Cholesterol - The Good, The Bad and The Ugly

Think your "normal" cholesterol means you’re safe? Think again.

In this episode of Cell to System, we sit down with world-renowned integrative medicine and cardiology physician Dr. Abid Husain, MD, FACC, ABAARM dr_abidhusain from Boulder Longevity Institute, to dismantle the 40-year-old myths surrounding cholesterol. If you are one of the 30 million Americans taking a statin, or if you’ve been told your LDL is "fine," this conversation is a life-changer.
In this episode, we uncover:
• Why particle size matters more than your total cholesterol number.
• How AI-based CT scans are finding "hot" inflamed plaque that standard tests miss.
• The hidden link between cholesterol-lowering drugs and cognitive impairment.
• How spike proteins and chronic inflammation are changing the landscape of vascular health post COVID.
• Why most primary care doctors are still using outdated "hammer and nail" diagnostic tools.
Stop treating a number and start treating the terrain.

🔗 More about Dr. Abid Husain:
•   / dr_abidhusain 
• Boulder Longevity Institute https://boulderlongevity.com/ 

🎙️ Follow the Cell to Systems Team:
• Leonard Pastrana, PharmD: Co-founder of nuBioAge & nuHx.Health / www.instagram.com/leonardpastrana
• Franck Kacou, PharmD: owner of Progress Pharmacy; co-founder of nuBioAge, nuHx.Health, Source Pharmacy and nuCliniq / www.instagram.com/nubioagewellnessnetwork / www.instagram.com/progresspharmacy
• Suzanne Ferree, MD, FAARM, FSSRP: CEO and Senior Physician of Vine Medical Associates / www.instagram.com/drsferree
• Kristi Fury, CFNP: A board-certified Family Nurse Practitioner; founder of Beyond Health. / www.instagram.com/beyondhealthabq
• Craig Mullen, MSN, FNP, ACNP: Founder of Remedy Functional Health Solutions. / www.instagram.com/remedy.functional.health
• Jock Putney - CEO and founder of Nuvolum, Quantum PRM, Stemodontics / www.instagram.com/jockputney

Transcript

SPEAKER_01 0:00

The Celtic Systems Podcast is for informational and educational purposes only and does not provide medical advice, diagnosis, or treatment. Listening does not create a doctor-patient relationship. Always consult a qualified health care provider regarding your medical conditions or before changing your health regimen. Do not disregard professional advice or delay seeking it because of something you heard on the podcast. Reliance on the information provided is at your own risk. Guest opinions are their own. Celda Systems may utilize affiliate links, feature sponsored content, or discuss companies in which hosts or guests have financial or advisory interests. Relevant disclosures will be noted during the episode or below.

SPEAKER_04 0:38

All right, welcome to Celda Systems. Today we're going to be talking about cholesterol, everything you need to know, the myths, and we're going to bust those. We're going to get deep into it. The good, the bad, and the ugly. And we have a special guest, Dr. Abid Hussein, who is a cardiologist practicing longevity in cellular medicine in Boulder, Colorado.

unknown 0:59

Dr.

SPEAKER_04 0:59

Hussein, you recently gave a talk at Calm that was phenomenal. And you were talking about labs that you wanted to see when you're kind of working up a patient. What do we need to know about cholesterol? And then bring it to the group and let everybody kind of chime in.

