drinking. I want you to drink and ride your motorcycle, and I want you to take up skydiving. And all those medicines we've been giving you for the last X number of years, yeah, stop those medicines. Just stop. So that's my big carrot, right?

Do too much.

Because I can't make you immortal.

That's right.

But just no early, predictable, preventable deaths. That's just so sad.

Right?

50, you know, and honestly, I see that all the time, and we read about it, and, and that's— every time I see that, I think, but for.

Yes.

Right? But for. I mean, just preventable.

Right.

That just shouldn't be there. And, and we, we just got to get over that. Yeah, well, I guess it was his time, right? As if This was like a lightning bolt.

Well, yes, you're awake explaining it away.

It started decades before that event.

Yeah, so all these people with stents, when should they have been in here? 10 years prior?

Yeah, you know, I'm gonna say if you're 40 and above, right, get a scanner.

Exactly.

Right? Now, and I will say too that You know, if you've had bypass surgery, if you've had stents, you know, we'll still put you in the machine. I mean, we already know you got the disease, right? But also too, even if you have stents, as an example, we can also make sure the stents are open. That's always, you know, it's good to know.

Okay.

And also too, we can also do all the quantitative analysis. So we can say, I have, yeah, I have a stent, because we didn't do cardiac CT beforehand to figure out I had disease. Treat disease, you wouldn't have got a stent, but I've already had a stent, but we can then do the AI at time A, do our magic on the preventive cardiology stuff.

Because it's still building plaque.

Oh, absolutely, right? Yeah, because people— interesting, people really worry after getting a stent, how's the stent? I'm gonna tell you, usually once you have a stent, that's not where the next problem is gonna be. It's all the other blood vessels in the heart where the next stent or the next heart attack occurs. That stent, usually once it's there, it'll be fine, right? But it's all the other vessels in the heart that can get you in trouble.

It could also collect stuff itself.

It can, it can. So we could both make sure the stent's okay, but more importantly, we can most importantly treat the disease, treat the plaque, the thing that bought you the stent in the first place.

They call it stent number 1.

Yeah, stent number 1, right? Exactly. I'm gonna steal that one. And I do love to say, right, so I think you guys are big fans now.

Yeah, oh, absolutely.

And I am always excited every time I go through what we did earlier today. Be sure to check out that podcast. I'm just as excited going through it with my patients as the first time I did it, because, you know, I remember the first cardiac CT, it was like, this is amazing. And now, 25 years later, I'm still pinching myself. So I always tell my patients, if If you're happy with us, please spread the message. There's very, very few preventative cardiologists, so I really lean into you guys and really ask a lot to work to put me out of business, as I love to say, right? And then I tell them, so anyone you like or love, right, please tell them about Clear Cardio. Now, if you do not like or love them—

Well, I can say as we sit I've got at least 8 people that have committed to come, said they're coming. They just want to look at our— they want to see my chest closure.

They want to see our closure. That sends chills down the backs of my interventional colleagues and cardiac surgeons.

And many more considering it, and I think it'll— this will be a so-called lightning rod.

We came up with— we were having dinner with one of our patients, and we had filmed a podcast thing, and he'd gone through it, and we were just talking and maybe having a little bit of wine as well. And it struck one of us, maybe me, I don't know, but struck one of us, you know, the cost of cardiac CT and a casket are almost the same.

No, well, the casket's more. Well, the casket's probably a lot more.

Yeah, I'm talking about a base casket, right?

But then you've got to get the flowers. Oh yeah, right. You gotta— so yeah, do it up front. Cardiac CT or casket? Yeah, yeah, you're cheaper to do the— yeah, clear cardio.

Well, listen, it was fantastic. Thank you guys for coming all the way from Alabama. Uh, thank you for Thank you for spreading the word for the people you like and love. And it was just a really remarkable day for me to be able to show your heart, do your virtual autopsy, as I like to call this.

Well, and you explained it so well, so, you know, where a layperson can understand and follow what you were showing.

Well, it's been a great day for us because hopefully we're gonna, you know, it'll help our health down the road, and hopefully we can maybe help other friends and people we don't even know get the word and help them also. So it's a great day for us.

And I think too, no matter what we find, as I said before, if you're breathing and have a pulse, I can help you.

Yeah.

Even if you lack one or the other, I might still be able to help you. If you're missing both, well—

Yeah.

So I think I think, you know, there's also just, you know, to know the unknown, right?

That's right.

You know, that stuff you don't need to worry about is also fantastic as well. Or if you have an issue, no problem, we take care of it, right? We have all the tools, all the data, all the literature. You know, nobody should be dying of plaque in the US, and unfortunately it is the leading cause of death. That's why I do what I do, but thank you for, uh, making the commitment, coming here, spending the time to let me educate, or as we say, I like to say, 'cos I'm from Texas...

You bet. To new ambassadors.

I appreciate that, to edumacate you.

Yeah, yeah.

It's been such a pleasure, Floyd, and thank you for all you have done, uh, on the electrical side. I'll keep working on the plumbing side of things to prevent the electrical problems.

I'm gonna work on both sides.

Exactly. So, Plumbing meets electrical.

That's right.

Well, and Claire, it was a sincere pleasure. Really appreciate you coming.

Pleasure to meet you.

And thanks for being willing to join our podcast and share your stories. Really was very powerful. So thank you.

It's been a treat on our end.

Yeah. So please subscribe, check out our website, clearcardio.com. Please subscribe down below, check out our website. We'll make sure there's a link as well to your charity, the lordwedgewood.org. So we'll make sure there's a link there too. So check that out too, knowing that some of that money that you donate would literally help to save a life. So it's a great day.

Thank you. Thank you. So thank you.

No stupid deaths. That's a good way of saying it. No stupid deaths, right? I mean, can't make you live Can't make you be immortal, right?

But just no stupid deaths, right?

Thanks, everybody. Tune in next time to Power Is Prevention, and we'll have more great stories to share. Thanks, everybody, for joining us on this very special program. Of course, I think all our programs are special, but this has been a really remarkable day for all of us here. Myself on the cardiology side, and I know for for Clare and Floyd. It's been incredibly enlightening, as you learned. But this is the Clear Cardio path. This is the Clear Cardio way. And I think, unfortunately, you know, this is how everyone should proceed to help eliminate the largest cause of death by far in the US, which is cardiovascular disease. We're out there to make a difference. And thank you again for joining us today, but also be sure, sign up, click below, Clear Cardio, find out what we're doing. We have lots and lots of great videos and educational aspects about how we can work to prevent heart disease and stroke for that matter as well. Please click below, please subscribe. If you like this program, you want to see more, please subscribe as well, please do that below. And until then, we're just going to keep working to eliminate heart disease at Clear Cardio.