Heart Attack Prevention They DON’T Want You to Know About | ClearCardio

Right.

Heart attacks, and I'll lump strokes in there together, because as it turns out, and I'll— well, I'm sure we'll get through this too, is that the same process that yields a heart attack, right, something happening in the heart and the blood vessels of the heart, is actually the same process that occurs in the blood vessels of the neck that we call a stroke. In either case, we have a blood vessel that has a plaque, that plaque ruptures, which we'll talk about, which then within seconds to minutes after that plaque ruptures, is the term we use, but if you want to say pops, flakes off, breaks off, whatever, all of those are really synonymous, that it is plaque rupture that is the final common pathway to a process that began and is detectable literally decades before you have that event. And you are correct. When I started out 30 years ago as a cardiologist, hung my shingle, we had one heart attack, about a fatal heart attack, about every 40 seconds. So what's happened over the last 30 years? We're down to one every 38 seconds.

Really?

Wow. Which is pretty disturbing.

Yeah.

And I can't say this enough. I share this with everybody. Just remember, priority-wise right now, first of all, I cannot make you immortal. However, an unfortunate, horrible, dramatic, tragic number of people, which represents 40% of the deaths in the US and has been stuck at that level for the last 30 decades— or 3 decades, rather. 40% of people right now that are watching this right now, that are listening to us right now, will predictably die of a fatal stroke or a heart attack, of a vascular plaque that ruptures.

Wow.

With half of those people, their first symptom of this plaque is when it kills them. And that's just no longer acceptable. We, we have technology at Clear Cardio Now layered on top of the incredibly easy, simple, quick cardiac CT tool that I've been using for 25 years. But now the latest, greatest breakthrough is the ability to add AI to that high-resolution, 3-dimensional imaging, which allows us to be able to quantify exactly how much plaque you have, see plaque that we cannot see with our eyes, And then be able to down the road not just say you have plaque, you have narrowings, you have blockages. We know what kind of plaque. We've divided it into the different kinds of plaques because there's different kinds of plaque that pose different risk of plaque rupture, breaking, flaking, popping, whatever. And then on top of that, and this is something we could never do before with AI, once we have the ability to quantify exactly how much plaque you have to a highly precise number is that now down the road, we can not only treat the disease, treat the plaque, we can stop it. And yes, we can reverse plaque. I can't tell you how many people, they say, well, oh, you can't stop it, you can't reverse it. No, we can stop it. And frankly, with good enough treatment therapies, we can reverse it. But for the first time ever, With the ability to see exactly how much plaque you have at time A, put you back in the scanner at time B, we can not only show, not only are the numbers better, your cholesterol's better, and your blood pressure's better, and your blood sugar's better, and you're on all the right tools, and you're dieting, and you're exercising, and you're losing weight, but for the first time ever, I can show you without any equivocation, is the plaque actually better? We could never do that. before we had AI. It didn't matter what tool you used— invasive tests, heart cath, angiograms, stress tests— none of them could say, I have X amount of plaque now, we do all the right good stuff, which is personalized for you based on you and your history and all of those various factors that we take into account at Cleer Cardio, and then down the road show your plaque is actually— better. And all this occurs before you have chest pain, angina, flunk a stress test, or keel over dead. Really the magic of Cleer Cardio.

You told me an incredible story. I'll never forget this. And that was, you know, 25 years ago when the CCTA scan was born. You forged your own path because you found out that your colleagues were turning their nose up at the CCTA, and They wanted to go in the reactionary way versus you said we have a way right now to prevent heart attacks. And so, Dr. Osborne, like, one of the most extraordinary things about you is that you are a unicorn. You, you are heavily on preventative medicine. What's the difference between a cardio— like most cardiologists out there today and your line of thinking and, and, and the few that walk in your path?

Sure. So heart disease, the management of heart disease has usually been waiting until the machine is broken, right? There's no preventative maintenance, or there's lip service about preventative maintenance, but no one really does it. And we're never really looking to see, do you have the precursors to a heart attack, which, as we well know, and this is nothing new about this, it's plaque, right? And unlike the vast majority of my colleagues, they're really not interested or frankly motivated, or— and there's a lot of organizational and institutional and individual apathy and inertia that The current MO right now for the diagnosis of heart disease is we wait until the machine is broken. There is very little interest or impetus to say, well, let's do some preventive maintenance. Let's first of all see, is there early baby plaque, as I like to call it, that we can target and treat and stop and reverse So that you don't develop what we think of as cardiovascular disease, which is a heart attack, a stroke, a mini stroke, or needing stents or balloons or bypass surgery. If you develop any of those things that we think of as heart disease, what it means is that we had 20 to 30 years to detect the underlying root cause, the plaque, take care of the plaque, treat the plaque, stop the plaque, reverse the plaque, We miss that window of 20 to 30 years. Instead, we let the machine break, which could be, again, a heart attack or a stroke, or about half the time you keel over dead. Not a good way of detecting disease.

No. A lot of the patients that I speak to when they come to Cleer Cardio, they said, well, my doctor said I was fine, and they said there's nothing for them to do. Meanwhile, you know, a detection showed that they were. You know, 70% blocked already. What— why does that happen?

Yeah, well, explain why. Literally, for the last, I'll say, 40, 50 years, the thought behind heart attacks and what kills people was the blockage, right? So a tight blockage. When I say tight, generally the number we talk about is a 70% blockage. So imagine There's the channel, the hole. I call it the donut hole. We'll get to donuts. There's the donut hole. In order for you to have symptoms, chest pain, angina, as we call it, or flunk a stress test, that donut hole has to be blocked up by 70%. So, in other words, my little finger here is the only flow through that vessel. This is all plaque and buildup.

Wow. Oh, wow.

This is the flow.

Wow.

This is the plaque.

Oof.

Okay? That's how much plaque it takes before we start having symptoms, if we're fortunate, because, again, half of people never have symptoms. Their first symptom is death.

Oh, my gosh.

So, it takes a massive amount of plaque to build up before we ever have symptoms or have enough disease that a stress test would pick it up. And, it is so disconcerting to me as a preventative cardiologist who has studied the disease, the biology, the pathophysiology, how all this works for, well, well over 30 years, right? Because I started out in medical school. This was my ultimate goal, right? I basically started out as a youngster. I started in medical school at 19 and got quickly put on a path that heart disease is what I am going to hopefully dramatically change our approach, how we diagnose it, how we treat it. So that goes back to— The 1980s now.

Well, you're famous for saying, my biggest, my biggest goal is to be unemployed.

Right, exactly right. The, the ultimate manifestation of preventive cardiology is you put me out of business. And you know what? I will be delighted when I'm put out of business, okay? Uh, and I'll be put out of business not because I'm going to retire, but we will have eliminated the disease.

Right?

And of all the things that can hurt us, harm us, kill us as far as medical conditions, imagine 40% we could eliminate tomorrow.