SPEAKER_03 1:14

Sure. Thanks for having me here. So it was it's uh great to see all these familiar faces here, too. So um, yeah, cholesterol is it's a you know, there's a big misunderstanding about cholesterol. And historically, it's been what has been associated with atherosclerotic heart disease and you know it's what's used for to assess cardiac health. But in reality, it's really not the marker that we should be looking at. What we need to be looking at is the what types of cholesterol particles they are, and what type of other uh what other processes are associated with that cholesterol. So cholesterol itself is not necessarily the uh the bad player. Particles are, and you know, when we look at the studies, yes, high particle numbers are associated with atherosclerosis and higher outcomes, higher cardiovascular issues. So there is an aspect of higher particle numbers that we do have to be aware of. It does contribute to atherosclerosis. Uh, but looking at the the big difference is looking at a cholesterol mass number versus a particle number. And that's where that differentiation comes between looking at what most physicians and and practitioners are looking at. Just a if you're lucky, an LDL, sometimes it's it's it's not even that, it's a total cholesterol. But they're looking at that, which is a mass number as opposed to the APOB, which is looking at the number of particles that are atherogenic. So the the particles are what ends up giving you the the number of insults to the lining of the artery. So the analogy I like to use is the particles are like bullets, you know, they can be really large, buoyant, and maybe like beanbags that don't really penetrate and you can recover from, or they could be actual bullets, they're small and dense. So there are really a lot of easy ways to assess what the size and composition of these particles can be, and then also looking at what's associated with them. And the big association we have to be aware of is inflammation. So, and and as the studies have shown us over the past many years, it's not just the particles. Particles that are associated with inflammation become highly more atherogenic. Uh, and where is that inflammation coming from? And then there's other layers to it. What's the glucose metabolism? What is, you know, what is the the hepatic health, because all those particles are being made by the liver. So if the liver is not healthy, it's going to crank out particles that are that are more atherogenic. So if I take a step back and kind of go through a a just a rough uh you know framework of how it is that I assess a patient, when someone's coming to me and they have all the labs that I want, it I can do a lot with just a CBC with a comprehensive metabolic panel, a lipid panel, and then an APOB. So one of the first things I look at is what's the the size of those uh those LDL particles? And that's a simple ratio with the LDL to APOB ratio. And if it's below 1.2, that usually means that they have really small dense LDLs that are potentially atherogenic. And that right away triggers, okay, what's going on in their liver because their liver is making these small particles. Uh, is their glucose metabolism okay? Then with that in mind, I can look at the total cholesterol or the triglyceride to HDL ratio and the total cholesterol to HDL ratio. So you can see that just by just by thinking about it in those terms, you already can start to differentiate where these pathways are are diverging and where or where they're coming in to cause you know a uh problem with the the cholesterol and with the LDLs. Um you know, the looking at it further, the there are uh looking at the APOB um to the I'm sorry, the AST to ALT ratio, that tells me what the the liver is doing, if the liver is got an inflammatory makeup, if there's fatty liver deposition, usually the ALT will be higher. Um and then the neutrophil to lymphocyte ratio and that you can get from a CBC. That really tells me if the innate immune system is is turned on, if it's uh if the those neutrophils are high, that can be is something that's that's uh that can be triggered elevated above about 2.5 is uh is a good cutoff, maybe even lower, you know, around two, above two can tell us that that innate immune system, those neutrophils are much more activated. And this can be uh a a uh uh prior to HSCRP being elevated. I didn't even mention that, but HSCRP is also one of those foundational markers that's easy to get that can tell us you know where these patients are in sort of that spectrum of uh of of atherosclerosis and in that evolution. Um that was the the gist of the of the of the of the talk. But you know, the if we take a look at the sort of the the the I wouldn't call it a myth about LDLs, but it's just been misrep misrepresented, you know, the and I think partially because the the industry, you know, we know that we have if we have only one thing that we can that we that we need to to modify, that becomes the thing that people focus on. And if we remember way back when we didn't have that many tools, and so that was the only thing we could focus on. So I don't think it's intentional, but I do think that that uh the dialogue has that should have changed as we've evolved and understood what atherosclerosis really is, has not evolved. It's been focused on this singular marker that really has been inefficient, despite having many other markers and other ways of looking at vast vascular health and uh you know general metabolic health that have not been updated as we've uh as we've continued.

SPEAKER_04 7:19

Yeah. So sort of what you're saying is uh when all you have is a hammer, everything is a nail, right? So you all have evolved past that, and yet so many people, patients are still seeing providers that are only looking at that single sort of dimension of this. I'm curious, um, Dr. Ferri, what your take is on all of this.

