MedEvidence! Truth Behind the Data

Why Does Context Matter with Coronary Calcium, Cholesterol, and Cardiovascular Checks? Ep. 324

• Dr. Michael Koren, Kevin Geddings

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Dr. Michael Koren joins Kevin Geddings to explain how having a conversation with a medical professional who is tuned into your personal situation can help you understand the confusing and sometimes counterintuitive world of medical information. Cardiologist Dr. Koren uses the examples of coronary calcium scores and total cholesterol levels, which must be interpreted in the context of individual factors, such as age and HDL/LDL ratio. They then discuss clinical research and how the experience in a clinical research setting is one of shared knowledge, where medical professionals take the time to explain everything you need to know about your health.

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Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.com

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Music: Storyblocks - Corporate Inspired

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Announcer:

Welcome to the MedEvidence Monday Minute Radio Show hosted by Kevin Geddings of WSOS St.. Augustine Radio and powered by Encore Research Group. Each Monday morning, Dr. Dr. Michael Koren calls in to bring you the latest medical updates with insightful discussions. MedEvidence is where we help you navigate the real Truth behind medical research, with both a clinical and research perspective. So sit back, relax and get ready to learn about Truth Behind Behind Data Data medicine medicine and healthcare. This is!!

Kevin Geddings:

Dr. Michael Koren is here with us medical doctor, cardiologist, research scientist. Of course he directs the efforts at ENCORE Research Group and they have an office right here in St. Johns County other locations throughout Northeast Florida, but they're located next to UF Flagler Hospital in the Whetstone Building here and folks go there to participate in some leading-edge clinical trials on all sorts of different health topics and of course Dr. Koren is a cardiologist so a lot of times we tap into his knowledge of heart health, including we wanted to talk a little bit this morning about coronary calcium counts,

Dr. Michael Koren:

Yeah, as I mentioned to you, we just got back from a little family affair in Connecticut and the discussion around the dinner table was about coronary calcium and cholesterol levels and why people are confused about these things.

Kevin Geddings:

Yeah, yeah. So that's a number I guess we get when we have our lab work done, correct?

Dr. Michael Koren:

Well, the coronary calcium count actually comes from a CAT scan.

Kevin Geddings:

Okay.

Dr. Michael Koren:

So there's a type of CAT scan that you can get. That's a very limited type of CAT scan with small amounts of radiation and that establishes the amount of coronary calcium, or calcium on your coronary arteries. And what that means, Kevin, is when you get older, there is a healing process that occurs, and this is the way our body heals atherosclerosis by creating these little stable plaques that eventually become calcified and can be identified with a CAT scan. So this is a normal part of aging, but it's actually very different in different people and it's extremely predictive of who's going to get into trouble with heart disease, particularly heart attacks. So cardiologists now all the time use this technology to determine who's at high risk for having a heart attack and who's at lower risk for a heart attack.

Dr. Michael Koren:

And because this is an age-dependent process, the numbers always have to be looked at through the lens of age.

Dr. Michael Koren:

So, for example, somebody who's in their 30s should really have zero coronary calcium.

Dr. Michael Koren:

There shouldn't really be any healed atherosclerosis per se, whereas somebody in their 80s will typically have some, and we hope that number is relatively low, meaning that there has not been a lot of healed atherosclerosis. But this leads to a lot of confusion because, for example, at our family table over the weekend we had somebody who was in their 80s and I asked them about their coronary calcium counts, since they had a workup for their heart recently, and they're able to tell me oh, it was about 75, which is actually a pretty good number for somebody who's in their 80s. But then I had a niece and she was saying yeah, I think my coronary calcium count is 20. Now, that would not be very good for a 30-year-old, but there's a lot of confusion as to why was 75 good for one person and something in their 20s bad for another person? And this gets into the whole concept is that you really have to take medical information and put it into the context of the individual, which doesn't always happen. It certainly doesn't happen when you look things up on the Internet.

Kevin Geddings:

Right, right, that's Dr. Michael Koren, of course, with us live. So if we have, I guess, obviously a low number is not good, a high number, I guess, is better. If we have a low number and like your relative who's only in their 30s with a low number, what can they do to make it better?

Dr. Michael Koren:

No, no. For coronary calcium, just to be clear. A higher number is worse.

Kevin Geddings:

Oh, okay

Dr. Michael Koren:

And that's a reflection of the amount of atherosclerosis that has, quote, healed over time. But the thing about the coronary calcium, Kevin, is that it doesn't go away.

Dr. Michael Koren:

So, let's say you had a healed plaque when you were in your 40s. Well, that will show up for the rest of your life, and so what you're really looking at is the cumulative story of atherosclerosis over somebody's lifetime. So, again, somebody in their 80s is expected to have more calcium than somebody in their 30s, and when you look at somebody in their 30s that has any calcium, that's something that would make us concerned as cardiologist.

Kevin Geddings:

Okay, okay. So yeah, that number is dependent obviously on age, because you might have a higher number if you're 80 years old, but that's understandable because you've lived your life, right, right.

Dr. Michael Koren:

There you go, exactly. So, with all these things, we look at this particular test, which again is a type of CAT scan that uses low doses of radiation to determine the likelihood of a heart attack or other atherosclerotic events, like a stroke or peripheral disease or an aortic aneurysm. And this gets confusing to people, for the exact reason that we were just discussing is that the number has to be looked at through the lens of how old you are, but the other thing that comes up;

Dr. Michael Koren:

Is that okay? So I have a coronary calcium count of, say, 50 at age 50. Well, that's not so good. So let's look at your cholesterol. Well then, people look at their cholesterol and again, going around the dinner table, somebody has a cholesterol of 250, which is a total number of cholesterol, but their HDL is 100. Well, that's not so bad.