Yeah.

Right? Can't make you immortal, right? You can still get hit by a bus or whatever. Um, but imagine that 40% of the things that kill us many times early when we're young, when we're still productive, when we have You know, our family, jobs, we're rocking and rolling on our profession. We're really at the peak profession in our 40s, 50s, 60s, etc. We've arrived. We have families and kids and grandkids. You know, we're now the head of our company and CEOs and all of that. But whatever you do and whatever your profession is, those are the people that heart disease takes out.

Yeah.

And it just has to stop. And that's why we put together Clear Cardio. It is, it is, you know, we're sick and tired of it, and I'm not going to take it anymore. And we're just going to prevent all of the needless suffering and death. And even if you don't die of a heart attack, you may end up with heart failure. Now you're on multiple drugs, or you need devices and heart pumps and all kinds of crazy things to keep you going and alive that all could have been prevented. And so that's why I've been on my, my agenda to put myself out of business. But I always love to tell people, my patients and the people listening, I cannot do it alone. I need your help to do it. But that's why I ask everybody, right, kiddingly, but a kernel of truth. But really, you know, if we eliminate heart disease, I will be the happiest person alive, uh, and that's my ultimate goal. So please put me out of business. But I cannot do it alone, and I need your help out there in the audience.

And the biggest challenge is because people feel fine, and they go through, and they don't know the risk factors, or, you know, what puts them more at risk to having heart disease. So they're going through life, they feel fine, they don't have any symptoms. Well, it's hard to convince someone to think about heart disease or to be aware of it if they're not experiencing things. And it's very easy to procrastinate when you're not actually experiencing those symptoms. So, Dr. Osborne, I know you've told me 8 significant risk factors that if you fall under 1, 2, 3, 5, or all 8, you really should be considering having this evaluated. So would you mind explaining those 8 risk factors?

Sure. So let me walk through sort of the risk factors for heart disease, but also appreciate when we talk about risk factors, Those are factors that increase your risk. However, it does work both ways. They do increase your risk. However, there are people with risk factors who don't have the disease. And, you know, it works both ways. We want to identify people who have the disease, take care of them, treat them, prevent that, prevent the deaths, the heart attacks, the strokes, the heart failure, etc. But conversely, there are people out there that are really worried that sometimes their lives can be put on hold because Because they're so concerned that, like their dad, their friends, their family, whomever, colleagues, that they keeled over dead or that their life became horrible because they developed heart failure, right? Or they had a heart attack and needed stents and balloons and surgery that not uncommonly will put people through our imaging and find out you're fine. You talk about the ability to sleep well at night, and I tell them, I'm glad you sleep well at night, but I'm going to sleep well as well. 'Cause I don't want anyone to have a cardiovascular event. If we find something, no problem, we got you covered. If we don't, yahoo, that's fantastic.

Yeah.

But the first step is we have to detect the disease. So of— there are many, many factors, we'll say 8, but there's many factors that give rise or that are risk factors for heart disease, kind of in no particular order. But, but I'll start with this one is family history, right? If you have a parent, a grandparent, an aunt, an uncle who had a stroke or a heart attack, but also too, a lot of people don't understand this. You can, you know, a lot of— I'll talk to a lot of people and say, yeah, well, my, my mom, my dad, my brother, sister, my grandparents had heart failure, and that's what killed them. Well, you know how you end up with heart failure? You end up with heart failure because you had a heart attack. Plaque, heart attack, bad heart, bad pump, you end up with heart failure, right? So heart failure is the end of a long stage of lots of plaques that have ruptured and ending up with a heart attack. One fascinating thing I think about the genetics of this— by the way, I, I did a postdoc in the Department of Genetics at Harvard Medical School when I was doing my training. As well. So, I really have a heart, pun intended, for genetics of this, that obviously having mom or dad with a heart problem, stroke, heart attack, balloon stents, bypass surgery, also peripheral arterial disease, blockages in the legs, right? Amputations, poor circulation, that significantly increases your risk of having it, right?

Yeah.

Doesn't mean you will get it, but it significantly increases your risk. Interestingly, the strongest genetic risk factor for heart disease, for all those things I mentioned, is not a mom or dad. Obviously, that's a major risk factor, but the greatest risk factor, genetic risk factor for heart disease, is having a sibling with heart disease. And most people don't understand that. So whenever I see somebody, I'm always asking about the family and also siblings. Because many times the brother sister has already had an event, or if they have not yet had event, I said, guess what? We put you the scan. We have plaque. We have disease. I'd be really worried about your brother and sister because the reason for that is genetically we're only half like mom and half like dad, but we are almost identical genetically, right, to our siblings. More we are more genetically alike to our siblings than any other buddy, any other person in the world.

Hmm.

So that's why if you have a sibling who's had a cardiac event, be afraid. Be very afraid. Well, actually, don't be afraid. Get in the scanner. Let's look under the hood, as I'm always going to say. So family history, smoking, and by the way, any kind of tobacco. I don't care whether you smoke it, vape it, snort it, chew it, inject it, rub it on your skin, use it as a colonic. Thank you very much. I'll be here all week. You're a great audience. Be sure to tip the waiters. Uh, I don't care how you consume the nicotine, right? It's going to get into your blood vessels to get into your arteries and veins. And literally on the lining of the vessel— back to the donut hole— on the lining of that vessel, there are nicotine receptors. When they get stimulated, your vessels go from Teflon Slick, the way it should be, to Velcro. You do not want Velcro, right?

I didn't know that. Wow.

Yeah. So I don't care how you consume nicotine, right? Right. It is toxic to your blood vessels.

Now, Dr. Osborne, that includes if those people were smokers as a teenager, they smoked for 10 years, and it's been 30 years since they smoked, it's still the case?

Oh, absolutely.

Yeah. Right.

So, you know, even if you don't smoke now or use tobacco in any form, which is great. However, if you did previously, you may have started the plaque ball rolling.

Wow.

Right? And that's independent of blood pressure, cholesterol, family history, et cetera. Okay? So, smoking's bad. If you, if you use tobacco, do not. However, even if you have quit, and that's great, You still be could be suffering the consequences of it decades later. Family history, tobacco, diabetes, but also prediabetes. Okay. Right now, depending upon how you identify it or define it, about quarter of U.S. adults have diabetes. It is rocketing up. It is epidemic, right? A lot of those people with diabetes don't even know they have diabetes. So, we figure that out for you, too. That's part of the testing we do to figure all that out. But that's the people that have diabetes. Another 40% of US adults have prediabetes that are on their way to develop diabetes.

And they don't know.