SPEAKER_02 7:41

So it's funny. Um this is the uh the the exam time. So I'll see my patient about about once a quarter and they'll come in for their exams, and this is their, they think this is their report card. Their LDL is is their, you know, LDL is not a moral failure. And so this is where we get into a lot of trouble with patients because they'll come in and and they'll say, Oh God, doc, what's my LDL? And you again, and then they get themselves all worked up. And I think, oh, your your cortisol being high is way more of a concern right now than whatever your LDL is. So we have to take it into the context of what the entire patient is experiencing, where they are in their whole metabolic flexibility. For example, what are they doing? How is their insulin resistance, like uh Dr. Hussein was mentioning? We're we're looking at them from this, like what is the terrain that we're providing or that is provided to us? And then rather than looking at the LDL as a thing we need to crush, remembering that cholesterol is actually a beautiful molecule. It is part of the cell wall of every single cell of your body. It is part of the receptors. Um, it is part of steroidogenesis, which is making um hormones. So we we this is not a fighting against the enemy problem. Where when we talk about dealing with cholesterol, we're talking about looking at the entire patient, which is one of the luxuries I have being a in a membership model. And I can see the entire patient for all that they are. I think two, this uh couple just came to mind of that I've recently treated. And both of them had relatively unremarkable lipid panels. Even their uh, even their HGL was lovely in the in the and both of them had similar, they were in their late 50s, or sorry, late 40s. They both had one of the husband had a f a pretty strong family history. So his homocysteine was high and his LP little A was high. But otherwise, his cholesterol was fairly unremarkable, and he was asymptomatic and was doing his own stress test for me pretty consistently because he was a trail rider for a bicycle trail rider. And we actually did a um CT coronary calcium score on him, which was all we had at the time, or all that I was exposed to at the time. And uh that came back a little bit high, but not significant. And so even though we optimized his uh lifestyle and his other measurements, his um APOB even went down to under 60. We were, he ended up having an event. And this is a person who was not taking care of himself, had a cortisol that was consistently in the 25 range. And despite making some adjustments in his life, we were unable to prevent that event. So uh these are disappointing. And one of the curious things about him, and the reason I specifically mention him, is because after the fact, he said, wow, I didn't realize how tired I was before for for many years now. He also had COVID several times, he had Epstein-Bar virus several times, uh, or had Epstein-Barvirus uh recurrence uh post-COVID. And uh despite all of that, he would come back and say, I didn't realize how fatigued I was until now, after his event, after he's recovering and doing much better. And he, I think what he's realizing that this wasn't a matter of being asymptomatic. And this is one of the things we as these people's providers need to recognize is that they're not asymptomatic. They are just adapted. So when you're looking at your clients and thinking about, hey, yeah, his cholesterol is pretty normal and he looks, he doesn't have any symptoms, so I'm not gonna pursue this. I think you need to dig a little bit deeper. And this is why my panel includes those genetic-related markers like homocysteine LP little A. I might include things like um a galactin III, looking for some scar tissue or fibrosis formation. In general, I'm looking at a larger panel of things. I'm also looking at what their hormones are, what they're uh what what they're doing in general with their inflammation, because I want to make sure that this sort of thing doesn't happen to these patients so that they are able to uh function well in the world and we aren't ignoring what the terrain is that the LDL is uh finds itself in.

SPEAKER_04 12:27

Wow, super interesting. It's funny. My lot my last labs came back and my um C reactive protein was up, had gone up. Which I was like, huh, that's strange. Some other stuff went down, but the C uh C reactive protein went up. Hey, Christy, I'm curious. You you run a membership model as well pretty successfully. How are you addressing this?

SPEAKER_00 12:48

I think one of the like the favorite things that I do on a day-to-day basis is I try to tell a story with the patient's labs. Um, you know, I feel like that's a successful appointment when I can truly sit down with the patient and tell a story about where they're at in their current lab state. And then to Dr. Freeze's point as far as focus on the trend improvements. I mean, we too see our the program members, depending on which program you're in, every three to four months. And so, you know, we have a throughout the year and then the years they're with us, we have a you know, a tremendous amount of lab values that we can look at. And um, it's focusing on trend improvement, not just single values. Because to, you know, to like your point, Jock, like, you know, something went up, okay. Well, let's let's look to see what else has changed and let's trend it out. Um, maybe it's more of a you know, um, you know, an insulin issue that we're dealing with. And, you know, I think for me as far as with patients, is they come in with this perception. And I mean, most patients that are seeking clinics like we all have, um, they understand they're not gonna get that normal um assessment, that normal lipid panel that hasn't been changed, what, since the 1970s or so? I mean, it's crazy. Um, I mean, the human body is totally different. I mean, just look at our food. Um, but it's, you know, I think for me, it's making it clear that, you know, cholesterol is not dangerous itself. Um, it is the inflammation is the hidden driver. And um, you know, cholesterol, there, you know, Dr. Bid has talked numerous times. I mean, there is a tremendous amount of people that will have heart attacks with normal cholesterol, but it's those that underlying inflammation that's leading them to that event.

