The Heart Scan That CAN See What Bloodwork Can't

Heart disease is the number one killer of women. Not breast cancer, not any other cancer— heart disease. It kills more of us than every form of cancer combined. And most heart attacks in women, they happen from plaque that was never actually picked up on any of the tests that most of our doctors run. So for example, your cholesterol could look fine, your stress test could look fine, even your EKG could look fine. Everything could look fine on paper, and then one day, heart attack. On the flip side, some Some of us, me included, have cholesterol that does not look fine. Maybe our numbers are very high on labs and our doctors are encouraging, or maybe they have put you on a statin, but nobody's actually checking for if you actually have plaque because a high cholesterol number doesn't automatically mean disease. Some people have a high cholesterol and clean arteries. Some people have perfect cholesterol and plaque everywhere. Labs do not tell a whole story, not even close. And it doesn't really matter if your numbers look good or bad if we're not actually testing for disease. And there's a reason that this is happening this way. Traditional cardiology has been treating us blindly. Our cholesterol number does not tell us all the answers. A stress test only fails when an artery is already 70% blocked. A calcium score only sees the old hardened plaque, and it can't see new soft unstable plaque that actually causes heart attacks. The soft plaque is what my guest today calls the lava, the stuff that ruptures, the stuff that flakes off and clots our arteries in seconds. And it's been quietly forming in our bodies since our teens and even 20s, which means that by the time we're a midlife woman, most of us have plaque. We do not know it. And 99% of people scanned at his clinic have detectable plaque, but only 1% are clean. So my guest today is Dr. John Osborne. He is my personal cardiologist that I went to for testing. He's an MD and PhD in cardiovascular physiology from Thomas Jefferson, founder of Clear Cardio in Dallas, and he has He's one of about 1,000 people in the world trained to interpret them at this level. His mission is early detection, and his words are the cardiac version of a colonoscopy. Find the plaque, measure it, track it, reverse it decades before symptoms show up. And he has stated his goal is to eliminate heart disease and put himself out of business. Every woman listening today needs this conversation. Dr. Jaws, I'm so Dr. Osborne, excited to have you on the show. Thank you so much for having me. welcome to the show.

Thank you so much, Natalie. Absolutely brilliant introduction. I'm gonna have to live up to that. I want to compliment you on— so eloquently said, I couldn't have stated it better. You'll give me some time to do that, perhaps, but just absolutely brilliant. And I have to say, with my patients, ultimately want to eliminate heart disease. As I told you, and I tell everybody, I want to put myself out of business. But I have to compliment you, you are an amazing preventative cardiologist. So clearly our time together has really rubbed off on you. So just brilliant explanation. That's such a beautiful expression and so evocative and accurate about your description.

Thank you for that.

Amazing.

So, y'all, if you've been following along on my show, you know that I have shared that I have had this genetically high cholesterol my whole life, LDL specifically. And I had told myself that when I was in my 50s, I would address it. I pretty much didn't want to deal with it for many, many years. I didn't have any other risk factors. Now being turning almost 55, I thought, okay, it's time to take it seriously. I've got to figure out what's going on here. And any cardiologist I've ever seen has always told me, you've got to lower the LDL, you need to go on statins, you need to do some type of medication, or you'll have a problem. Now, my dad, my own personal father, died of a heart attack at age 49, so I took this very seriously. But I was— I knew about 3 years ago to get a scan that we'll talk a little bit about that scan today. which could show very early detections of soft plaque. And when I did that 3 years ago, I had very, very, very minuscule traces of it and I knew, okay, I need to retest again in 3 years. And I'm happy to report that when I had my consult and new scan with Dr. Osborne, that had actually gone down significantly and we're going to talk about that today. So, I personally, personally, I'm not giving medical advice here, I am not starting an LDL-lowering medication. medication right now because everything I'm doing has been working to not create disease right now. But we're talking not about me today, we're talking about you, and we're going to talk about how serious this is and what we need to be actually looking for and testing for. And I'm— we're going to give you a whole education here around this. So, Dr. Osborne, let's start with what is plaque? What is it?

Sure, absolutely. So plaque is the stuff, it's the fatty, fatty, buttery Goopy stuff that gets deposited in our vessels, in the wall of the vessels, it's a very slow glacial process. So in most people, as you said earlier, and it's completely accurate, the process of the earliest deposition of cholesterol, which is what that plaque is made out of, usually occurs in most people in their teens or 20s. So it is a very slow glacial process. Obviously, we don't have heart attacks in our teens or 20s. We have our heart attacks in our 50s, 60s, et cetera. Because over decades, that cholesterol continues to deposit. Again, we call it plaque. If you want to be a little more scientific, we'll call it atherosclerosis, but that's too hard a word to say. I like plaque. And by the way, this is not the stuff in your teeth. That is plaque. We're talking about that fatty, buttery, waxy stuff that can build up in the arteries. And the key thing is, and you've talked about it already, there's a huge number of—

Of people.

of factors that control whether that plaque gets deposited or not. Now, on the surface of it, you could say high cholesterol is bad, right? Because that's the fertilizer. However, that cholesterol, and in your case, the cholesterol was quite high and high enough that, you know, several of my colleagues, and I think you went to Hopkins and—

I've been all over.

Lipidologist there, you've been all over. They said, you got to get on a drug.

Yes.

And I said, well, let's, let's instead, halftime, let's just think about this. Let's first of all answer the question, do you have plaque? How much plaque? What kinds of plaque? Then let's figure out what the numbers should be. So that's kind of our approach, which is quite different because we now have tools like cardiac CT, which we can talk about in depth what that means, and then layering that, like everything else in our world nowadays, with— With the blood work. an incredible tool of AI that gives us Superman-like vision of the blood vessels of the heart to really fully, completely understand to the level of what I call a living autopsy. Do we have plaque? How much plaque? What kinds of plaque? What categories of plaque? Soft plaque, hard plaque? So that there really are, in the diagnostic world of understanding if we have plaque or not, there is really no such thing as maybe, could be, possibly. We start with the ground truth. The ground truth is you have plaque or how much, then we'll figure out what your cholesterol numbers should be. And in your case, phenomenally, you'd already had the scan a few years ago. You'd already had AI, so we had that data to start with. Then 3 years later, without taking any cholesterol medicines, we put you through the same scanner. Now, I will say our scanner is pretty phenomenal.

Mm-hmm.

We have a Ferrari. There's lots of Fiats out there, but we have a Ferrari of a scanner, and we were able to show Wonderfully, and without any doubt, that you had a little tiny bit of plaque 3 years ago, and via diet, exercise, lifestyle, clean living, doing all the stuff that you preach and practice, that your plaque was actually better 3 years later.

Which is wild, because you would— most cardiologists would say that's not possible. They see a creeping up number your age, right?