Dr. Michael Koren:

On the other hand, somebody there has a cholesterol total of 180, but their HDL is 35 and their LDL is 140. Well, that's not so good. So then they're telling me well, you told that person that 250 was pretty good, and here you're telling me my total cholesterol is 180, and that's kind of bad. And these are the kind of things that get people extremely confused, and that's why it's so important to have a conversation with medical professionals that can break down these numbers for individual people and explain why this number is either better or not so good for the particular individual

Kevin Geddings:

Right, that's Dr. Michael Koren.

Kevin Geddings:

Once again, you can connect with him and all the work that they're doing with Leading Edge Clinical Research by going to EncoreDocs. com, EncoreDoc s. c om and Dr. Koren. Since we're on the topic of cardiovascular health, I would imagine there are a variety of studies that people could participate in if they've had issues along these lines.

Dr. Michael Koren:

Absolutely, as we speak, we probably have a dozen studies that are enrolling patients with a number of either cardiovascular risk factors or known cardiovascular disease, where we're trying to improve your odds and reduce the likelihood of a heart attack or a stroke likelihood of a heart attack or a stroke. We're doing this, for example, with GLP-1 agonists which, as most people know, will help you lose weight, in addition to lowering your cardiovascular risk.

Dr. Michael Koren:

That's one area of research, but we also have other areas of research where we're directly treating cholesterol issues, or lipoprotein( a), which is called a really really, really, really bad cholesterol a form of a lipoprotein that's more likely to cause heart attacks and strokes, and other programs as well. We just finished up a really interesting study with patients that had hypertension, using a new mechanism. We have other studies now that are treating people who have congestive heart failure with medications that will block the negative hormones that cause people with congestive heart failure to have complications.

Dr. Michael Koren:

So really across the board, if you've been diagnosed with cardiovascular disease, there's a really good chance you'll fit into one of our programs. That would be helpful.

Kevin Geddings:

Yeah, and you can do that and you can learn more about those programs and how you can get, really honestly, some of the best health care you'll ever get. A couple of us here at the radio station have participated in this clinical research with ENCORE Research Group. We highly recommend the experience. You could have fun actually Go to EncoreDocs. com EncoreDocs. com and I should mention, there's compensation involved as well and, speaking of cardiovascular health, when you're looking for information about all this stuff, there's a great resource online for them, right?

Dr. Michael Koren:

Yeah, that's our MedEvidence! platform and thanks for bringing that up, and I'll give you another example of why MedEvidence! is so important and general information on the Internet may be suspicious. So at the dinner table again there was discussion about statins and people asking me do I think statins are good or bad? And this is very typical, Kevin. Everybody looks at things at lenses. Is something good or bad? And this is very typical, Kevin. Everybody looks at things at lenses something good or something bad?

Dr. Michael Koren:

Well, asking a cardiologist, especially a preventive cardiologist, if statins are good or bad is like asking a mom with a four-month-old is mother's milk good or bad? So statins are something that are a wonderful class of drugs that prevent heart attacks and strokes. Do they sometimes cause a little hiccup here and there? Sure, like anything else, but overall there's no question that statins are a very, very important part of how we reduce cardiovascular risk, particularly in patients at high cardiovascular risk. But here's the funny thing is that around the dinner table people say oh, I heard statins are bad. Well, that's just crazy. If you read anything that says statins are bad, you need to immediately cross that website off your list of viewing opportunities.

Dr. Michael Koren:

On the other hand, if somebody says well, sometimes people can have intolerance of statins and what are the? Alternatives. Well, that's an interesting question.

Dr. Michael Koren:

And we actually have an answer for that at the research offices.

Dr. Michael Koren:

So that would be a legitimate question. But here's the other really interesting thing, Kevin. There's been some information out there that says, oh well, statins will increase coronary calcium counts and that must be a bad thing. Well, actually that's a good thing, and the reason it's a good thing is, as I mentioned, is that the coronary calcium count is a reflection of healed atherosclerosis. So something like statins that helps atherosclerosis to heal will, of course, in the short run, increase your coronary calcium count.

Dr. Michael Koren:

So again, this is where things get confusing for people. Something that causes healing will also cause a number to go up that people will sometimes associate with a bad outcome. In fact, it is not a bad outcome. It's a medicine doing what it could be doing to reduce your risk. So I know that could be very confusing, but that's why coming into the research setting and having a conversation with a professional that truly understands these things and can present these things to you through the lens of your personal experience is really vital. It can't be replaced by anything on the internet or with artificial intelligence at this point.

Kevin Geddings:

Yeah, and you can do that very easily here locally by calling 904-730-0166. That's the number for ENCORE Research Group here in our part of Northeast Florida, 904-730-0166. I know it's hard to remember phone numbers when you're driving around, but go to the website EncoreDocs. com that's E-N-C-O-R-E Docs. com. And of course, MedEvidence! is available to you to answer all kinds of questions and a reliable resource online, which it's hard to put. Those words all in the same sentence. Medevidence. com that's MedEvidence. com, Dr. Koren. Any closing thoughts this morning?

Dr. Michael Koren:

It's go get good information for people who are listening. Now. There's so much information, much information. Again, I was actually blown away during our family discussion about all the information people are getting from sources, be it TikTok or their friends on Instagram or a number of different places. Be suspicious about any kind of information that's promoting a particular product, particularly some of these supplements, and get objective information, whether it's on that evidence or in other places. It's so important because people actually make very poor decisions based on poor information.

Kevin Geddings:

Yes, absolutely All right. Well, good stuff, Dr. Koren.

Dr. Michael Koren:

We appreciate your time this morning Be safe out there and we'll speak with you next week. You have a great week, Kevin.

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