SPEAKER_04 14:44

This is the cool part about being about doing this is like getting um past the veneer and getting into the deep, deep dive. Um, Leonard, what what do you think?

SPEAKER_06 14:58

Well, I think that I can't imagine being a patient right now and trying to understand what's going on with cholesterol. Because like the information that they're getting is like constantly from one one place to the other. You know, they're going in somewhere, um, talking to their doctor where they're trying to get them on the highest dose statin possible, and then they're going online and they're saying, you know, cholesterol is a great thing for you. And um, and it just must be so confusing for patients right now because most of the medical practitioners can't even agree on it, right? You have doctors and experts that are so polarized on this subject. And, you know, you can hear something that sounds really convin convincing, and then you go and find somebody else that sounds says the same thing. And there's so much truth to both sides of the argument. Um, and I think that the the answer is really in the middle. That's why I felt like I've never had a place on either side of it, because it's like, yeah, I understand that cholesterol is not bad for you, but I also understand someone with a family history and very high LDLs and um is is at risk. And yeah, maybe we over-prescribe statins, but maybe somebody needs a low-dose statin because they're at high risk. And so I've never felt like I've had a place on one side of the spectrum or not. That's why I love having conversations with Dr. Hussein because he's the one of the first people like in the longevity industry where I was like, I can, I could actually have a an in-depth, nuanced conversation about this. Um, and and and the more what patients are seeing out there is just more and more complex labs, you know. So now they start, now they have to start understanding about particle sizes. And then they start have to now they you're hearing a lot about uh devices like Clearly where they can actually look at your plaque or the um your the the health of your plaque, the you know, at what level it's at. And so it's it's just you know so confusing for them. And so uh one of the conversations that me and Dr. San have been having for a while is you know, he's done some amazing work, especially in this uh this one peptide certification course we did where he talked about he went really deep into um wrist stratification and very advanced biomarkers. And we were sitting around and we talk about all the time. We're just like, hey, you can get so much information from a basic panel that is like 80 to 90 percent of the information that you actually need before we start getting more and more complicated. And that's why his talk at COM this last year was amazing, because that panel that he used was a basic panel that even traditional conventional medicine uses about 80 to 90 percent of that stuff. So looking at things in context, you know, ratios, not looking at a biomarker by itself, I think is um one of the coolest things I've seen on this topic in in a long time. Because the truth of the matter is that more and more patients are coming into med spas, they're coming into um these weight loss clinics. And if we can just teach some of these uh practitioners about simple things like APOB and LP little A and what it means to stratify risk and how we want to be maybe a little bit more aggressive in patients, especially one of the things that we forget to ask is just family history. Really, the question we're trying to ask is like, how aggressive do I want to be with this patient when it comes to cardiovascular disease? We can make a really big impact. And Dr. Hussein's doing that on multiple fronts with multiple companies, um, you know, working on their biomarkers, working on educating practitioners. And so I think that's the exciting thing is scaling it back a little bit and saying, hey, what can we say about these like very basic uh biomarkers that tell us so much? Because if we wait for the guidelines, um, we're we're like a decade late, right? The guidelines, even with everything that we have on APOB, which is telling us like the most athrogenic potential, the guidelines recently just did like a small little nod to it. Like, yeah, we can tell that's important, but you know, they're still pressing on the LDL. And then recently we had this study that came out that said that if you're really aggressive on LDLs less than 50, um, it could it could have a positive benefit. And so the entire internet was like, debate's over, you know, you just have to aggressively lower LDLs without the nuance of like who was in that study? Was it patients that had already had a heart attack? Was it was it male patients? Were they in Korea? You know, how do we extrapolate that? So there's just so much confusion, but I like the way that Dr. Hussein does it, and let's bring it back to some of these basic biomarkers.