Yeah, to answer that question, yes, we absolutely can reverse plaque. Now, in many people that might take medications. And I will also point out, and I want to be very careful about saying this, the pyramid, the base of the pyramid of prevention is always founded on diet, exercise, lifestyle. Don't smoke. Be good to your body. Right? 100%. And then everything else is above and beyond that if we need it. But with tools like cardiac CT and AI, we can absolutely understand, is there plaque? How much plaque? not guess whether we do or not, because that was the problem.

Sure.

Right. And I admit, you know, most of my colleagues— I'm fortunate— most of my colleagues guess whether you have plaque by looking at numbers and they go, well, your cholesterol is high, therefore you must have plaque. That is not necessarily true. It is a risk factor. And cholesterol and many other factors— smoking, inflammation, diabetes, high blood pressure, on and on, many, many others— are risk factors. They do not tell me if you have the disease. So we're still guessing, unless you look directly at the blood vessels with this incredible technology that we use every day at Cleer Cardio. They're still guessing. Have disease, don't have disease. I still have no idea. It's kind of like, and I'll give you a silly analogy, colonoscopy and colon cancer, right? Everybody should get their colonoscopy.

Mm-hmm.

It used to be 50. Now we do it at 45. It'll probably move to 40. We're seeing more and more young people develop colon cancer. And really what we're doing with colon cancer screening is we're visualizing your colon. That's it.

Right.

You're normal, you got polyps, you got cancer, whatever it is, we take care of you. And it's early detection. But if you went to a GI doc and said, geez, everybody in my family has colon cancer, they have colon polyps, all this colon stuff, he said, well, geez, it sounds like you're at high risk for colon cancer. Therefore, based on the fact you're at high risk without ever having looked, Look, I'm going to recommend 6 months of chemotherapy.

Well, that's insane.

That's ridiculous, right? I mean, I'm just being silly. Well, guess what? That's what we've done specifically for cholesterol.

Yeah.

We go, you look like someone who has plaque, and because you look like someone who has plaque from your numbers, here's a drug. We certainly do not do that for cancer.

Sure.

Right?

Now, I know some people listen—

Why do we do it for heart disease?

Yeah, you're right. It's backwards that we don't test first. We're just— jumping to a conclusion based on a lab or jumping to an assumption. But that being said, there are many people, because I don't want to get— there's no disagreement from you that LDL could be problematic for people. So even if you are super healthy, like—

Right, there's the paradox of cholesterol. They're always at the scene of the crime, 100%. However, knowing your cholesterol tells me nothing, because when we measure cholesterol, we're measuring how much is floating around the bloodstream. It tells me nothing about is it sticking. And I will be the first to say, and you're part of this party, is I only care about your cholesterol if it's sticking. If it's not sticking, we have choices.

But this is an important conversation to this part because, like, for example, if I had had this scan and the appointment with you and you had said, hey, you've got— it's getting worse, you've got stage 1, you've got stage 2, whatever, it had gone up, I was prepared to— Do something about that and start a medication. And it's important because I do think, and I know you've seen patients like this where you're surprised that they actually have that. So you're thinking they're lean, they're strong, they're eating well, and you're seeing stage 2, stage 3. So that's the other side of this scan, of the testing. It's not just to make sure you're not on something you shouldn't be or you don't need to be yet, but it's also the other way where you have a false sense of security. Without the test.

Yeah, absolutely. So, I mean, there's really 2 things we do with the test. One, confirm you have the disease. Okay, let's do the— use the right tools. And there's a bunch of different things we can do to stop and reverse plaque, right? Cholesterol is critical and central, but there's a number of tools. We have an incredible array of highly effective tools that not only change numbers, but more importantly, have been proven to reduce the risk of balloons, stents, bypass surgery, heart attacks, strokes. But here's the other problem, and this is the reverse of you. There are people whose cholesterol looks perfect, looks great. In fact, could be average or even well below average, and they can have extensive plaque. And if you're only looking at the cholesterol, you go, your cholesterol looks great, you can't have plaque. And that is absolutely not true.

Yeah.

And so there's really 2 things. There's de-risking you, which is what we did for you. We de-risked you. You look like you're at high risk, you're not. And then conversely, we can identify people whose numbers look great. And guess what? Their cholesterol is sticking. And you may never have even imagined that.

Yeah.

And that's why with cardiac CT and AI, it's no longer maybes, couldbes, possiblies. It's zeros and ones. It's binary.

Makes sense.

Then we can talk about a plan, as I like to say, over the next several decades to keep you healthy, happy, and medically born.

And this is also important because there's many people that have been diagnosed with something like a high cholesterol and they've been on statins and they also now have have a false sense of security because they're not getting that test.

Exactly. And, you know, what's interesting is, in general, now with the ability to check, monitor, track plaque over time, in general, and I'll give you averages, your mileage may vary, that plaque will increase by about 10% per year as a general rule. Okay? If you do nothing, just sit back and watch it. So in your case, that plaque should have progressed by 30% over the last 3 years. And in fact, we actually show it was better now than it was 3 years ago. So kudos to you.

Yeah, thank you.

Diet, exercise, lifestyle. This stuff really, really works. And we do know, by the way, that even people who are genetically very high risk for heart disease, remember, that's kind of a guess, but genetically at very high risk, that by diet, exercise, lifestyle, not smoking, staying height-weight proportionate, working out, all those good things, that we can lower the risk Without medication by 50%.

Wow.

Just with diet, exercise, lifestyle. But don't completely trust diet, exercise, lifestyle, 'cause there may be other genetic factors. So that's why I'm going to be the first to say, I do not know. And it's humbling. I've been doing this for 30 years, 2 doctorates, 7 boards, Harvard trained. People say, well, what do you think my vessels are going to look like? And I'm going to say, I don't know. You got to get in the machine. Okay.

And you told me on that, you even said, looking at your labs, I thought you were going to have a high number based on that until you saw the machine.

Yeah, yeah, I absolutely did. So I, I, it's sort of like being a pilot, you know, there's visual flight rules, right? Looking out for planes, or there's instruments, right? And you're always taught as a pilot, always trust the instruments, right? So I'm going to trust the instruments with respect to diagnosing heart disease.

Makes sense. Let's talk about soft plaque versus hard plaque, because this is also a false sense of comfort. I know I had done that where I had a calcium coronary artery scan. A lot of people are prescribed that, they go and get that, and they say, oh, your score is zero. And that's detecting hard plaque. Can you share the difference in why that could be problematic if we're only testing that?