And they have no idea. We have tools, we check for it, we test it, we can identify. Obviously, if you have diabetes, that's easy, but also that 4 out of 10 that have prediabetes, we also can figure that out. And all this is treatable. We can stop diabetes, we can reverse diabetes, uh, in most all people. Uh, if you have prediabetes, we have proven effective tools, right, in large clinical trials where we can stop the progression onto diabetes, right? So every person who developed diabetes went through about, depending upon the person, maybe 10, even up to 20 years of having prediabetes, and no one recognized it, and no one did anything.

Wow.

We now have tools available, and this is just recently published data. Some of the tools available in patients with prediabetes, which is 4 out of 10 of us, if we use some of these tools, we can lower the risk of going on to develop diabetes from anywhere between 93 to 100%.

Wow.

So that prediabetes is really important. And people have prediabetes, they generally have high blood pressure, they've got fat on the belly, right? You got the basketball belly, right? You're using, you know, you're 42, right, if you're a guy, right? So if you have a waist above 40, a waist above 35 as a woman, that's one of the criteria for prediabetes. High triglycerides, low HDL, high blood pressure, modestly elevated blood sugar that's not even in the diabetic range. Easy to detect. We also have tools and tests and all that to figure that out. Easy to detect, but incredibly important and actionable, right? So if you're not worried about getting heart disease, but you are worried about getting diabetes, well, this is all part and parcel to how we make sure you don't develop heart disease, which, by the way, 40% right now. We talk about 4 out of 10 people right now that are watching this right now. At this point, if we do not change the trajectory, we'll die of a fatal heart attack or stroke. If you have diabetes, it's not 4 out of 10, it's 2 out of 3.

Whoa. Wow.

Yeah, still get hit by a bus.

Wow.

But if you have diabetes, your risk of dying of a fatal stroke or heart attack is now elevated to 2 out of 3.

My goodness.

So, if you want to put your eggs in one basket, don't become diabetic.

Right. Right?

So, diabetes, big, big deal. Cholesterol, right? We all talk about cholesterol. I think people sort of have this intuitive understanding about cholesterol and heart disease. Well, I'm going to tell you, and I'll be the first to tell you, as a preventative cardiologist, not only board certified in cardiology, But also board certified in lipidology, the study of cholesterol, right? There are about 100 people that are both certified in cardiology and lipidology or cholesterol. 100. So right now you're watching 0.5% of all of the people that are board certified in cardiology and lipidology. So lipids for me are a very, very big deal. I'm also a not there's a organization called the National Lipid Association. I'm one of their fellows. So if you hang around long enough, do enough, whatever, notable enough, you get to be a fellow on one of those and spent about 8 years on the board as well. So very, very intimately related to lipids.

Someone told me there's only 3 in Dallas and she found you as being one of them.

That is true. And I will say the other 2 are the people who cloned and discovered The LDL receptor, which is the cause of familial hypercholesterolemia, back in the '70s. They got the Nobel Prize in 1985. So it's those 2 guys and me. So I hang out with pretty, pretty cool people. I'm sure they're probably embarrassed to think, oh, it's us and then Dr. Osborne. But anyway, they're on the science side, on the, on the basic science side, on the genetic, molecular genetic side of this equation. I'm on the Let's save the world part of that equation. So yes, Sherry, thank you very much for pointing that out. However, I will tell you unbelievable number of myths about cholesterol. I don't have time to cover them all. I think this is going to be another podcast. But briefly, HDL, the good, happy, heavenly cholesterol, doesn't matter. Ignore it.

Wow. It doesn't protect.

Doesn't protect. Okay. If you think you will not have heart disease because someone said your HDL is high, Completely wrong.

Wow.

Doesn't work that way. Triglycerides, another fraction of the cholesterol, right? Many people completely ignore them, don't bother with them, are really, really important. Okay? They are very important for both heart health as well as things like pancreatitis as well. And incredibly, we have incredibly effective treatments for those as well. In fact, even in people who had known heart disease or diabetes, on cholesterol drugs like statins with well-controlled LDL, the lethal, life-threatening cholesterol that we'll come to in a moment, if they still had modestly elevated triglycerides— when I say that, I'm being very precise— anywhere from 135, which by the way would not even show up as being abnormal on your lipid profile, right?

Mm-hmm.

Anywhere between 135 up to 499, again, modestly elevated, most everybody would probably ignore them, say eat right, exercise, blah, blah, blah. Those individuals, despite statin therapy, despite well-controlled LDL, are at substantially higher risk of people who don't have those modestly elevated triglycerides. In fact, with using the tool that we have that has been clinically trialed in a study of 8,179 patients, everybody on statin therapy, they were all high risk, they all had plaque, They're on statin therapy, good LDLs, enrolled people with triglycerides 135 to 499, again modestly elevated. By using one of these proven tools, we further reduce their risk of cardiovascular events, strokes, heart attacks, balloon stents, bypass surgery, and cardiovascular death by another 25%. So important, actionable, treatable, and preventable. Most all people Physicians, providers completely ignore those. So they're important. HDL is not, triglycerides are. And then LDL cholesterol is really fascinating. That's the lethal, life-threatening bad cholesterol that you hear about, the LDL cholesterol. I will tell you that, remember, when we measure your LDL cholesterol in your bloodstream, right, we pull a sample of blood from your bloodstream. All I'm seeing is how much cholesterol LDL is in your bloodstream. tells me nothing about is it sticking to the vessel and causing plaque. I can show you people with LDLs of 84, which by the way is well below average, on no drugs, that have extensive plaque at age 48 in the neck and in the heart.

So—

I can show you people with LDLs of 200 that have not a speck of plaque. So as it turns out, LDL Levels that we measure in the blood tell me nothing about, is it getting deposited? Is it getting sticky? Is it sticking? The only way we can tell that is by looking under the hood, putting you in our scanner, and then seeing if you have plaque.

So if you've gone to your primary, they've done the blood work, they've looked at your cholesterol, and they've said, we've looked at your cholesterol, it's a little high, it's a little low, it doesn't matter. It's not telling you anything other than what we see in our imaging. So if they say you're fine, you can't believe that.

Right. Or the other— I've seen people on drugs, on statins and other drugs to lower the number, who, by the way, have no plaque whatsoever. So when you lower cholesterol and you do not have plaque, you're taking a drug, you're paying for a drug, you're subjecting yourself to side effects, but it's not doing anything because you do not have the disease.

That blows my mind. So, if, if a patient went to their primary, they got their blood work, they said, oh, you have high cholesterol, we'll put you on some meds without seeing the scan. You could be paying for and taking these meds and having the side effects for completely no reason, potentially, because it's not accurate data.

Yeah. So, we know we've already done these studies, right? We know if you take people who have no plaque, we put them in the scanner, they got no plaque. If you treat them with a statin or don't treat them, there is no difference in cardiovascular events because these people didn't have the disease.

Right.

Right? Now, if you do have plaque, which can occur at high cholesterol, average cholesterol, below average cholesterol, right? You never know. If you do have plaque, lowering it Is incredibly important, right? That is the fertilizer. However, measuring how much cholesterol you have in your bloodstream, how much LDL in your bloodstream, tells me nothing about whether you have plaque.

