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Joel Jamieson did everything right and was still walking around with a 50% blockage in his widowmaker artery. He’s a world-renowned cardiovascular expert who doesn't smoke, doesn't drink, sleeps well, manages stress, trains consistently, and has a VO2 max probably north of 55. He got screened at 40 and... show more
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I would not recommend that. Get a calcium score 1st (~$200) check your Alpha lipoprotein and cardiolipin A&B, look at your family history, and then get a CT angiocardiogram if any of those show risk. The risk of nephrotoxicity due to the contrast is real and the risk of radiation is real especially when young.

I'd test these before a heart scan. They're cheaper, <$200, and show heart disease earlier: - ApoB (more accurate than cholesterol) - Lp(a) (strongest hereditary risk factor for heart disease) - Inflammation (hs-CRP) - eGFR (kidney health) - A1c (metabolic health) Lots of great options including @EmpiricalHLTH.

In Joel's case, this would have failed him. His full blood panel (including the markers you listed) looked great, and his first cardiologist told him there was no need for additional screening. He got the imaging done anyway, and it probably saved his life.

In 99%* of cases, a heart attack is proceeded by a risk factor in a blood test. So most people are better served by getting the $200 blood test before they get the $1,000 CCTA. * actual stat from the medical literature, not just a figure of speech

Well... tbh. If you have a significant family history, then that combined with ApoB, Lpa, hsCRP, Trigs, etc., should have led to far more aggressive lipid/lifestyle mgmt without the need for a CTA. If folks are on the fence about starting lipid-lowering meds/lifestyle changes, then perhaps CAC or CTA could help them... but those tests shouldn't be necessary for a cardiologist to initiate aggressive mgmt in his clinical scenario.

Agreed, and I know Joel does as well. In Joel's specific case, he had worked with a cardiologist, who told him not to pursue any additional imaging or make any changes because his lifestyle was good. Had he not sought out a second opinion, things could have turned out very poorly.

Agreed... it's terribly unfortunate that the only variables weighed to determine his risk profile were his lifestyle and physical activity.

@AJA_Cortes What was his CAC? ApoB? LpA? HDL? HS CRP?

The main issue is that a 50% blockage just means he needs aggressive guideline directed management of risk factors- blood pressure, lipids, diet and exercise…his family history , particularly with is brother, should have triggered that…

At 54 I had a Ca score check even though my cardiologist said no. I got a devastating score of 927! An angiogram found 100% blockage of my Widowmaker. Endurance exercise saved my life due to extra arterial growth above the blockage. Exercise can protect from horrendous genetics.

@grok is Andy a doctor and has he ever ordered a CCTA or interpreted a CCTA THANKS IN ADVANCE

My father did not take good care of himself and made it to 87. My maternal gma made it to 96 not taking care of herself. My mom is fit as can be at 85 and does not take of herself. I take exquisite care. HypOtensive my whole life. No smoking. No drinking. I tried to raise my cholesterol because I was worried it was too low. Will I live forever?

I wouldn’t recommend CT angiograms for all…this will open a pandora box of endless chaos. All those 40 and above, including very fit individuals, should get annual screening for hypertension, diabetes, and high LDL including a one time LPa measurement. Appropriate medical treatment should be started early and promptly. A healthy lifestyle is great but it wouldn’t make you immune to the no. 1 cause of death worldwide.

Did everything right is subjective and your omitting many other factors and variables besides genetics Like certain foods or supplements he took to contribute to his disease

What about a calcium CT for $100?

This hits home - at 49 I was having issues - just not feeling right, Docs never got it right, eventually 1.5 year later - a cardiologist did the CT, damn the room said - 95%. Doc said I did everything right, was just my DNA. I am now better than 95% of my gen pop peers -vo2max.

Probably ate a lot of seed oils?

Joel Jamieson the MMA conditioning coach?

Yes.

Great post. Reminds me of Jim Fixx, who wrote The Complete Book of Running, and died at 52. Family history.

Would you recommend a CAC test first to determine if atherosclerosis has started? Then, if yes, prioritize this test? Would one give insight into the other, given it's significantly cheaper?

39 just had a heart attack. Fit the bill you described to a tee. Had a 100% clogged artery, surgery and stent. One week ago

"Did everything right" How much sunlight was he getting. How much blue light was he avoiding? I thought so.

Is he COVID vaxxed? That seems to make a difference these days. It is an important data point.

for south asians who have even higher earlier risk than the general population, early screening is vital. But important to differentiate what is the best route.

Would love to know his take on diet and what he considered “heart healthy”

Lpa is the culprit in most, not all, of these genetic family history stories.

Certainly a very important thing to take a look at.

💯 agree. Just got a Coronary Computed Tomography Angiography (CCTA) done to be safe. I'm assuming it's the same??

He didn't do it right then.

Let me guess. Avoids animal fats/protein, consumes heart healthy seed oils, refined grains, fibre and copious amounts of fruit and veggies.

Please tell us his LDL burden for the last 20 years.

Is there an instance where this blockage isn’t a big deal? In isolation may not be an issue. What if he was developing his own arterial cross collateralization? Is occlusion with aging more normal than we realize?

@clvyevolved “did everything right”

“Half the arterial flow in my body is blocked; the trouble is I don’t know which half.” John Wanamaker (1838-1922)

Noticed you didn’t say he eats healthy

@AJA_Cortes Also check Lp(a)

Wild to assume that someone with a high VO2 max would just be healthy.

💪🙏

I thought of the huge difference any supplement could make would be life changing. Tomato loads of it! Astronomical levels probably wouldn't work. Thoughtful effects of Lycopeen ?