Yeah, so a great point, Natalie. So going back, we talked about cholesterol, that fatty, buttery stuff that gets deposited. Remember, there's no calcium in there, right? So all of that all as that process occurs very slowly and glacially, as I say, over decades, that the earliest plaque, and frankly, the most important plaque, the plaque that is most likely to break off, flake off, we use the term rupture or pop like a pimple, whatever way you want to think of it, is that lipid, soft, cholesterol-rich plaque. Those are all synonyms. Over time, as we have birthdays, some of that cholesterol-rich plaque And behind the scenes will start a genetic cascade because of injury to the blood vessel, which will then cause calcium to get deposited in the blood vessels. Now, we've known this for hundreds, if not thousands of years, right? We call arteriosclerosis— literally translates from the Greek— calcium in the blood vessels. Okay, so we knew that people developed plaque, had calcium and hard plaque in their blood vessels, which was absolutely correct. However, What we missed was the fact that the calcium is always secondary. It always starts out with the active plaque. I call it lava. That's the active plaque, the unstable plaque, the vulnerable plaque, the plaque that's likely to rupture. And then over time, some of that may, by itself, or diet, exercise, or medications, or whatever, convert from the active plaque, the lava, into the hard, inert plaque. So when we do a calcium score, and this is the important message, All we're seeing is the hard plaque. So if you have a non-zero calcium score, and I'm going to be hardcore about saying not zero, if it's not zero, whether it's 1 or 10 or 100 or 1,000, and there's obviously differences between those numbers, but what we've shown is if it's not zero, you have plaque, 100%, full stop. What it's not telling us, and we've been doing calcium scores since the 1980s.

Sure.

So this is a 40-year-old technology. Only in the last several years has it begun to become more available, acceptable, prescribed. Okay, it's a great tool, right? It's not a complete understanding of plaque, but I will take a calcium score, and you can quote me on this, over a stress test any day of the year.

Wow.

Right? Because if you have a non-zero score, you have plaque. Now, here's what we don't know after calcium score. It doesn't show me blockage, right? So you could have a lipid-rich plaque, non-calcified plaque, soft plaque that could be extensive, even causing a blockage. You couldn't tell it from the calcium score once it's not zero. But it says you got plaque. It says, you know, it is the smoke to the fire. Okay.

So if you— and now when you were talking about plaque before, you showed me it could go on either side, like it could go on the inside and be— or it could be on the outside. So, and if it's on the outside, you're less concerned about it. Is that accurate?

Well, to a degree. So plaque always follows the same rulebook. The earliest plaque is always in the wall of vessel, and I'm going to ask everybody to think of a donut. You got the donut hole, you got the donut, okay? In the early aspect, the early years of plaque, as far as its development, in the first years to even decades, all of the activity, all the plaque formation is occurring in the donut.

Mm-hmm.

Not in the donut hole. When that cholesterol gets deposited in the donut, in the wall of the vessel, technically, it literally will grow outwards. Okay. Think of it as a warehouse or a storage unit. It'll literally say, hey, no problems. You got no issues. We have no symptoms, no chest pain. I'm just going to store this plaque and we're going to grow outwards.

Okay. Okay.

Well, that's feasible for a while. It kind of pushes off the day of reckoning. But what happens is, once that vessel, if you think of the donut hole in the donut, or bagel in a bagel hole, once that plaque starts growing outwards, there is a limit to how much plaque, how much cholesterol that vessel can store. Once that donut or bagel doubles in size, the hole plus the donut, then that storehouse is full.

Yeah.

The warehouse is full, then it begins to grow inward. But historically, and when it begins to grow inward, we'll not have symptoms, chest pain, angina, flunk a stress test, Till that donut hole is blocked up, constricted, narrowed by 70%.

Wow.

So historically, if we're waiting for symptoms, if we're waiting for Flintco stress test, that occurs really at the very, very end of a multi-decade journey.

Makes sense.

And on top of that, it gets worse. The lipid-rich plaque that's growing outwards is fragile, okay? It's like butter. It's soft, goopy stuff. It's separated from the bloodstream by about the thickness of a hair or less. So at any moment, that plaque can— we use the term rupture— that cap, as we call it, that separates the lipid plaque, the cholesterol-rich plaque, from the blood vessel can rupture. Then within seconds to minutes, when that blood comes into contact with that plaque, we then form a blood clot.

Oh, wow.

And that is how over 85% of heart attacks occur, not because of a slow glacial process where, like an onion, it's growing inward. It's actually plaque ruptures. And to make that matter worse, the plaques that are more likely to rupture are not the 70s, 80s, 90s. They're actually quite unlikely to rupture. They can cause symptoms and chest pain. We can pick that up with stress tests once you have extensive plaque. But the plaques that are likely to rupture are the 20s, 30s, 40s, 50s that would not show— have symptoms, not show up on a stress test. And you would have no symptoms, and you just had your normal stress test, and they pat you on the back and say that you have the heart of an 18-year-old. And then the next day, the next week, the next month, the next year, you have an acute catastrophic event we call a heart attack. Or, by the way, the same process can occur in the neck, in the carotid arteries, causing strokes. So that's why Stress tests can— you can go, you know, you can look perfect. I mean, I can't tell you how many people I've heard say, I had a stress test last week, last month, last year, a year ago, patted my back, said it looked great, have the heart of an 18-year-old. We put them in the machine and they have extensive plaque.

Wow. Yeah. So, this is so misleading for people because there's so many people in my age range that say they had a stress test. They had an EKG and they had a coronary artery scan. And so, they think they're fine.

It's a cringe moment. It's a cringe moment. You know, 'cause I know, right? I mean, I've been doing this for 30 years, cardiac CT for 25. And they tell me, I went to the cardiologist, they did the standard rubber stamp, echo, stress echo, nuke, nuclear cardiology, EKG, Holter, echo, whatever. And I'll go, guess what? That's probably $10,000. of spend. And guess what? You know almost no more—

No.

Than you started with. Now, a $100 calcium score, very helpful. Stress tests, horribly inaccurate. And I will be the first, as a cardiologist, to say they are horribly, horribly, woefully inaccurate. And I'm going to go out on a limb here, okay? I'm going to stick my neck out. I would say the only place we should find stress test equipment is in a museum, behind a velvet rope with a little descriptor that says, this is how we tried to look for heart disease in the old days. Wow.

So it's just a complete waste. It's really— it's not doing anything.

The value of stress testing— and I'm going to take flak for this, but it's okay. I got big shoulders. The value of stress testing in 2026 and 2025 and 2024, etc., is to the provider who lacks a Ferrari, a Lamborghini, a Cessna, a lake house, or a boat. That is the value of stress testing in 2026.

Wow.

Right? Nearly worthless. Lots of false negatives. There are severe blockages, severe narrowings, or extensive plaque, not even causing blockages, that's really important for us to know about.

And you don't see it.

That can be rupture-prone, right? And your stress test is normal. And then conversely, it works the other way. There's a 25 to 40% false positive rate. The stress test looks fine. That's then followed up with a $20,000 invasive heart cath, that I gave up over 20 years ago because of cardiac CT. And then it's fine. And remember, on a heart cath, an angiogram, $20,000 later, risk of kidney damage, heart attacks, strokes, vascular problems, infection, bleeding. All I can see is the donut hole. I have no idea what's happening in the donut.

Wow.

Which is where all the early activity occurs.

Why?

Stress tests and heart cath, I gave up 20 years ago. Never looked back.

Why are CT angiograms not prescribe more? Why aren't— why is that like a last resort?

