@TheBhupiThakur @jaideeppatelmd @MichaelJBlaha hi @TheBhupiThakur

For LDL>190 mg/dl
In MESA nearly 35% have #PowerOfZero
13 yr FU, event rate 3.5% (well below threshold for statin consideration)

atherosclerosis-journal.com/article/S0021-… @TheBhupiThakur @jaideeppatelmd @MichaelJBlaha #2
For genetically confirmed #familialhypercholesteremia

See below, clearly not a homogenous disease, many shades of atherosclerotic disease

Events track with CAC score

With CAC zero, can possibly avoid PCSK9i (statins for all)
@rauldsf_santos @miguelcainzos23 @reed_mszar

While there is so much established about CAC..

for @Heart_SCCT Prevention Symposium, I was asked by @RonBlankstein to talk about

"what's next for CAC Testing in 2021 (and beyond)?"

What are the main applications in the future?

@miguelcainzos23 @jaideeppatelmd #1 CAC has come a long way
-evolving to the needs of the past decade from screening test to a SDM tool
-best tie breaker, adding the dimension of de-risking
-cost-effective and reassuring ok to avoid treatment
-cautiously approved by ACC/AHA guidelines
@Heart_SCCT

#1

While as preventive cardiologist we all organize information from imaging and biomarkers in a debate with my dear friend @CBallantyneMD , asked tough Q what would I choose if I had one option?

The answer is clear and maybe not debatable anymore

@ASPCardio @Heart_SCCT # 2 What ur risk? remains the foundational strategy in preventive cardiology and in this pursuit we continue to rely on risk factors and a growing list of biomarkers

@ASPCardio @CBallantyneMD @DrMarthaGulati

#COVID19 recovery?

My thoughts below

For most of us on the frontline including myself, the 100% focus in the last 4 months, rightly so, been on beating the initial sickness

Unaware it may be just the first of many battles

Sometimes we all need perspective (definitely I did) #2
For me, As a physician, it was my collogues, including Dr Wu a surgeon one of the first doctors falling sick all across in US

learning from their personal experience as a patient….

getting insights on their anxieties, isolation and struggles was an eye opening experience

Debate CAC vs CTA in primary prevention?
I will start with a provocative statement
Screening, foundational strategy for decades in prev cardio is a seductive paradigm
Its so 1990’s
We are barking on the wrong tree
In 2020, I will explain why this strategy is a fallacy
#ASPC2020 #1 Both primary and secondary prevention lower disease burden and outcomes
#2 Marginal benefit of extensive screening
#3 Whats left to screen? Majority already treatment candidates
#4 Our stakeholders asking for "derisking" vs "screening"

#APSC2020

Humbly honored for this recognition today

Thank you, @Heart_SCCT and especially my friends @RonBlankstein @Agatston_Center presenting it, made it more special

Truly proud to be among the pantheon of cardiology giants who were previously recognized. In reality honor for #PowerOfZero is really a tribute to the man with Midas touch

Privilege to work & learn so closely, this relationship blossoming not only with him but entire family

@Agatston_Center is national treasure & even today remains a source of inspiration for me🙏

#1 Many raised concerns reg racial disparities in face of recent COVID-19 pandemic
@eff_ve leading efforts @HMethodistMD to systematically examine inequalities reg susceptibility to SARS-CoV-2 infection in nation’s most diverse metropolitan area: Houston
medrxiv.org/content/10.110… #2 @eff_ve building a novel data platform form to automatize ingestion, organization & analytics serving @HMethodistMD entire research community data needs via COVID-19 Surveillance and Outcomes Registry (CURATOR)

Operational details of this registry/platform coming soon.

Nice piece by @CoronaryDoc

It was interesting to see almost similar views for

"Is CAC Imaging Ready to be the Gatekeeper For Advanced Imaging in Low-Risk, Symptomatic Patients?"

Whats to disagree😀
@lesleejshaw @RonBlankstein @ChinnaiyanMD @CoronaryDoc @lesleejshaw @RonBlankstein @ChinnaiyanMD @WilliamZoghbi @Heart_SCCT @FiRSTSCCT @ACCinTouch @escardio @YaleCardiology @HMethodistCV @HMethodistMD @almallahmo @MBittencourtMD Q1
"Do you think there is enough evidence to use CAC as the front-line test and the gatekeeper for coronary CT angiography (CCTA) in low-to-intermediate risk symptomatic patients?"
@RonBlankstein @lesleejshaw @CoronaryDoc @ChinnaiyanMD

With 5 days to Chol management guidelines update @AHAMeetings..gentle reminder in @JACCJournals: It’s time to accept the #PowerOfZero.

Hope it’s not too late! @rblument1 @hmkyale @MichaelJBlaha @RonBlankstein @ErinMichos @MBittencourtMD.
Some thoughts👇
onlinejacc.org/content/early/… #1 Going back to early 2000’s when many showed RF-based approach fell short for individual patient management decisions... aspirations for CAC ‘screening’ gained momentum, though progress stalled due to lack of RCT & waiting for prospective cohorts to confirm prognostication

makes some good points. agree from screening prospective (not on treatment->screen->find disease->treat->improve outcomes), there is no RCT-> show "screening" helps. I may even go further & said in 2015 (apply more in 2018) do we need screening (even with CAC?) #1 so basically statin are great, we decide candidates based on PCE in asymptomatic, but what are the tradeoffs (too many eligible, PCE overestimates, patient uncertain & reluctant).