Healthy heart refresher on the most important “cholesterol” measures from a top metabolic health MD 

Fully sympathize with your sentiments and thank you for your comment @zoe.thebody360 The other issue of courses after you test, what to do with the results. There’s a huge gap in understanding what is optimal, and how to get there at the lowest risk whether it’s from the lifestyle medicine coaching perspective, for the webinar that I posted in the description area provides a good background and how to coach regarding stages of readiness for change, pharmaceutical intervention which is a form you have really understood how to leverage at the spot of high efficacy/low risk. If you ever want to do a discussion for our mutual communities, happy to consider..

No IMO. It is not worth the IV contrast risk to kidneys or even the radiation to prove what is almost assuredly there - ie soft, noncalcified plaque. The question is whether atherosclerosis is advanced enough to have calcified, for which a CACS can do the trick without contrast and less radiation than CTA. At that age, it’s questionable whether even a CACS (coronary artery calcium score via CT scan - no contrast necessary and much cheaper than a CTA) is worthwhile, but it might be if the 33-year-old has significant family history of early cardiovascular diseas, in which case they should have their lipoprotein(a) checked as well. CACS may be helpful if it in fact would motivate them to agree to intensify their prevention approach, preferably in terms of lifestyle but even pharmaceutical. It’s typically a “tiebreaker“ on decision-making for “yes or no to pharmaceutical enhancement over and above lifestyle for reducing lifetime risk of ASCVD (atherosclerotic cardiovascular disease) My concern is that when there is a zero CAC score that people over interpret the finding as more than simply a low risk over the next 3 to 5 years. Ie if a zero score is found, it should be cherished (as I do with my zero score in my 50’s despite very high lipoprotein(a). In other words, even with a 0 CAC score, everything done lifestyle-wise to maintain zero as long as possible. With zero CAC, argument could be made that adding risk of pharmaceutical intervention with a zero score may not have benefit that outweighs risk. All that being said, for 33 year-old to have full-blown type 2 diabetes means that there is some serious story to unpack (and should likely be investigated for having LADA or MODY -discussed in lesson 2 of module 1 of the Flex5 Lifestyle Masterclass) like a likely family or tight social network pushing risky lifestyle behaviors or living in a high risk zip code.

@@DrTomMD thank you doc. Diabetes was induced via a vicious cycle of emotional binge eating and sedentary lifestyle during the lockdown period. Was reversed within months of diagnosis via 180° in diet & lifestyle with the help of some supplements. Lp(a) 33, but Apo-B has been elevated since teens. Early ASCVD events have occurred only in paternal grandfather at this point (may it stay that way). The big Q is whether to start pharmaceuticals. Apo-B is now only mildly elevated (80-100) thanks to very rigorous (and possibly unsustainable) lifestyle.

@@Seanonyoutube see if you can find a place to do a carotid CIMT ultrasound nearby. That would give almost as good information as a coronary artery calcium score, but much earlier detection via carotid arteries’ media thickness, which substantially precedes calcification. Of course if a clear plaque is visible that would also be detected, but the CIMT is a much more sensitive way of assessing the level of atherosclerosis progression in a younger person by simply accessing the easy to visualize via ultrasound carotid arteries with a skilled ultrasonographer who knows how to do CIMT. At your age with aggressive reversal lifestyle I am fairly confident you don’t have any un reversible vascular disease of any significance. The more substantial concern is whether you can maintain a continued sclerosis lifestyle. It may not need to be as strict as you are doing now. Honestly, as motivated as you are, I would sincerely suggest considering our Flex5 Lifestyle Masterclass (info: dpm.drtomrifai.com/)

@@DrTomMD thank you doc, I will do that test, and look into your program. I’m always playing with various lifestyle levers to see how it impacts my bloodwork; i’m hoping I can find a balance, especially in terms of minimizing the cost and time involved in it all. Thank you for your response and your great content!