They absolutely should be. Now, I will tell you where we stand right now. Um, again, we've been doing cardiac CT for 20— I've been doing it for 25 years. Uh, most of my colleagues were a little bit behind that, but I will tell you, important date, October of '21. In October of '21, all of the big groups in cardiology, the American Heart Association, American College of Cardiology, smaller organizations such as the National Lipid Association, American Society of Preventive Cardiologists, and many, many other guideline-promoting and writing people got together and said, if you have chest pain, if you have angina, I suspect you've got a blockage. Or it could be what we call an anginal equivalent. I've got shortness of breath.

Okay.

I can't mow the lawn now. I could 3 months ago. Those kind of symptoms that could be symptoms of a blockage, what we call now a 1A indication. So we have different levels of indication. A 1A indication means, 100% standard of care. If you do not do this, that falls below standard of care medically, legally. So cardiac CT is now a Class Ia indication if we suspect you have blockages because of symptoms, chest pain, angina, shortness of breath, other similar symptoms, right? So that's Class Ia indication. Most of my colleagues still do stress testing.

Wow.

Why do you— Where the threshold detection starts, it's Starts at 70%. Anything less than 70%, your stress test will be normal by definition. And we have a 25 to 40% false positive rate, which takes you to the cath lab for no good reason, and a 25 to 40% where there is a severe blockage and you miss it and the stress test looks fine.

Okay, why are they still doing that?

Why?

Yeah, why?

In my era, right, 30 years ago, when I did my cardiology training, we had stress tests, we had the heart cath. We had EKGs, but EKGs to figure out if you're blockage is a really horrible test. It's only useful after your heart attack.

So that's like if they think you had one. So they think you had one, they're checking that. Right.

And even then, you could have an abnormal stress EKG and have a perfectly normal heart, or have an absolutely completely normal EKG and be ready for bypass. So EKGs, not very good. EKGs are great for electrical, which we're not talking about today. but not for plumbing.

Okay.

Okay. And then we had stress tests and heart casts, and most of my colleagues were brought up in that era and they never evolved, to be honest. Right. I evolved. I see, hey, what amazing technology that allow me to be a better doctor, more accurate, more definitive, more black and white. No more of the maybes, couldbes, possiblies. And frankly, that's what we did back then. But I said, no, here's the technology that will be we could be incredibly more definitive. And for the first time ever with AI, literally track plaque. That was impossible to do until we had quantitative AI. 'Cause I can now, like we did with you, understand exactly how much plaque you have, what kind of plaque, what categories plaque. And then we look 3 years later and I can say, oh, there is now less plaque and less soft plaque now than there was 3 years ago. Yahoo for you. We can kick the can down the road. You don't need drugs.

So the thing that I, didn't fully understand until recently was this whole difference between soft plaque and hard plaque. So the visual that sort of helped me was this, I think of like a soft-boiled egg. So, and maybe that's a way to look at it. So if you think of like a hard rock as like the calcified plaque, and then a soft-boiled egg as the soft plaque, that's the one that causes the majority of heart attacks. Is that accurate, that soft plaque?

Yeah. And we know this, we know this from the 1980s, right? We showed, 86 is the number, 86% of the people who had a heart attack, if you looked at them with the old technology, we used to use heart casts and stuff, we would see those soft-boiled eggs or the over-easy eggs, if you will. We would see those plaques not causing blockages, not causing obstruction in 86% of the people who went on to have a heart attack.

Wow.

So it wasn't the blockage, it wasn't the narrowings, And it wasn't the hard plaque, it was the soft plaque that really you can only see with cardiac CT. And then now we have quantitative AI because the soft plaque, by the way, is very hard to see. And here's what AI does. We take the images with a CAT scanner, that's the donut of destiny we call it, get this very high-resolution imaging. We then take that CT data, put it through AI, upload to the cloud, And here's what happens behind the scenes. With our CAT scanners, we can really readily see, easily see with our eyes unaided, the hard calcified plaque, the inert plaque. Okay, it shows up with these bright white spots, easy to see. The soft plaque, much, much more challenging. It is dark. Okay, and here's what happens when we look at CT images. It could be, by the way, X-rays, MRI, CT. X-rays, these are called grayscale images. And what that means is we basically can see with our eyes unaided, black to white and about 50 shades of gray.

Okay.

However, coming out of the CT machine, all of the millions of pixels that make up those images are encoded not with 50 shades of gray, but with over 2,000 shades of gray. So as I like to explain it, my analogy is without my glasses on, I can see red, green, and blue.

Wow.

I put on my fancy AI glasses. Now I can see red, green, blue, infrared, ultraviolet, X-rays, gamma rays, radar waves, or basically analogous to the entire electromagnetic spectrum that I could not see unaided without the AI.

Wow.

Then we can see plaque we could not see, particularly the most dangerous plaque. We can then quantify it extremely precisely down to a fraction of a cubic millimeter. which is an extremely small volume. I think that if you think of a period at the end of a sentence, that volume, if that were a sphere, would be about 1 cubic millimeter. We can see a fraction of that volume, measure a fraction of that volume with AI. And then the last big breakthrough of AI is we can literally now track plaque as we did in you over time. Is that plaque getting better? Is it staying the same? Is it getting worse? And also look at the kinds of plaque. Was it mostly soft? Now it's hard. Yahoo!

Yeah, which is huge because this, this you would not be able to see with just a regular CT angiogram. You'd need to add this AI piece to be able to see that tiny amount.

And I will say calcium scoring, yay, more people are getting it. Great, I'll take that any day over a stress test, okay? And the way I think of it, calcium scoring and a mammogram, pretty similar, right? Kind of screening tools. For the population, cheap, accessible, lots and lots of data. Now a Class Ia indication in our most recent, which is standard care, by the way, as a decision tool where we're trying to guess, should we treat, not treat cholesterol, etc.? So a Class Ia indication, now standard care. But here is the upsides and downsides of calcium score. Think of it as a mammogram. So a mammogram, you can miss cancer.

Sure.

Okay? Your mammogram can be normal. And by the way, in the cardiology literature, depending upon the age and the study, anywhere between 10% to 50% of us with a zero calcium score, which we're going to say is great, that's the goal, will have significant lipid-rich plaque that we could not see with the calcium because it's not calcium.

Which is kind of the same thing that would happen with the mammogram. Like, you hear— you'll hear that, like, if you catch things, but it also can miss things.

You got breast cancer, you missed it.

Yes.

It happens. We can also have false positives. That is, you can have a lot of calcium and have very, very little lipid and have no blockages. Okay. So a calcium score, I'm going to say, is equivalent to a mammogram. Okay. Very, very useful test. But don't always take it to the bank. Right. There are some caveats. And like a mammogram, if the mammogram is positive, we don't say you have breast cancer. We say the mammogram looked abnormal. we do a biopsy.

Sure.