Wow.

And again, we're overtreating people and getting worried and worked up they're going to keel over and die of a heart attack, and overtreating some people who are on drugs that don't need them. And then we're undertreating probably even more people who, who say, well, my cholesterol's average. Right? So, by the way, average LDL in the US right now is about 120, right? That's the average LDL. But appreciate, as I said before, 40% of us will die of plaque.

Mm-hmm.

So, if you put those 2 things together, think about this. If you tell me, well, I have average cholesterol, well, then I'm going to say, well, guess what? Because the person with average cholesterol 40% of us at average cholesterol levels will die of a heart attack or stroke.

Wow.

So, I tell people, if you're talking about average cholesterol, do not be excited about that. Don't, you know—

Be concerned.

Well, be wary.

Yeah, be proactive.

Be proactive because, you know, don't rest on the fact that you have an average LDL cholesterol. Because odds are you'll probably have the average heart attack or the average stroke.

Wow. Right?

So you have no idea when you measure lipids without knowing if you have disease, whether you have disease, right?

Yeah.

And so we overtreat and we undertreat, right? Also, too, LDL cholesterol, 95% genetically determined. So eat right, exercise, you might change it by 5%. If we need to stop plaque because we have shown that you have it, we need over a 50% reduction, probably 50 to 70% reduction. That will never ever happen. Well, I'll back up. I've seen one person in 30 years that was able to really drive down their cholesterol, uh, and I was shocked and surprised, honestly. So, I have seen one person in 30 years be able to do that with diet and exercise.

Wow.

The rest of us, it is genetic, it is hair color. If you're not blonde, but you need to be blonde, as I love to say, it's going to be in a bottle. That's just how it works, right? With diabetes, weight, high blood pressure, yeah, diet, exercise, weight loss can have huge impact upon that. For cholesterol, you're trying to change your hair color With diet and exercise, it's not going to work.

Okay.

But again, I have seen people that have really been browbeaten to get on drugs and lower their cholesterol when they don't have plaque.

Right.

And I love saying, good news, you don't have plaque. You know, we're changing a number. We're changing your LDL. You're changing your cholesterol, but you don't have the disease itself. Okay, imagine I'm an oncologist, a cancer specialist, right? And people come into me and I go, well, yeah, you look like you have cancer, so you get chemotherapy. You don't look like you have cancer, you don't get chemotherapy.

Right.

Well, that's insane talk. That's crazy talk, right? That's magical thinking. That's ridiculous. We don't do that.

Yeah.

Why do we do that for heart disease?

Yeah.

And in fact, in oncology, and I learned this as a medical student, right, years and years ago, it's kind of crude, but I'll say it, right? In oncology, no meat, no treat. In other words, we don't guess that someone has cancer. We get tissue, we do biopsies, we cut the stuff out, we go, ah, yeah, put it under a microscope. Yes, you have cancer. This is that kind of cancer, right? And now it's even more sophisticated with genetics and markers and all that. But we don't go, oh, you have a nodule in your lung, you're going to get chemotherapy because it probably could be cancer.

Right.

That's silly. But that's what we do in prevention of heart disease. It's crazy. It is very 20th, if not 19th century. But that's where we're at right now in the diagnosis and the appropriate treatment of heart disease. It's, you know, you look like someone who has heart disease, you look like someone who doesn't have heart disease. And how many people have you come across, right? who say, oh, he was strapping and fit and worked out, no bad habits, never smoked, etc., and keeled over dead, right? I just heard that story today.

Those are the people who are most at risk because they think, I'm super healthy, I'm a vegan, I run Spartan races. So they have this illusion that says, I'm fine. Meanwhile, if genetically they're inclined to a lot of plaque accumulation, they're the most at risk because they're not even conscious, they're not paying attention to it, versus someone who thinks, I'm high stress, I have high blood pressure, I'm diabetic. Maybe I should go and look and get this checked out.

Exactly right.

Yeah.

So I really, really worry about the people who eat right, exercise, do everything perfect, no bad habits, because they can also equally have strokes, heart attacks, or kill over that.

Right.

If you have a lot of risk factors, you might go, I got a lot of risk factors, let me go check it out. Right. And even then, checking it out, you get an EKG, tells you nothing about your blood vessels. You get a stress test, tells me nothing about your blood vessels. You get a nuclear stress test, tells me nothing about your blood vessels, right? All of the testing that we do, save for cardiac CT and AI, the CleerCardio approach, is pretty much a massive waste of time, money, effort, and involves actually really, particularly if you have a nuclear stress test that we do literally about 10 million of a year, Pretty impressive amount of radiation, right? I mean, you'd be shocked how much radiation we give you. If you look at background exposure to radiation, we all get exposed to radiation every year, right? A nuclear stress test gives you the equivalent of 10 years of background radiation. Wow.

I had no idea. Oh my God. Wow.

Yeah.

Wow. Well, Dr. Osborne, I'd love to show our audience Pictures so that you could explain the difference between the donut hole and outside the donut hole. So if I could, if I could maybe bring up some pictures and you could explain them to our audience, say what—

That would be great, Sherry. Love it. Okay, there we go. Okay, so, so what we're looking at here for everybody—

is it white screen? Hang on, something just I'll start drawing. One more time for the folks in the back. Give me 30 seconds for me to bring this up again. Where did, where did it— oh, this is me. Hold on, folks. Let me— where did my— that's why. Okay. Oh, because I zoomed in too much. And, and, and I told you I was tech savvy. Boy, did I lie. Okay, is this a little better?

There we go. Perfect. Okay, so let me, let me orient you to what we're looking at. This is a cardiac CT image of, of your blood vessels, which, by the way, we can take your heart, pull out your heart. I call this cardiovascular CAD/CAM. Pull it out, this, this incredible high-resolution 3-dimensional data set, right? Because it's digital, we can then began to dissect the heart, pull out the heart. This is the virtual autopsy. I love to tell people. And then what we've done here is we've taken one of the blood vessels up top here. Exactly. That's one of the blood vessels. We've now cut that vessel right through the middle. Now we're peering inside the blood vessel.

Right.

Pretty cool. And you get to walk away from this. Before we did autopsies, Wasn't a good outcome. So, what we're seeing is you can see the channel, that's the gray-white area, that's the channel where the blood flows down, okay? And you can see there's some tapering, if you will, so sort of in the middle of that picture, you can see a little bit of tapering. However, we'll not have symptoms, chest pain, angina, flunk a stress test, even a nuclear stress test, till we have at least a 70% blockage.

Okay.

