In this interview, a Harvard‑trained cardiologist explains why cardiovascular disease remains the leading cause of death in the United States and why traditional risk‑factor calculators are insufficient. He introduces coronary calcium scoring as a cheap, low‑radiation, highly predictive test that can overrule cholesterol numbers— a zero score indicates very low risk, while any non‑zero score signals the need for preventive therapy. He critiques stress tests and invasive heart catheterizations as outdated tools that cannot directly visualize plaque. The conversation then traces the evolution of cardiac CT technology from the first 64‑slice scanners (circa 2005) to today’s 640‑slice machines, highlighting how modern CT can differentiate soft, lipid‑rich, active plaque from older calcified plaque. He likens a CT angiogram to a “biopsy” of the heart, providing 3‑D images that reveal the true state of the coronary arteries. The cardiologist also mentions that his center installed North America’s first 640‑slice cardiac CT, underscoring the cutting‑edge nature of his practice. Throughout, he emphasizes that a non‑zero calcium score is actionable and that widespread adoption of cardiac CT could dramatically improve early detection and prevention of heart attacks.
Chapters
Cardiac issues kill far more than any other condition out there.
So strokes and heart attacks, fatal strokes and heart attacks, basically kill about a million people a year in the US, which is greater than the next 7 causes of death combined.
Including cancers, then, I would presume.
Oh yeah, cancer's number 2. Yeah, but there's motor vehicle accidents and—
2, 3, 4, 5, 6, 7.
And all that.
Roll all that together, still less than heart. No one ever had mentioned to me this idea of having a calcium score done until I met you, and you're like, well, it's the only thing that— you could have high cholesterol numbers and a 0.0 calcium score, and you're really good to go.
Yeah.
But you could also have low cholesterol and a high— and any number really of a calcium score is a bad number, and you'd want to potentially be on a statin or some other sort of therapy to help that situation. And I was thinking, this is— I'd never heard that before until I met you. So maybe talk a bit about—
Well, and first of all, Eric, I got to say I'm really, really happy you're a zero.
Yeah, thanks. Appreciate that.
No problem.
First time ever.
I've always threatened I've got to come up with a t-shirt that says, I'm a zero.
I'm a zero and proud of it. Right.
Proud of it. So I'm happy you were zero. Right. So let me go through a little bit on— well, one thing I'll cover, right? So historically, we have tried to assess people and guess what's in their blood vessels, right, by never looking at their blood vessels, right? We use risk factors, right? Age, sex, smoking, diabetes, high blood pressure, cholesterol, a variety of things, right?
Right.
All those things are population-based, right? So what it's saying is, if I look at those risk factors, and we have fancy tools to be able to risk, understand your risk over the next 10 years and all that. But if I look at that, what that tells me is it says someone that looks like you is at X percent of risk over the next 10 years of having a cardiac event. But what about me? Well, I can't tell you anything about you because we never looked at your blood vessels.
Right.
Right. Imagine you went to a GI doc and you're worried because everybody in your family has polyps and colon cancer. And he does this, gets out this piece of paper, does a calculation assessment, and It says, your risk of colon cancer is very high. Well, tell me something I didn't know. I just told you my whole family has it. But because your risk is so high, based on the fact that your risk is so high, I'm going to recommend 6 months of chemotherapy. That's pretty insane.
Pretty intense.
That's crazy. You'd run out of that office. You'd go, you're insane.
You're crazy.
You never looked at my colon. That's what we've done wrong in cardiology. MCATs as a freshman in college.
Wow.
And, um, in one year from Penn State, in one year, the next year you could be starting medical school. So I started medical school at 19. In the last 2 years of medical school, you do your clinical rotations, right? So I rotated through cardiac surgery, I rotated through, uh, cardiology, uh, and I realized cardiology is definitely my interest, right? Surgery, not to dismiss my excellent and most esteemed surgical colleagues.
Of course.
You're standing on your feet for 6 hours, you're staring into a bloody hole, people show up, you fix them, hopefully no problems, issues, then they disappear. That's not— I like continuity of care, I like to educate my patients, I like long-standing relationships. So that became a very, very easy decision. And so by 2005, They came out with what I'll call the iPhone One equivalent, right? This was a 64-slice cardiac CT machine, now with better hardware, better software, still rough compared to what we have 20 years later. But this was now the tool that allowed me to see the entire donut. I could see the plaque, I could see the blockages, I could see what's happening in the wall. Furthermore, we could see the different kinds of plaque you can have. Really active, growing, nasty plaque, the kind that causes heart attacks. We call that soft or lipid-rich plaque. And then you can also see older plaque, calcified plaque, hard plaque that's really no longer active. But none of that you could see even with an invasive $20,000 heart cath. With cardiac CT, I could begin to see that. So by 2005, before then, I did stress tests, which frankly I'm going to say are not useful.
Mm-hmm.
I did heart casts, which have now been replaced with cardiac CT in my practice, but all that occurred by 2005.
And this is effectively like an MRI for the heart, or an X-ray, would you say?
Yeah, it's basically a CAT scanner. If you ever— a lot of people, we do about 20 million CAT scans a year, so if you've ever had a CAT scan, it's the big donut, right? I call it the MRI is more the coffin, right? Where you're like—
Yes.
Get a calcium score. It's a great place to start. We'll talk about other tools, et cetera, and how those work out. But do not let anyone tell you you have a low score. You're zero or you're not zero. Okay? If it's not zero, that is actionable. Okay? So calcium score, very cheap, simple, easy, great, low radiation, et cetera. What a CT angiogram is, is the next level. So if there's a mammogram, We'll call a CT angiogram the biopsy.
Yep.
When we do a CT angiogram, we use a much more sophisticated CAT scanner. We started out in 2004, 2005 with a 64-slice CT. We've now evolved to the iPhone 16 equivalent. It's a 640-slice cardiac CT. The machine we use, actually— thank you, Carrollton Regional Medical Center— is the first install of this 640 slice machine in North America. There are very few people putting together all the parts we've put together.
Right.
We are not going to eliminate heart disease via stress tests, EKGs, heart cath, because we've been doing that for over 50 years. And by far, heart disease, cardiovascular disease, still after throwing those tools at it, is still by far the leading cause of death. So those are not working.
Right.
With a cardiac CT, a specialized CAT scanner, very high resolution, very, you know, pull out all the stops. We then give you contrast. We give you IV in the vein that allows us to get— if you've ever seen those 3D pictures of the heart and, you know, with all the blood vessels and they look cool and you can look like you can reach out and touch it, that is a CT angiogram.
Okay.
And with that, now we can And the latest big breakthrough in the last few years is now we can take all that high-resolution 3D data, upload to the cloud, do this incredible AI analysis, which will output exactly how much plaque you have measured down to a tenth of a cubic millimeter. By the way, if you look at the period of end of sentence, that if that were a sphere, that would be about a tenth of a cubic millimeter. www.clearcardio.com ClearCardio.com, and let let us save your life.