So the way I think of cardiac CT now with AI is there's the calcium, there's the mammogram, and then there's biopsy. When we do cardiac CT with AI, that is the biopsy. We will see it. If it's there, it is there. If it is not, it is not. We will quantify it, categorize it, track it. That's the ground truth. And I love telling people that Even the old tests, again, that I gave up over 20 years ago, like heart caths, one of the dangerous things is your channel, your donut hole could be fine and your heart cath is perfect, but you could have extensive plaque in the wall that I can't see. That is not something we miss on cardiac CT. It's the ground truth.

Before I ask you a bunch more questions around that, the scan and everything, because I have a lot there, I want to not skip this one really critical piece that seems to be very controversial online. I want to go back to cholesterol for a minute. When we hear about cholesterol, I don't know how much you've seen of this, but there's like this huge divide between—

Oh yeah, I'm— Yeah, you see.

But I think there's a lot of—

Very involved.

There's some truth to some of it, and then there's a lot of just really false narratives around it. So I wanted to get your help here understanding, because it's my understanding now from what I've learned, LDL is not a good thing. You don't want LDL, but it's not LDL alone that creates an issue. But what we— what I've learned and what I believe now is that you test like you're talking about, and if it's creating a problem, then you do have to address it with more aggressive measures than maybe diet and exercise and the lifestyle things. And if it's not, you have more time. However, there's this whole train of thought that we need it for our brain, LDL, that statins are bad, they're going to create all these problems. Can you help us? Because I don't know that it's that black and white either. So help us understand because it's a very hot topic around cholesterol.

Yeah.

And people are confused what to do.

Oh yeah, we've waded into some very, very deep waters, but let me give you some—

Yeah, help us with some practical, like, yeah.

So 30 years in preventive cardiology, board certified in lipidology as well. Only about 100 cardiologists are board certified in lipidology and cardiology. So, you know, 2 doctorates, 7 boards, Harvard trained. So anyway, with that, not that those mean a whole lot, but—

No, it does though.

It's been my passion.

More than that random influencer online talking about LDL. Yeah, right, for sure.

So I'll state that as I hopefully I have some degree of credibility.

Yes.

Okay, so let me talk about the brain and cholesterol. Okay. You will see people say your brain has lots of fat in it. Absolutely right. A lot of that fat is cholesterol. Absolutely. 100%. The cholesterol that your brain has and needs, right, to do essential brain stuff is made by the neurons, technically astroglia, of the brain. And they have all of the chemical manufacturing, all the metabolic pathways, all the enzymes to make as much cholesterol as you need.

Okay.

Okay? Your brain never is short of cholesterol, okay? And the cholesterol metabolism in the brain, on the other side of the blood-brain barrier, by the way, it's really isolated immunologically from the rest of the body, and the body are completely 100% different. As an example, and I think this is a cool way of seeing into some of this complex biology, is LDL cholesterol, like a drug, has a half-life. So it circulates for a period of time. In normal people, its half-life is about 3 to 5 days, okay? If you have very high cholesterol, that half-life could be much, much longer, in which case more cholesterol is left in the bloodstream.

Okay.

The half-life of LDL cholesterol in the brain is 5 years.

Wow.

Completely different.

Yeah.

ApoB, that is critical and we measure in everybody as we understand their cholesterol issues, is not even present in the brain. It does not exist. Okay. It has an entirely different cholesterol lipid pool environment than, than the rest of the body. So it is true. Yes, your brain has lots of fat. It has lots of cholesterol, absolutely true, but it does not depend upon, it is not derived from circulating cholesterol or LDL, period.

So, okay, yeah, so this is really interesting. What I've also learned is so many times people chase this lowering number where, like you said, with me, for example, my lifestyle things made it so I didn't get the soft plaque, Increased. It didn't reduce the number. So just chasing the number is never the good idea.

Correct. And let me give you, everybody, hopefully a deeper insight into these things, right? I will say 2 things that may sound paradoxical, but I'm going to hopefully prove they're not. One, cholesterol, mandatory, necessary, and I'm talking cholesterol in the blood vessels.

Sure.

You get cholesterol in the brain, but mandatory, necessary, has to be there. Always there at the scene of the crime. If you look at any plaque in any blood vessel, whether heart, carotid, anywhere else in the body, it is the deposition of cholesterol in that vessel.

Okay.

Okay? So 100% absolutely has to be there. It is mandatory, it is necessary, but it may not be sufficient.

So that alone is not the thing.

You have other cofactors, right, that gang up on you to cause that plaque. So cholesterol is the stuff, again, always there at the scene of the crime. It is the old— it is the fertilizer. Okay. However, think of the blood vessel. You've got this, this lining of the vessel called the endothelium.

Mm-hmm.

It is what gives the vessel the ability to be like Teflon, so nothing sticks to it. You don't want anything sticking to your blood vessel. You don't want clots in your blood vessel. That is the Teflon, or as my partner calls it, and I love this term, it's the slip and slide.

Right.

Now, there are people, through no fault of their own, that their Teflon changes to Velcro. As we get older, more likely our vessels turn more to Velcro. Smoking, high blood pressure, insulin resistance, diabetes, inflammation, systemic inflammation, lupus, rheumatoid arthritis, kidney disease, and, and many, many others, right? Change that environment. And if your vessel becomes more like Velcro than Teflon, then if it's like Velcro, I can show you people like you who have quite high cholesterol, but it's truly not sticking.

Right.

And we had the luxury of seeing over time it actually got better. But there are people who have vessels like Velcro, and not because they got bad habits, not because they have diabetes, prediabetes, insulin resistance, smoking, high blood pressure, whatever, but just because they chose the wrong ancestors, I like to say. who have vessels unbeknownst to them that are like Velcro, then you could have plaque develop. It's going to stick all day long, even if your cholesterol is average or even well below average. That's how you can— I can show you people who have extensive plaque and their cholesterol has always looked perfect.

Why does your body—

Because you're not looking at, is it sticking or not? That's the key thing. Is that cholesterol sticking?

Why does our body make cholesterol? What is it? What's the purpose of it besides the brain?

No, it's a great question. So, so cholesterol in, in, in animals, insects, right, is absolutely critical. It maintains the fluidity of the membrane, and it's how we can be warm-blooded, and, uh, cold-blooded animals, uh, have trouble, right, because their ambient temperature. So cholesterol is absolutely necessary, not only for membrane— if we did not have cholesterol in membranes, they wouldn't be very fluid. not do well. But also, it's critical for a variety of hormones, right? Anything from vitamin D to cholesterol— well, to, to all the things made from cholesterol. It is the substrate that makes testosterone and estrogen and progesterone and vitamin D and many other hormones, right? However, all of those different organs, whether the testes, the ovaries, the adrenal glands, that make these steroidogenic hormones, of which there are many, They make all the cholesterol they need. They don't need circulating cholesterol to make those hormones. So you'll see another myth out there. Well, you do this and your cholesterol falls and your testosterone, your estrogen, and vitamin D. Not true. That is not true. That's not science. Okay, that's stories. I don't go with stories. I go with data and science. So the reason we have cholesterol is cholesterol piggybacks upon our body's way of distributing energy from our gut. So we use these little lipid particles called apolipoproteins. They're going to ferry energy around in our body. They're going to grab it from the gut. They're going to convey it to muscle and fat in general and any other organ. And they're going to convey energy in the form of triglycerides to these other organs, which is absolutely critical. We got to get energy from one place to the other. The triglycerides are fat soluble. You can't put them in water, which is water soluble, right? If I put triglycerides, you'd have a slick on the top of your blood. Not good. These apolipoproteins are water soluble on the inside, but lipid soluble inside, so you can carry all this energy in the form of triglycerides around the body.