And on a heart cath, an angiogram, which is actually what that's showing. So there's your 70-plus percent. That's a 78% narrowing in that vessel. But the other image, which— this is the before image, right? Down the other one is the after if you don't listen to what we're talking about today. So please listen. Is note we have the channel. That's the donut hole, right? There's a little tapering, right? So that's maybe— 30%, 40%, not enough to cause symptoms, chest pain, angina, make you flunk a stress test. That does not occur until you have a 70% blockage, right? So my finger would be the hole, everything else is plaque. Plaque always starts, and this is critical to import and how to understand how this works. Plaque always starts in the wall of the vessel. I like to call it the donut, right? And early on, and literally for decades, can— will actually grow outwards. So early on, go back to that first slide. This is someone who's had plaque for a long, long time, right? Probably decades, 20, 30 years perhaps. It's— the plaque has basically stuck into the wall of the vessel, into the donut itself, not the donut hole necessarily, and it has grown outwards. So if you look at that, And there's a cross-section right through that one section with that cross-section in the middle. There's the donut hole, the white-gray area, the— yep, exactly. And then now we can see what's actually happening in the donut itself. You can see the plaque has grown outward, and the channel is still pretty fine, right? It's more than adequate to deliver blood flow. You wouldn't have symptoms, you wouldn't have chest pain, you wouldn't have angina, you wouldn't flunk a stress test. And, um, if you're an adult, right, we know that about 92% of us will develop plaque at some point in our life, right? Some earlier, some later. But if you began to take people who have no symptoms, and these are middle-aged people actually, put them into a scanner like we use, use the AI, which is incredibly sensitive, we'll find 92% of people with no symptoms.

Wow.

Have plaque. The plaque again starts in the donut, it grows outwards for decades. The donut hole is fine, but also too, when you look at these colors, these colors are very, very meaningful and important. The first plaque that's laid down is actually the red plaque. So if you go to this other cross-section, we're taking a cross-section through that vessel, and you can see the red stuff. Is the really nasty plaque that's vulnerable, as we call it, but that is most prone to rupture and to cause that heart attack. It is the red-colored plaque. This is really, really bad plaque. There's no good plaque, but this is the really bad plaque. This is the plaque that really is unstable, can rupture at any moment. And the only difference between this plaque and a heart attack Or a stroke, because again, this blood vessel could be a vessel in your neck, a carotid artery. The only— what is the difference between this vessel and a heart attack when plaque ruptures is seconds to minutes, because any moment that plaque can rupture, form a blood clot, and that white-gray area, which is where the blood flows down, is rapidly plugged up by that blood clot. All this occurs in seconds to minutes, and then you're off to—

Death.

Having a heart attack, we're having chest pain. Hopefully we get to the emergency room, they throw a stent in there quickly before our heart starts dying. Or as in half of the people, the first symptom is plaque rupture followed by sudden cardiac death, and you never make it to the emergency room. Or maybe you do, but it's still too late and you die in the hospital. The red is the really, really bad plaque. The yellow is bad plaque. And you can see with the AI, We can identify the really, really bad plaque, the red stuff, the bad plaque, which is the— or I'll say really, really bad is red, really bad is yellow. That's that fatty, buttery plaque. As these plaques mature and change over time, they will begin to calcify. So I always call the red and also the yellow the lava, but we can differentiate how bad the lava is. There's different kinds of lava. The red is the worst lava, the yellow is bad lava too. As these plaques mature and change, and as they get older, they will begin to calcify. So the whites, the blue stuff, which is what the AI colors, is the calcified plaque. That is the end stage of plaque. That's no longer an active plaque. It's not prone to rupture. It's not gonna usually cause trouble. It stops growing. The red and the yellow are the lava. This is the active— Growing rupture-prone, vulnerable, unstable plaques that within seconds to minutes can rupture. I feel fine, had a normal EKG, normal stress test last week. Within seconds to minutes, these plaques can rupture, and now you're in the midst of a heart attack, which could be fatal. As they get older, they begin to calcify. And so when people get calcium scores of the plaques we're seeing here, the 3 kinds of plaque, We only see the plaque on the right. This is the old extinct volcano. This is the cinder cone. We only see the calcified plaque, which is blue with the AI. Or if you look at the raw data we call grayscale, you can see looks like the white stuff. That's the hard calcified plaque that will show up in a calcium score. All the other plaques are completely invisible.

So, if they do a calcium score and it's 0, That doesn't mean you don't have the lava plaque.

Absolutely not, because the lava plaques will always 100% precede the calcified plaques. The plaques always mature left to right. So when they find a calcified plaque, it means good news, we've survived any lipid-rich plaques at that point. But I can only see calcified plaques, I can't see if there's blockages, and we, more importantly, We can't see the vulnerable plaques, the lipid-rich plaques, the plaques that are prone to rupture. Those are completely invisible on a calcium score. With AI though, this is exactly the data we get. We can see them, identify them, determine the different kinds of plaques that there are as shown here, the yellows, the reds, the blues. The other thing is with the AI, and this is humbling for me to say, if we go down a little bit, This is where we apply the AI. It identifies the plaques, colors them, does all this beautiful stuff— reds, yellows, and blues. If you look at cardiac CT without AI, I can see the channels, right? So there's the, the gray-white is the channels where the blood is flowing. But the plaques that are most likely to rupture, that are the growing active plaques, the vulnerable plaques, are dark. So if you look at the plaque on the right, you can see there's calcium. It's easy to see. It's bright, easy to see, right? The plaques that are prone to rupture, that are unstable, that are growing and active, are actually black. And if you look at this without the AI, you might see a little shade in the middle, in that middle plaque right there. It's beginning to calcify a little bit. The plaque to its left, there is no calcium. That black stuff, which the AI can see and detect, is invisible to our eyes. So this is where I have to be humbled by AI. But the AI that we use will be able to pick up all of these plaques, plus— not shown here— to be able to quantify them extremely accurately. So we'll know exactly how much plaque there is. We'll see narrowings. We'll measure all that. But more importantly, we'll determine how much plaque there is, the total amount of plaque, How much lava-type plaques you have, how much calcified plaque you have, and to be able to see literally things that we cannot see with our eye. To give you a background, on the bottom, we're showing you the raw data that comes out of the CT machine. We call that grayscale, right? So it's shades of gray between black and white. Our eyes can see or differentiate. So this is grayscale. You can see the heart and the blood vessels. Right? So it's just black, white, grays in the middle. Our eyes can see or differentiate about 50 to 100 shades of gray. However, each one of these pixels coming out of the CT machine is actually encoded with over 2,000 shades of gray. So it literally— the AI can literally see plaque that is invisible to our eyes. So if you go back to that prior image, By eye, I could see the calcified plaque on the right. It's colored blue. Easy peasy, not a big deal, right? The plaques in the middle and to the left, which are actually the active plaque, the lava, the lipid-rich plaque, the soft plaque, the growing plaque— these are all synonyms— can absolutely be invisible and not detectable, even though I've done 20,000 cardiac CTs over the last 25 years. These lipid-rich plaques can really be not seen until we apply the AI to that, to be able to see things that we cannot see. It's almost like putting on glasses for the first time. The world is entirely new.

