Take These Tests to Detect Heart Disease Early, with Dr. Joel Kahn

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And I'm Dr. Ed Levitan. Welcome to the Feel Freaking Amazing podcast.

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I want to go sort of drilled in, Joel, because when you say heart disease, what are you talking about? What are you referring to?

There are pediatric cardiologists. I'm not a pediatric cardiologist. And they're going to see a lot more, of course, congenital heart disease. People born with holes in the hearts, bad valves, three chambers, not four chambers, you know, very often requiring complex surgery.

But when we're talking, let's set those.

To the side like the adult audience. I mean, some would include high blood pressure as a cardiovascular disease. It is. But let's even carve that out because so many different disciplines deal with high blood pressure. But it's so important. So I just want to stress again, we're largely talking atherosclerosis, the progressive accumulation of debris, plaque, cholesterol, calcium, fibrous tissue, white cells in arteries from the brain to the toes. Most importantly, between the brain, the toes, is the heart and the sexual organs, because atherosclerosis is involved in the development of heart disease, number one killer of men and women, nearly 700,000Americans every year. But it's also very crucially involved in erectile dysfunction, sexual dysfunction, probably in women as well, although that's less well studied.

And.

And we're fighting it. And we're fighting it. A two pronged war. One is the same war we do for breast cancer, colonoscopy, colorectal cancer, uterine cancer with gynecologic exam, early detection. And that's more ingrained for colon cancer, breast cancer, uterine cancer, prostate cancer, early detection than is for heart disease. Just when you were 50 and you see an internist, you're not getting a heart detection recommendation on par with the recommendation you got for your cologuard or your colonoscopy or your thermogram or your MRI or your breast mammogram, you're not getting it. And you should. It's that all. So that's what.

Pause, wait, question, question on the field, what is that exam? What are you saying people should be getting? Or you would, you know, you have a practice. What is it that you recommending your practice to do and at what ages do you start. And just to make it more complicated, what does family history have to do? Anything? Is it just your age or is it whether your family history is suspicious?

Well, we have this happening. It's a great question. I'll answer directly. But you're going to get the recommendation for a colonoscopy now at age 45, and mammography around the same age, whether you have a family history or not. Of course, it's going to be a bit more of an urgent recommendation if you do have those diseases. There's nothing being recommended for heart disease in reality. In 1990, at University of California, San Francisco, they identified on a brand of CT scanner they developed at the time novel, a fast CT scanner that you can see the heart and you can see the arteries and you can see plaque in the arteries on a simple fast CT scan that involves no needle, no injection, no iodine, no allergic potential, no kidney damage potential. And that observation has evolved into 10,000 medical papers on something called a coronary ARTERY Calcium scan. CACs, some people say CACs, which now, just to bring it up to date, in your town of Boston, my town of Detroit, anywhere, any medium or large hospital that has a decent CT scanner, which is basically all of them, has the software to do this simple test. You're on a stretcher, you go in a CT scanner, the machine says, hold your breath. About three seconds later, the machine says, breathe, and you go home without a band aid, without a needle poke, without anything injected in your body. There is radiation from a CT scanner. It's equivalent to a mammogram. It's called 1 millisievert. It's considered low dose and it will tell you you have a coronary artery calcium score of zero, which will hope for Wendy and Ed and celebrate that meaning nothing was detected. That's like a clean colonoscopy. That's like a normal mammogram. It's like a normal digital rectal exam of the heart. Or you're going to find a number, and the number can go from 1 to 2000, 3000, 4000 if your arteries are really riddled with plaque. Almost all atherosclerosis includes calcium in the pathology, and calcium is easily detected. The soft plaque, not so easy. The fibrous tissue, not so easy. The white blood cells, not so easy. The calcium is easy. There's normally no identifiable calcium in coronary heart arteries on a CT scan. Who should get it by 50? I would say everybody. The American Heart association still drags their feet a little and would still talk about intermediate Risk people. I guess if you're a diabetic and a smoker and Your cholesterol is 350 and your parents died at age 45 of strokes and heart attacks, you probably can assume they have rotten arteries and you're going to do everything you can. I would still argue that person might want to have a little more quantification. This test I want to emphasize generally costs between zero if you go to the University Hospital in Cleveland because they actually give it away for free. Covered by insurance in the state of Texas because they're a little more progressive on preventive issues. Apparently legislator got it through, but most of us pay about 100 bucks for this scan is rarely covered by insurance, but it used to be well over $1,000 and I would argue probably even at 45, it's arguably, if you have any concerns, I'm stressed. My cholesterol, my weight, my sedentary lifestyle, my family history. If you got a wicked family history, I would do it at 40. But it takes a while for plaque and arteries to become calcified. It's a slow moving process. So you might sneak by with a calcium score of 0 at age 40 and still have a little of the soft immature plaque. And you know, the recommendation is if you're a zero, do it again in five to seven years. So I've been able, I'm proud to say in my early 60s to have every 10 years a zero. I'm not sure I'll do it at 70 and hopefully I'll be around at 70. But I don't think it's heart disease that's ever going to get me because I check. I never would assume, I wouldn't assume with a lipoprotein A you're going to have an abnormal one. I would be very optimistic you'd have a calcium squared zero. But the frustrating ones are the thin good eaters that have great lab work, including all the extensive labs I mentioned and their calcium scores are messed up. There's something in their blood we don't know by yet, but that's for future research.