Hmm.

Cholesterol is in the membrane of those apolipoproteins. So it is purely a byproduct of the transmission of the ferry that ferries energy around our body. In many people, though, they have problems with clearing these apolipoproteins, which is where cholesterol is.

Right.

And then we measure that as an elevated cholesterol. Okay. If we looked at your liver, your liver clearance of cholesterol is not great. I'm sorry, you chose the wrong ancestors. That then means your clearance of cholesterol is low. And we measure that as high cholesterol. Okay?

Makes sense.

That's fertilizer. But again, we looked at your blood vessels. It's not building up.

Yeah.

Right? So I don't care about cholesterol unless it's—

Totally. What about, just to get a little nitpicky on cholesterol, there's some variations. So like, we always focus on LDL, but what about HDL? And is that true that you want a higher HDL number? Is that not true? Triglycerides, can you talk about those specific parts?

Absolutely, yeah, so different fractions of cholesterol. You hear about LDL. LDL's great, but LDL's old school.

Okay.

If you really want to understand the total amount of fertilizers, I call it, the cholesterol that's fertilizing that plaque, the best measurement, we check it in all of our patients and monitor over time, and hopefully your doctor is too, okay? So write this down, it's called ApoB. A-P-O, capital B, ApoB. That stands for apolipoprotein B. That is the best way of measuring, monitoring, tracking the total amount of bad cholesterol. It includes LDL and then several, several other bad actors. But all of these lipoproteins, these little fatty balls, all have one copy of ApoB on them. So if I measure total amount of ApoB, I'm actually measuring how many particles are there to feed the plaque. Doesn't mean you have plaque.

Yeah, which by the way, y'all, like, those are my 2 things. I have high ApoB, I had high LDL, and I didn't have the problem. So just because you have it, it's information, it doesn't mean it's creating that.

And LDL and ApoB certainly correlate. However, there are many times where the LDL may look fine and your ApoB will be high. And the truth is the ApoB. So don't stop at LDL anymore, have your doctor check ApoB, it's much more useful. Number 2, the other important lipid particle out there that 20% of us will have, the vast majority do not know this, make sure this is checked, it's now in our cholesterol guidelines from March of this year, is this nasty form of cholesterol, 100% genetically determined, it's there when you're born. You can blame mom and dad, I like to say.

Apo, are you about to say?

Apo, I like to say, is Lp.

Oh, Lp, yeah.

Lp, 80% will be normal. We check it once, if it's normal, Okay. We're done. It will never become abnormal. It's finished.

And what happens if you have that?

If it is high, which is 20% of us, which is a lot, much higher risk. It is a force multiplier, right? What are the risk factors you have? Diabetes, blood pressure, cholesterol, family history, whatever. It will increase your risk of a cardiovascular event. This is strokes and heart attacks and even valvular heart disease. By 2 to 3-fold.

So critical. So like, if someone comes in with that, you're going to be more likely to— like, if I had had that, you'd say, you know what, we really need to look at a medication because it's higher risk.

Well, again, at the end of the day, yeah, let's just say— and I've seen people who have high Lp, who, again, we check for everybody, we check this in everybody first, who don't have plaque.

Okay.

I can say, again, very slow glacial process, all those things.

Sure.

There are some tools available right now today that lower it modestly, 20 to 30%. However, this summer— so I'm going to tell everybody, keep an eye out for us.

Wow.

In the lipid world, this is like not one, but 5 Super Bowls. This is 5 FIFA championships all at the same time in the world of lipids for us nerds out there. Okay, I know we're pathetic, but coming out this summer will be data using a novel drug that's been in development since 2019 that will lower Lp not by 20 to 30%, But by 80 to 85%.

Oh, that's amazing.

That trial will be reporting out this summer. So, you will see it. It'll be big, big news when it comes out. It's called pelacarsen, by the way, P-E-L-A-C-A-R-S-E-N. The trial's called HORIZON. We anticipate that trial will report out this summer.

Okay? Makes sense.

So, we in the world of lipids, we're just like, oh my gosh, this is the greatest thing in a decade. So, that will be coming out. There are other drugs in development behind that one. That's the first key drug that will lower Lp by 98 to 100%. So, if that trial's positive, and I say if, we got to do the data, we got to do the trial. If it's positive, if it's well tolerated, we don't have weird side effects, we will now have an amazing new target— targeted way to lower Lp.

Wow.

So, there's a lot we can do. And even a baby aspirin can really help to lower the risk of cardiovascular events if you have Lp. So absolutely 100% worthwhile checking it. Current lipid guidelines say everybody should be checked. At this point, only 0.3%, 3 out of 1,000, have actually been checked. We check everybody. So ask your doctor, check my Lp, particularly if you have heart disease, or if you have a positive calcium score, or if you have family history of early heart disease, or, uh, you know, that kind of theme of heart disease or strokes. Make sure your Lp is checked. But again, everybody should have it screened for once. 80% will be normal. You never have to repeat it again. 20% will be high. And we want to— there are things we can do about it. And we also want to look for other members of the family who also have Lp, because if you have it, good chance your kids have it or your sibs.

What about HDL? Because we're told to have certain fats.

Yeah.

So raise that.

Great, great, great question. So we'll get to HDL and triglycerides.

Okay.

HDL, sit down, everybody. Are you ready? Has no impact upon plaque.

Wow.

Okay.

None.

Here's where the— here's where the mistaken belief came from. Decades ago, we knew— this is not new news, but decades ago, we knew that HDL, we used to call it the healthy, happy cholesterol, right? We talk about reverse cholesterol transport, garbage trucks taking cholesterol out of the blood vessel. That was the model. Okay, we popped that bubble 15 years ago. It does not work that way. Okay, and here's how we fell into this trap. We did know that triglycerides, which are bad— these are bad forms of cholesterol, okay? They're a marker of accelerated plaque deposition. Okay, high triglycerides, bad. That HDL and triglycerides are in a teeter-totter. So as triglycerides go up, HDL falls. Triglycerides come down, HDL goes up. So what happened was, here was the big mistake, we confused the HDL for being good, when in fact it was the triglycerides that were being bad.

Wow.