That— this technology is definitively what makes this life-saving, life-changing information. This is the information right here and now that if you were ever worried That you would have a heart attack, your mother had a heart attack, your sister did, whatever. If you had any—

You got cholesterol, high, average, low, doesn't mean anything, right? We talked about prediabetes, diabetes. The other thing, and I apologize because I, as usual, get carried away, but high blood pressure, right? Half of US adults, I'm just talking over the age of 18, half of US adults have high blood pressure. Half of those are diagnosed. Half are treated, and half are diagnosed, treated, and controlled. Half of a half of a half. So, in other words, an epidemic problem. Half of us have it. In fact, from the age of 40 onwards, and Sherry, one of these days you'll hit 40, and you'll understand this. But from the age of 40 onwards, the lifetime risk of developing high blood pressure in the United States that can cause cause blindness, strokes, heart failure, blow out your kidneys just with high blood pressure alone. You don't even need plaque for that.

Wow.

Half of adults have it from the age of 40 onwards. The likelihood that you develop high blood pressure in the US is 90%. 9-0, not 1-9. 90%. And it is the silent killer. You feel fine until you don't, until you have your heart attack, You're stroke, you go blind, you blow out your kidneys, or you have a heart attack or stroke because of the fact that high blood pressure— we talked about Teflon versus Velcro— high blood pressure will convert that Teflon lining of the vessel into Velcro. Now, you have nice sticky vessels, and plaque is more than happy to set up shop there.

Wow, that's— I learn something every single time I talk to you.

Well, thank you, Sherry. That's quite the compliment, as knowledgeable as you are.

Oh my goodness. So, right, so what do these numbers tell us, Dr. Osborne?

So we looked at the qualitative AI, right? The colors, we can kind of look at the vessel, we can see some lumpy bumpy stuff that I call it. In fact, that's actually how I got engaged and inspired to do preventive cardiology, because 3 decades ago, we'd do heart caths on people, do an angiogram. All I could see was the donut hole. I couldn't see what's happening in the donut back then. And we'd see— we'd do these heart caths and see what we call lumpy, bumpy disease, kind of like what you're showing here. And we go, you're fine. And then toodles, off you go. And then we'd basically let them ripen up until they came back with a blockage or narrowing. But again, and then we did another heart cath, and then they got stents or surgery. But appreciate, we only did that in the people that survived. Half the people had plaque rupture, they died, they never made it back to the cath lab. So when I saw that and thinking about polyps in the colon, right? So I'm saying, we based on a heart cath, an angiogram, which is pretty crude technology that unfortunately we still do millions of year— that we do millions of every year in the US and globally. I stopped doing that literally this year, 20 years ago. Because cardiac CT evolved to the point— of course, we didn't have AI— but evolved to the point where it was so good. 5% of the cost, none of the risk of an invasive procedure like a heart catheter angiogram, and I could now see the donut and what's happening in the donut, not just the donut hole. 20 years ago, I stopped cathing people, and I have not cathed anyone since then because cardiac CT is so good. Now, in the last few years, we have the AI to do the beautiful pictures and the colors. So we talked about the colors, we talked about the difference, the colors, all of that. But then furthermore, what AI will do is if you're looking below that picture, you'll see these numbers. On the left is the total plaque of all of the plaque measured here in just this one blood vessel. Remember, we have 3 major blood vessels, right? This is just one of them. This person has 178.9 cubic millimeters of plaque, which, by the way, is a lot. The computer will also develop and determine the exact— we call it stenosis. That's the fancy word for saying narrowings or blockages. So it does all that as well. Also, too, to the right of that, you'll see this thing called remodeling index. Remember, talking about plaque starts in the wall, grows outwards. Well, that's the ratio of how much plaque we have in the wall versus the channel. So this means that 50% of that plaque has expanded outwards in the donut before ever causing any narrowing of the vessel. So that remodeling index is very important. And also, the higher that number, the more likely that plaque is to rupture.

Oh my goodness.

And to break off, flake off. So all of this is very important stuff that we could not do without AI. The number shown here over to the left, that 178.9, is the total plaque volume. That includes the 3 kinds of plaque. We have the red plaque, which is the really, really bad, nasty plaque. This is a really— if you see this plaque, this is major urgency that we need to change the trajectory, as I call it. We need to stop this, reverse it, get rid of it. So this is the really, really bad plaque. They're all bad, But this is the really, really bad plaque, most likely to rupture and cause a heart attack. So we have 4.4 cubic millimeters of that. The next plaque, the yellow, is the lipid-rich plaque. That's the yellow stuff. You can see it's all over the place. That is that fatty, buttery stuff. Again, this is lava. This is the active growing plaque, is likely to rupture as well. And then on the right side is the calcified plaque. And you can see relative to the total amount of plaque, basically 180 cubic millimeters, only 15 is calcified. When we do a calcium score, all I'm seeing is the 15.5.

Oh yeah, that's scary.

Part of this fraction. Everything else— narrowings, blockages, lava, lipid ridge, soft plaque— completely invisible with a calcium score. Again, great place to start perhaps, but do not take that to the bank, and this is the reason why. And we do this analysis for all of the different blood vessels of the heart. This is just one. We do this analysis for all of the different blood vessels. We also, by the way, another AI package is if we see a narrowing that looks concerning that could be blocking the vessel, we can actually, beyond looking at stenosis, which is saying what percent of the vessel is blocked, we now can also run an AI package on top of this. Called ischemia. Ischemia just means reduced blood flow. So we can take that vessel, hit this little button, ischemia button, that will then tell us, is there reduced blood flow down that blood vessel, also using AI as well. So that's why it is so disturbing to me, because I have seen the future and I've been living the future for 25 years, that we're still doing millions of heart casts, tens of millions of stress tests, And all of the data I'm showing you, none of that can be derived from those kind of testing.

Wow. Well, Dr. Osborne, a lot of our patients or people that I speak to on the phone, they wonder once they have the diagnosis, now what? Like, what happens at that point? And, and a lot of doctors don't give the same kind of care that you do. What happens after you've Read all of this information to them?

