Does Calcified Plaque Really Reverse CV Risk from Soft Plaque?

I didn’t want to cover this because this
is a critical question that comes up a whole lot. People are looking at calcium
scores versus CIMT and that whole conundrum of “Wait a minute, my calcium
got worse, so I’m worse off, right?” And we keep saying, no, we want that… we
want soft plaque to calcify. This is the actual… this is an actual study that
shows that. So these are two plaques. They’re basically comparable. This one…
you can’t see quite as well because that’s… which one’s soft and which one’s
hard? Somebody in here knows? The right one is hard. That’s calcium, that white
stuff is calcium. Radiolucent… and what is that radiolucent? This, no, I can’t remember those terms. The white is calcified. So if you look at it, you can actually…
it’s not just subjective. They actually quantify it using those little bubbles
and some technology. Here’s what happens. The guys with the calcified, it still did
have a couple of events. But those are the guys that had soft plaque (29 events in 112 cases). There’s the guys that had hard plaque (4 in 103). So that’s why we keep saying we want you here, and
lifestyle will get you here. We don’t want you there. Do you understand what
this is? Life table analysis. It’s the probability of having an event. Every
time somebody in the study in the population has an event, the population
goes down. So each one of these drops is an event. And this solid line is the
people that had the soft (echolucent) plaque. The same lifestyle. His lifestyle. Well,
that I mean we know that from some other studies. This study won’t tell us that.
But you know they’ve been studies where they compare medication to lifestyle. Hit
the head. Moderate the lifestyle. Winds out every time. So there’s nothing that I
or any other doctor can do that will impact your health and future like youth
like the decisions you make all day, every day. How much you sleep, how good
your sleep is, how you protect that sleep, how you do the boring stuff that helps
you sleep, have how many carbs you eat, what your BMI is, how heavy you are.
That’s called a Kaplan-Meier life table analysis. So what
that is is you’ve got two populations. You got a study population. You got a study population that’s got… they have clear plaque.
Let’s go back up. They have clear plaque. This is important for what we’re doing
today and for a major reason the most of you came here. The question again is is
calcified plaque really that much safer? Because all I hear is the higher my
calcium score, the worse off I am. And what they did… this is a study where they
took people, and they measured… they classified them into two different areas.
This is somebody with a calcified plaque (right). That’s what it looks
like on your IMT. You’re not likely to see a whole bunch of other people’s I am
teased but I can tell you it’s out there. It’s clear. And we look for
progression from this to this. This is soft plaque (left). That’s calcified plaque (right). Any
questions about that concept? This is soft plaque, and that’s… and
this is again if she said well how do you know that you can get certain
gradations. You do get certain gradations. We do have quantification systems for
grading. How much quantifying how much plaque there is now. So they took
the two populations 112 in the solid line echolucent. And is that confusing
you? The term “echolucent”? Because it confused me. These are the guys
that had soft plaque on statins. They had hard plaque. But this isn’t a gun and it
stands have impact this issue. But this has got nothing to do with whether you
got statins. This has got to do with whether you’ve got soft or hard plaque. This…
of the guys with hard plaque/calcified plaque did have some. They can’t… they had
a couple of events early on. So yeah. Which is what you’d expect actually.
Lends some validity to what these guys are telling the truth and not…
making something up. This is the hundred. So this is
what… 112… wait, and it’s sort of like a double negative and I keep getting
confused on trying to use the term “echolucent.” Listen, I’m not going to try. These are
the guys that had soft plaque (solid line). These are the guys… they had a hard plaue, calcified
plaque (broken line). Well, you can assume even more so that they were probably doing some stuff
in terms of their lifestyle. I mean it’s clear… it’s clear lifestyle has a bigger…
a 30-pound weight loss, you can’t match with any kind of statin. A 15-, 20-
pound weight loss, you can’t match with any kind of statin. Fat mass in and of
itself drives inflammation, drives softening of plaque. Yes,
statins do impact. If there’s no question. But is it all statin? No. I mean
that’s part of the… that’s part of the difference between what you’ll get here
versus what you’ll get out in the standard community. They’ll look very
quickly for a whole bunch of reasons to put you on statin that I wouldn’t put
you on a statin. The Louisville event was an incredible
success. Many people didn’t know that that was our first attempt to coordinate
the whole thing ourselves. And it was better than we had had hoped. A lot of
focus, and people saying, you know what, I know that we can deal with this together
as a group. There are other people that I’m meeting here at this event that are
doing the same things I’m doing and with success. I don’t have to be a doctor to
know all this stuff. We are going to go ahead and have another one on February
28th in the Hyatt Regency Grand Cypress in Orlando.

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