So we ignored triglycerides, which are very important, and instead we said, HDL's great, if you get your HDL high, that's wonderful. We did those experiments almost 20 years ago, using several different drugs now, to raise HDL by different mechanisms. This is now, in total, over 100,000 people in long-term, randomized, double-blinded, placebo-controlled trials, multiple different drugs to raise HDL. None of them work.

Wow, that is wild.

HDL doesn't matter.

So we've been told completely wrong.

Here's the problem with HDL. Right, here's the problem with HDL. There are many people who go, my HDL is great, I'm immune, who cares about my LDL? Some of my providers still say this, run. Okay, run. That's absolutely not true. Okay? Low HDL is what it is, but get in the machine. Let's see if you have plaque. High HDL is not protective.

So this brings me back to this whole topic around the machine because— and testing, because if you think about cholesterol, cholesterol is like the big conversation. I feel like that's the one everyone focuses on. And then there's the argument of, do you treat it, do you not? Like all the things you're going to do to lower it, but I want to be really careful here because we've all been chasing that wrong thing. Just focusing on lowering cholesterol is the wrong thing to be focusing on. We need to test and say, do we have a problem? And then reverse engineer.

Not the risk factor. Remember lipids, whatever it is, ApoB, Lp, are risk factors.

Yes.

They increase risk. They are not the disease, and the problem is We have conflated and confused risk with disease.

They're not. Yeah, because you see these high numbers and then you think, okay, well, I'm going to just start having psyllium husk and I'm going to do all these things and I'm going to take a statin. I'm going to do all this stuff and—

Or I'm just going to die.

Right. But you're not. We don't actually know, like, what are we trying to reverse here? Because if we're just chasing the number, that's the problem. So I really had my eyes open to this and I'm so glad I did because this is— I just wish more people This was more common practice.

Yeah, it will be, right? I mean, we're talking in 2026. I've been doing this for 25 years, right? You could imagine what this discussion was 25 years ago.

Oh yeah.

You're doing what? You— whoa, whoa, whoa, what? And again, this is years before we even had the AI, which is just a whole nother level of cardiac CT and the analysis.

Talk to us about radiation too, because that's the other thing that comes up.

They say, well, I don't want to have the radiation. So I think that's We're very, very mindful of that. Any procedure that involves radiation, we use radiation for lots of diagnostic procedures, we want to be very thoughtful and circumspect, right? Is the radiation dose we're giving the lowest possible? And is the bang for that information buck that we get, is it worth the radiation we're giving? Now, I will tell you, there's probably at least 100,000 CAT scanners in the US.

Okay.

But they're not all the same. They all look the same. They're all donuts, right? But there's lots of Fiats, and there's a few Ferraris. Now, we're fortunate, of course, I selected the equipment, to identify equipment that gives us beautiful pictures, high-resolution pictures, amazing pictures, high spatial and temporal resolution to really see plaque, understand plaque, track plaque, but do that with a minimal dose of radiation. Our scans, when optimized, we can get all of that cardiac data, which, by the way, only kills about 40% of us, strokes and heart attacks lumped together, plaque, only kills about 40% of us. We can get that cardiac CT data for the same radiation dose as 20% of a mammogram.

Wow.

So many women are having mammograms every year, every 2 years or whatever, for decades, right? We can get the cardiac CT data for about 20% of the dose of a mammogram.

That's crazy.

If you consider risk versus benefit, yeah.

That's a big difference.

So yes, we use radiation. I want people to be aware of that.

But so is flying in an airplane. You're going to get radiation in an airplane too.

Just sitting on the face of the Earth gives you a radiation dose every year, year in, year out. You'll get twice as much radiation in Denver than you will at sea level because you're less of the ozone and all the protective things above you. So yeah, I mean, radiation is something we're going to work clearly to try to minimize that. But if you look at the information that we glean, that is important, critical information that in your case can de-risk you.

Yeah.

So now you can know, hey, I'm on the right track. This is fine. Or we can identify plaque in people that we wouldn't have expected. Then that radiation dose, again, we always think about the cost of the radiation. Is that cost worth it? And I would say for cardiac CT, yeah, it makes sense. And again, we go to great lengths to have Ferraris, if you will, Really exquisite machines. In fact, our machine in Dallas was the very first machine of this kind installed in North America, and our machine up in Manhattan was number 2.

Wow.

So we go to great lengths to spend the money to— and the equipment and the right techs so that we get incredible pictures and diagnostic pictures, but also we're doing it in the most safe possible way we can.

So if somebody has plaque, you see soft plaque, you see a problem here. So you've got stage 2, stage 3, or whatever it is that you see. Is it doomsday or can they reverse it? Because that's also confusing.

So I'm going to say, yeah, no, great question. I'm going to say, if you're breathing and have a pulse, you're going to be fine. I mean, that's the thing about preventive cardiology. I can take people with extensive heart disease, right?

Wow.

So can I tell people your number?

Yeah, you can share it.

So your first number, I think, was 7, 10, 14, right? Something like that. I mean, a really, really— I can't say zero, but very, very small.

Right, but very small.

The second number, and we're looking at the lipid, that's most important, the active plaque. was literally lower than the first one he had 3 years ago.

That's without medication.

So lipid-rich plaque, the active plaque, is actually getting better. Uh, I, I saw a guy just the last couple weeks, his total plaque score was 1,640.

Wow.

LDL below average, right? No symptoms, no chest pain. No one even suspected he had heart disease because his cholesterol looked great, right? Ate right, Diet, exercise, height-weight proportionate, no diabetes, never smoked, 1,640. And again, I wouldn't—

You wouldn't have known.

I couldn't even guess.

Nobody.

Right? So that's why you have to get the machine.

It's so important.

And it's very humbling, right? Get the machine.

I'm having my husband do this. So you all, I'm gonna link this all below, but where I went, I went to Clear Cardio, and I'm gonna actually, I'll link everything below so you can just click in the show notes and find it, or you can go to midlifeconversations.com/heartprevention, but I'll link all this down. I went and did the whole process. several centers in the US. So I wanted to just do it thoroughly. So I flew in, I did the test, did lab work, and then actually had a call with Dr. Osborne to go over everything in detail. It was also the other really cool thing I wasn't expecting. It wasn't just my heart education. He could see all of my upper organs. So he was like, your lungs, your— like, you— it's preventative for everything, really. It gave me so much reassurance Because this is something I've had in the back of my mind for many, many years and worried about. So it just gave me such reassurance that I'm doing the right things. And if he had found something, I wouldn't have— it would have been good too. Either way, I was happy. Like, if you had found something, I would have had a plan.

And that's the great thing about preventive cardiology. Even if you have extensive disease, right? Guess what? We have multiple proven tools.

But you're not guessing.