Sure. So what makes me a little unique, even there aren't that many preventative cardiologists. We talk about how many cardiologists and lipidologists there are, which is a very, very small number of people. However, I'm going to make myself and use the first, even more of a unicorn, right? I've been doing cardiovascular imaging for over 25 years with cardiac CT. And then adding on all the things that have developed like that, just as we went from the iPhone 1 to the iPhone 16. I've been doing that for 25 years now. We have this incredible high-resolution imaging with cardiac CT. The machines have only gotten better, better resolution, less radiation, etc. The latest big breakthrough, which is massive, is the ability of using AI, which we walked you through. So there certainly are imagers out there that do what I do. Okay, not that common, but there certainly are. There are imagers like myself out there. Here's the problem. There are very few people that have a foot firmly in imaging and understanding and getting and interpreting and also communicating this to people as well. Because I think very few people— most of my colleagues speak medicalese. I have a translation degree. converting medically to human. Okay, very few of my colleagues do that. They could be really bright Einstein people, but they could not explain to people what's happening, right? So that's another aspect of this, uh, that I particularly pride myself on, and being able to take really complicated stuff, images, concepts, and then be able to discuss that and explain that to anybody so that everybody understands. The other foot that I have is firmly planted in prevention. Being aware of, okay, we've made the diagnosis. You have plaque. What can we do about it? What can we stop? How can we stop and reverse it? There are people and preventive cardiologists that do that. However, they don't have much knowledge about the imaging because they take the imaging from somebody else. But very few people both have a foot firmly planted in imaging and figuring out what's going on. And understanding where the future is going as well, but also have a foot firmly planted in, okay, now we know we have plaque. What are the proven things we can do to stop it, change it, reverse it? That really, to be honest, most importantly to you means, do I need stents? Do I need balloons? Do I need surgery? Do I— will I have a stroke? Will I have a heart attack? If we pick this disease up early, it is extraordinarily unlikely. Any of those outcomes ever occur to you, particularly if we work together and we're productive. I will always educate my patients. And one thing that also makes us different is, again, feet firmly planted in both diagnosis as well as therapeutics, imaging, and ways to stop and reverse plaque. But also, we have an incredibly effective tool that almost no one has. Is we have time. We will walk you through this. We will describe it. We will show you the pictures. You should have no misunderstanding about what's going on. Then we'll tell you what we're going to do. And everything we do is really based on incredibly hard, firm science, right? We have incredible tools out there that exist right now, but a pipeline that is unbelievably Mind-blowing as well, but incredible tools right now, right here today that have proven to lower the risk of balloons, stents, bypass surgery, heart attacks, strokes, prevent heart failure, treat heart failure if you have that. So all we have incredible therapeutics right now at this moment. Our biggest sin in cardiology is early detection. We wait until the machine is broken, then we leap into action. Now, appreciate you've had the disease, you've had the problem for 20, 30 years, but we waited until your machine was broken, and it could be permanently broken, meaning you're dead, or just something we can fix with stents, balloon surgery. But we have incredibly effective therapies, both diet, exercise, lifestyle, and of course medications as well, to stop and reverse plaque long before you ever have symptoms. And that's really gonna be the goal of how we take care of heart disease in the future. Never waiting till you have symptoms, never waiting till you need mechanical interventions, balloons, stents, and bypass surgery, or keeling over dead. Instead, we detect it, we analyze it, we educate, we're all on the same page, then we talk about what the appropriate strategies are. And now again, we loop back to the AI. Once we take these images and we have both the what kinds of plaque you have, where they're located, what types of plaque, How much plaque, all of that is laid out in the prior pictures. We can then use these tools, and I'm going to say, do not trust me. And I'm saying, because I'm going to get all the gauges in the green, blood pressure, cholesterol, prediabetes, weight, tobacco, whatever. And this is where it has to be personalized to you, right? We'll do a personalized program. And here's where I say, don't believe me, because we're going to put you back in the machine after a suitable period of time. And then show you that the plaque—that not only are the numbers better, blood pressure, cholesterol, weight, etc., whatever might be relevant for you—but then put you back in the machine and don't take my word for it because I'm going to show you that the plaque has improved. And that's something we could never ever do before in cardiology. We do it in oncology: early detection, screening. Stage. If you have it, treat. Then we restage you because you, you, after you go through all that surgery, radiation, chemotherapy, you go to your oncologist. How am I doing, doc? He wouldn't go, well, you look okay. No, he puts you in the scanners, right? That's what we do. And he says, okay, the cancer's gone, or it's better, or it's remission, or maybe whatever we're doing hasn't been working and it's progressed. But you know that because we did imaging, and then they redirect accordingly. Well, we could never do that in cardiology, right? I'd say, well, are you having symptoms? Chest pain? No? Okay, good. Well, is my plaque better? I have no idea. I couldn't tell you. I couldn't tell you until we could do absolute accurate plaque quantification, and we could not do that until we had both cardiac CT Now coupled with AI. So that's why it's so exciting to be a preventative cardiologist. We are leading the curve, right? We are going to eliminate heart disease as we know it, right? We're going to detect plaque, treat plaque, stop plaque, reverse plaque using both the appropriate imaging coupled with the appropriate interventions, which again can be diet, exercise, weight loss, all of those things, stress reduction. helping you sleep better, and of course, medication if appropriate. This is how you are going to help put me out of business, how we're going to eliminate heart disease together. I cannot do it myself. I need everybody in this audience to help put me as a preventative cardiologist out of business. But before I'm out of business, we're going to put out— put out of business the interventional cardiologists, the people who do stents and balloons. We'll put the stress tests out of business. They should have been out of business 20 years ago. We'll put out of business the cardiac surgeons, the people who do bypass surgery, right? We'll put all them out to pasture first. Nice people, I love them, but we're just going to make them irrelevant, right? And then ultimately, once we have all that under control, then you guys can— I'll be able to retire knowing we have solved and eliminated heart disease. And yahoo!

That's incredible. I have a question, Dr. Osborne. I'm curious how many patients that you see that are new coming from other doctors that are on a cocktail of medications that don't talk well to each other. They shouldn't be taken together. They're taken needlessly. How many times do you—

Oh, I would say that's the rule, not the exception.

Yeah, all the time. Like every—

All the time. Yeah, all the time. Occasionally I'll see someone come in And they'll go, those spreads are pretty good, right? Once in a great while.

Right.

But even then, they still don't know, do they have disease? Do they have plaque? Is there buildup, right? But yeah, unfortunately, even on the therapeutic side, you know, fixing the problem, it's pretty terrible, unfortunately. I have to admit, I wish that were not the case. I'm going to be the first to say I don't think what I do is really complicated. I said before, I do some plumbing, I do some electrical, but apparently it must be pretty incredibly challenging because what I think is really simple, easy, okay, bing, bing, bing, right? And plus, we walk people through it, we educate them, we're showing them pictures, we're telling them, here's what we're going to do, here's the plan, here's what we're going to look for, here's any problems, issues, side effects you might run into. So all of that. And again, We have an incredible asset that most all providers— I don't care whether you're an MD, DO, PA, NP, whatever, whoever you see, whoever's managed you— that they do not have. Forget the incredible CT machines that we have, the incredible AI, my knowledge, experience, wealth, talent, whatever. But we also have an incredible gift, an asset that almost no one has. Is we have the time. We have the time to walk you through all this, explain it to you, answer your questions. We're not going to see 5 people an hour. That is the guarantee of horrible medicine. You will not be happy. Things will happen to you. And I could not do that. That's why we have Clear Cardio. So there's multiple parts, the right imaging, the right technology, the right AI, the right plan, The right therapeutics. But covering all of that, embracing all of that, is making sure that you are very, very well educated. You understand— if you do not understand everything that I just discovered or just discussed here, from how we detect it to what that means to what we do about it, then I have not done my job for you. But that's where we have an incredible asset that almost no one has, which is the time to educate and walk you through this. Plus I have my, as I kid people, my degree in translation from medicalese to human.