So I'm curious and this might be a little off topic, but it's going.

Because you go down the rabbit hole.

Well, it's my curiosity. I know there's a new company, I think it's called Clery that does AI assisted CAT scans. Are you starting to use those? Because that looks for more of the soft plaque. Is that something that you recommend or is that something that's still beyond the fold?

Yeah, I'm actually just Joined their thought leaders group because I have a lot of experience. But to break that down, there's a simple. Well, obviously most people get offered nothing. You know, see you next year. And we'll do your blood work and put a stethoscope on your lungs. The calcium score is the most accessible. I mean, hundreds of hospitals across the United States or freestanding imaging centers. Very inexpensive, very low radiation. I've kind of fought for years that we don't need to up the game to the next level of sophistication. But I'm changing tunes, and your question is right on target. Because if you take the time to put an IV in, and while you're in that CT scanner, they give you dye, which means you have to have healthy kidneys, not be allergic to dye, and be able to tolerate 20 seconds of feeling warm flush, because dye does that to you all over your body. Now, you can see the hard arteries. You can see the calcium. You can see the soft, non calcified plaque. You can measure how narrow the artery is. And clearly Health C L E E r l y. Health.com has artificial intelligence software that provides me reports now. Exactly. It's insanely advanced how many cubic millimeters of plaque my patients have up and down their heart arteries. Where that plaque is. They characterize it to lower risk, medium risk, high risk. How narrow the artery is.18%, 11%, 72%. We don't even get that much precision from an invasive heart catheterization. And the data is. The data is at least on par with an invasive, risky $10,000 heart catheterization. This test is not routinely covered by insurance, but typically it's less than $1,500. Some component of that may be covered by insurance. So there is still a line of who can access it or not. The radiation goes up some. It's like three calcium scoring scans. It's actually way less than a stress nuclear scan. If your doctor says, I want to check your heart with a stress nuclear treadmill test, that's way more radiation than even this ultra sophisticated Clearly Health artificial intelligence scan. So I've started to use them, and they've taught me a ton that has translated into different recommendations for patients. A few have been good news. You know, Bob, that catheterization three years ago said you had a 65% narrowed artery, but that was an eyeball estimate. Your upgraded clearly health CT angiogram says it's 22% narrowed. Maybe the diet, maybe the meds, may be the nutraceuticals. Maybe eliminating toxicants from your environment, but you can sleep better at night. And I have a lot of people that feel better about their cardiovascular health and just they're less anxious. But it's usually the opposite. It's usually how much plaque we didn't see on the routine calcium score. And we've got to really whip your diet and your fitness and probably pharmacology to get down to those new LDL cholesterol recommendations, like 40, 45, 38, you know, that are compatible with good brain and good body health, but only for those with advanced disease. Or if you live in the bush, you might be walking around with an LDL cholesterol of 40, eating twigs and insects, but most of us can't quite reproduce that life.

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