Cholesterol is one part of that. But, and the other thing too is statins, they're one tool, right? Sometimes you need a flathead, sometimes you need a wrench, sometimes you need a screwdriver, a Phillips, right? So just remember, they're one tool. They're not the only tool. I got lots and lots of tools. We have a very large toolbox full of proven therapies. Cholesterol is important, but lots of other factors are as well. Lots of other tools. So whatever we find, I like to say, as long as you're breathing and have a pulse, We'll be fine. We know what's going on. There's no more maybes, could-bes. And then let's initiate. And this is where it becomes very targeted, very precise, very bespoke and customized to you and your physiology, your factors.

Yeah.

That's why everybody's cocktail will be a little different, right? But that's, that's why we always start with, let's ask the question, do you have the disease? What kind of plaque? Where that plaque is located? What is the burden? Once we have that data, then we can put you on the right trajectory.

Yeah.

As I like to say, our goal is to keep you medically boring.

And, y'all, I've had extensive conversations with cardiologists over the years and had my workup done many times. This is the first thing that, like, fully made sense to me. And it gave me that full confidence because now I'm like, I'm not guessing. Like everybody else, it was a guess. It was like, we're guessing. This gave me that confidence around it. I think it's so important that I'm having my husband now. He's actually flying to Dallas. He's going to actually do the whole process with you because his numbers are great, but I want to also now know, because again, the numbers are misleading, whether— we don't know, and he's 50.

Well, and I love it, Natalie, because for me, I'm going to say that's the sign of true love, right?

Yeah.

So I tell people, you know, there are very, very few preventative cardiologists, and particularly imaging cardiologists that also do prevention lipids. It's a very, very small population. So I want to thank you for having me on. Getting the message out, walking people through this. For me, what we do I think is a no-brainer. I think you've been through it. I think you'd probably agree. You know, you're validating that by having your husband come, and we'll get him checked out. So what we've been doing for decades now in the world of cardiology now, before we had cardiac CT and AI, we did the best we could. But now that we have this, you know, thank you for getting the message out. I will say again, I'm going to always speak. the power, the gospel of prevention. And because there's so many— so few preventive cardiologists doing what we do, I want to thank you for getting that message out. And I love saying I have no problems speaking the gospel of prevention. And anybody out there that wants to become a disciple or apostle in the group of those speaking the power of prevention, yahoo. And that makes me very happy.

And so, y'all, I'll link this And if you end up not going through Clear Cardio, just have these conversations with your cardiologist.

Here's what to ask, right? Get your ApoB checked, not just your cholesterol, ApoB, Lp, get a calcium score. It's great, it's cheap.

It's a start.

Not perfect, but it's a great place to start. And if you do go through cardiac CT, here's— I'd say a mistake, but not what I would do. Cardiac CT is step 1. It should be one word, cardiac CT with AI.

Yes, that was the big difference. And somebody that knows how to read it. Someone that knows how to read it. Yeah, you have to do CT scans. And that's what I had 3 years ago too.

Yeah, and if your doc says, I don't know what that is, or I don't know—

Find another doctor.

Just keep looking, that's all. It's got to be paired with AI.

My big thing that I want you all to hear is to just not chase just a number because that's the thing that I see, people just chasing a lab number like, I just got to get my cholesterol down, or I got to get my blood pressure down, but we're just chasing that number then and we don't even know what we're navigating beyond that. So I think the test is huge and I like your comparison to the colonoscopy or a mammogram Any of that. I think it's great. I love what you're doing. I love the work. I'm excited to see what Brooks, what my husband, what he finds on his. And y'all, if you're listening and you're like, well, I don't know that I want to know, I'd be scared. I really had prepared myself either way. I was going to be fine. So I was ecstatic that yes, I was better and it was fine. I don't need to start a medication, but I was also very prepared. He knew I was asking about Repatha already, and I was very prepared if he had said, hey, you've got this going on, I was prepared to deal with it. But I like operating from that knowledge. So I felt great. It was worth the trip. It was worth everything. And I hope some of you will take this very seriously, whether you go through Cleer Cardio or not. Thank you so much, Dr. Osborne, for being here today. Thank you.

My pleasure. And I have to tell you, Natalie, when I told you, because we talked about Repatha, it's a great drug. I loved Repatha. It's a great drug. It's expensive. It's a great drug, right? I love telling you Natalie, here's the bad news. You're too healthy for it.

I loved it. Well, you actually— what you said to me made a lot— you said, you know what, you can— it's like a glacier. It's very slow. If you have anything, you can retest in 3 years. If by chance in 3 years you have something, we can address it then and there'll be new things out then. So that gave me the confidence. And you didn't say— so yeah, you gave me the choice.

It's pretty cool to be able to kick the can down the road.

Yes. Right. Yeah, it felt great. It was great. But like I share, if it had been bad news, I was ready for that too. So either way, I felt confident that I I was going to take control of this. And that's what I want for my listeners, is to know that you actually can take control. It's not a gamble of just, let me just chase a number and pray. It's like, there's more— you can actually find out how far along you are or not far along. It helps you make better decisions.

And one of the big advances that plays perfectly into what you said is that now we can measure very accurately how much plaque, what kind of plaque at time A, Do whatever we think is appropriate, and then remeasure.

Right?

That was impossible to do. Even people had stents and balloons and bypass surgery, or had a positive calcium score. You went to see your doctor, and he flipped out. You flipped out, and now you're on all these drugs or whatever. Right? If you then said, okay, I've been doing this. I'm eating right. I quit smoking. I exercise. I'm losing weight. If you then said, well, Doc, by the way, tell me, is my plaque better? That was an unanswerable question.

Yeah, that's true.

I couldn't tell you. It should be better. The gauges look good, but I can't tell you, is the plaque better? That is something we can now do with AI.

Well, and that was the exact thing all the other cardiologists I saw were telling me the opposite because they were just guessing. So it was like, well, it's going to be worse because of your age.

I can't even tell you have plaque now, let alone is that better.

So good.

All of that is a solved problem. Which is wonderful, which is why I love preventive cardiology.

Well, thank you for everything that you do. Thank you for being here and educating my audience. Everyone, I will link that below in the show notes, and you could do a free consult with them, by the way, where you get on the— it was actually, I thought I found that very helpful, very educational. Like, you get on a call with them, they go through your specific concerns and history, and then educate you more about this, and then give you options from there. So, I thought that was very helpful. So, thank you.

We love giving people options, right? Just nothing happens on my watch. That's all. But we love giving people options, informed options, right? Not guessing options.

Yes.

Thank you. Well, I can't tell you what a joy this was. It was absolute pleasure. Thank you for the honor of letting me spread the gospel of prevention. I hope we created a couple more disciples and apostles out there.

I love it.

Ultimately, I want to eliminate heart disease. That's my ultimate goal. Now, along the way, make sure nothing happens to you, Natalie. But really, I just want to eliminate heart disease. And I always love saying at the end of any of these discussions, my ultimate goal, therefore, if you think about that analogy and follow it out far enough, is really what I'm asking you and everybody in your audience to do is something very simple, is put me out of business.

I love it.

Please put me out of business. Okay?

I love it.

I'll be very happy.

Thank you.