And speaking about time, I just spoke to somebody today who couldn't even meet with a cardiologist because it was months and months out. The waiting list was so long. So once they speak to Cleer Cardio, what's the timeframe from speaking to us to getting answers, would you say?

Yeah, I, you know, Sherry, I'll have to say you're, you're the, the person that really has your, your finger on that pulse. But I will say pretty typically phone call to scan easily could be in a week without, without any major big deal issue. If it has to be even quicker, we'll make it happen, right? We're, we're there to serve and take care of you. And as I say, the first step though, you gotta look under the hood, right? You, you can't guess what's under the hood. I don't know how much gas is in your tank by looking at your car. I can't tell you if you have leaky valves, car valves, whether you have low oil or whatever, right? You got to look under the hood. So we promise we will. We are very highly efficient at doing that. And I would say probably within a week is pretty typical for a lot of people. And again, if it's even more urgent, well, we will make sure we get you in that machine as soon as we possibly can.

And the famous question that gets asked all the time, what about insurance?

Yeah. You know, some of the things that— well, pretty much all the things that we do, I think, will be done in the future. Hopefully, I pray to God, will be done by everybody, everybody, But, you know, that's in the future. And I can't tell you whether that's 5 years or 10 years from now. Right now, to do these scans, for insurance to pay for it, you have to have symptoms, which is crazy. So, you've already got a 70% blockage potentially, right? Maybe you do, maybe you don't, because you don't know. You know, you can have heart disease and have no symptoms. You can have symptoms and have no heart disease, right? So, you don't know until we put you in the scanner. But unfortunately, how insurance pays for things is they wait until you have symptoms. Okay. Uh, you know, cardiac CT is great, and if you do have blockages, it's a great place to start. But I'm going to encourage people, never wait to have symptoms, because the, the top half of the class, the lucky half of the class, have symptoms and we figure it out. And then they usually have to get by this point because we're talking about severe disease. Stents, balloons, surgery, mechanical things. Then we take care of things medically, right? But that's the top half of the class. The bottom half of the class, their first symptom is they died.

Right.

So, we'll put anybody in our scanner. I mean, we've had people with stents and bypasses and all that's fine, and we can still add tremendous value because most people still don't know how to treat and reverse plaque. We can do that. But, you know, the biggest part of the pyramid, the prevention pyramid, the tiny little bit are the people with symptoms. Okay? They need to be acted upon very, very quickly, readily gotten, you know, taken care of because they have— they're at the end stage of a 20 to 30 year disease process. Right. But the people that really will benefit from this are people who don't have symptoms. Insurance does not pay for that. Alas, I'm not in that business. I don't— it's not my— Right. I don't do that. I'm just telling you how the system works. The other thing is, even if they did, they would probably would not have access or use or familiarity with or training in the AI that we use on a day-to-day basis. And then even if all of that occurs, is someone who has knowledge, experience, training, hopefully maybe talent, And also really good at communicating these concepts, they're not going to have the time it takes to walk you through this process to make sure that when you leave and when you finish our interaction, that you really have a great handle on both what's happening and what we're going to do about it. Because the typical insurance hamster wheel, you know, I'm seeing 4 to 5 people an hour, right? If I did that. Which I can't. That's not practicing adequate medicine for me. I can't sleep well, and I'm not going to do that to my patients. We have the time and the ability and the knowledge and the training, but also the educational ability to make sure that you completely understand what's going on, both as far as any issues with the heart, but also what the plan is. And that's something that You can't do within the insurance world. I mean, if you're gonna play in the insurance world, you know, you got 10 minutes. And that's just— it could be inimical to the Clear Cardio strategy plan and what we have, what we're gonna do for you. And then, of course, you know, on the follow-up, you know, we do a lot of specialized labs that are really important to understand what's going on, highly selected for me. We don't need to do a massive amount of labs, but the right labs, and then overseeing that, make sure everybody's on track and all of that stuff. And there's just nobody that has all of those different parts together, plus the gift of time, the ability to educate. That's just— that's what people are paying for. And if you want that level of care and understanding and knowledge. You know, this is why we have Clear Cardio. And I will say, and I think I've said this to you as well, Sherry, I always love to say I don't have patience, right? Not either manifestation of patience, right? But I love to say I don't have patience. But once you're in the Clear Cardio family, I always love to say I don't have patients, but I do have a really, really extended family, and that's how I treat all my patients, right? I kind of even hate to use the term, you know, because once you're part of the family, you know, we're going to take care of you. I'm going to take care of it like your brother, your sister, your kid, your mom or dad, because that's how I want to be treated, and that's how we're going to treat you too. So we love spoiling our patients, right? So again, We don't have patients. We do have a very, very large extended family.

And as I've met all of your family members, they all sound—

I got lots of them.

Madly in love with you for over a decade, for over 2 decades. They just love you and adore you. So amazing. Amazing. Well, team, if you are looking to connect with Clear Cardio, You just there it is the website clarecardio.com on there you're going to find another training with Dr. Osborne. You'll see an opportunity to submit a form. We'll reach out to you the moment that form is submitted and connect with you, and we'll jump on a call and we'll explain how this works. And to be clear, we don't take insurance. Deny, delay, and defend is. Not our model at all, and we don't like putting life-saving decisions in the hands of administrators. So reach out to us, we'll walk you through how it works. We're excited to welcome you to the family. Thank you, Dr. Osborne, for all of that.

And, and one of the things, Sherri, uh, check out our YouTube, uh, channel, right? Lots of educational stuff, people's stories. Lots of educational stuff. If you haven't got enough of me, I'm sorry, you can get even more on our YouTube channel, and we're expanding that every week as well. So, please check that out just for informational purposes or hear other people's stories and all that. Lots of good stuff on there as well. So, check out our Clear Cardio YouTube channel as well.

Absolutely. Power of Prevention podcast, we have, we had Uh, Olivier, Anthony Tolivier, come on. We, we have lots of amazing guests coming in. So thank you again, Dr. Osborne. We're here at the top of the hour. I know you have a very important, uh, meeting to get to. Thank you so much for all of that information tonight, and, um, we'll be hearing from you guys soon. Thank you.

Sherry, thanks so much. You're, you're, you're so, so wonderful, and, uh, I, I am delighted that you're my Partner in prevention.

Thank you.

Have a great day, people. Bye.