Soft, lipid-rich plaque in coronary arteries predicts heart attacks far better than cholesterol levels or visible blockages. AI imaging can now identify people with zero plaque, who never have heart attacks, making plaque presence the decisive factor.
Whatever your cholesterol is, whatever your habits are, good habits, bad habits, whatever. If you don't have plaque, they don't have heart attacks. If you look at lipids, cholesterol, or just risk factors, or even blockages, they're only poorly related to heart attacks and cardiovascular events and stroke. The greatest relationship is how much plaque you have, your plaque burden, and of course the type of plaque, particularly the more soft lipid-rich plaque. That is really the best predictor. And if you look at people that have zero plaque using AI, they don't have heart attacks. It's just not gonna happen. Whatever your cholesterol is, whatever your habits are— good habits, bad habits, whatever— if you don't have plaque, they don't have heart attacks.