SPEAKER_04 19:02

It's so interesting to see how it's like all kind of leads into these different directions. And Franck, I'm curious, as a guy that you know can see things the way that you do, uh, what your sort of perspective is on all of this.

SPEAKER_05 19:14

Yeah, I think um, I think this cholesterol conversation is almost like stuck in, you know, what in 1985. You know, I think we're still you know treating a number of uh you know, a bunch of patients out there with very you know with standard panels, you know, as if they're telling us the whole story, you know. Um, you know, doing the knowing the you know that the research has moved beyond that. Um you know, we know it's not about high HDL or I LDL anymore. It's so nuanced. And I just I just feel really bad for for patients out there trying to navigate um the information overload out there and the confusion. Um I I think that um this is potentially um, and quote me on this, the biggest opportunity that we have in uh what we call longevity medicine because um I just did a quick Google search here um on something that I wanted to share with you guys. Um that's that's telling, you know. The you know, I like to look at the top 200 drugs sold in the US every year. And I looked at it real quick just to kind of take a look. And it's not based on dollar, it's based on the volume of prescription prescribed in the United States. And um number one, Lipitor, it's our statin uh with um total patient 30 million, uh total prescriptions 115 million. It's the reality. And I remember when I was you know a new pharmacist back then, I used to love to look at those numbers because I was trying to figure out back in 2000 um in 20, in tw in 2012, it was ambient. Um and then after that, I remember when Lipitor came out, it was it was Lipitor, and it's still being you know, it's still Lipitor. Sometimes, you know, it used to be Gabapenton at one point, and it's always been Lipitor, number one. Um and number 12 is Crestor with 11 million patients. So where I'm going with this is it's it's extremely impactful because it's um affecting the most amount of patients being treated by people out there. Um and our space got a lot of um tools and resources and know how on how to. really kind of um help a lot of the patients and i think this this can become potentially the biggest opportunity that we have uh in the in our in our space um and you know and and i think aggressively treating cholesterol is one thing but you know treating it differently um in the you know in the most in a more nuanced way might be the way to go right um there there's no question about it there there's there you know there's some crazy most amazing data driven studies that was that was back then that we still have now right a lot of them were obviously uh funded by the pharmaceutical company back then but the data still exist we know that we do have to treat cholesterol at one point but definitely not to the number of 30 to 50 million um or 150 million total prescriptions a year right uh because the reality for for for people listening is that you know they have side effects serious side effects and I am not an anti-statin guy I'm a pharmacist I believe in statin uh but it do cause problems you know and and uh we can talk about it all all day today you know I'm sure but um I I think this is really kind of where the uh uh the value prop is for for for for us here and and how we can really impact a lot of uh patients out there.

SPEAKER_04 23:26

Frank before you go give us the black box warning what what are the side effects of statins?

SPEAKER_05 23:31

Well there's a lot of side effects you actually one of them that that's um obviously you know reptomiolysis is the biggest one which is which is which is muscle pain so you know your muscle um um get affected by taking statins that's the number one side effect you have to be worried about right it happens well you know with with a lot of patients out there right um but there's a study that came out that I I kind of like I think it was it wasn't a study but it was really a a new warning by the FDA they like to add new warnings when they start getting some information filtering through um was the risk of cognitive impairment on patients taking statins um so that is big so you're telling me that for people that are usually taking statin after age 45 you're actually increasing the risk of cognitive impairment and nobody's talking about it that is a big one and by the way you can look at their package insert it's now in there and nobody nobody said anything about it but that's that is a big one right and then you have your usual right you know you have um uh brain fogs right fatigue which is a big one um and then one of my favorite is you know co-Q10 depletion I remember Len was talking about nutrition depletion last time coQ10 is another one right so coq10 is extremely important in your body right um and I don't think um a lot of pharmacists or pharmaceuticals or physicians when they're writing a script for statin have a conversation with their patient about the importance to um replenish your coQ10 right but that is that is extremely important because obviously um you know it it is it is extremely important for mitochondria function you know it's biochemistry 101 so you need coQ10 for it and if you have no good mitochondria and dense mitochondria everything else get affected downstream so you don't really need to be the smartest person in the room to understand that you need to have coQ10 in your body right um you know most patients like you said you know uh that's storage standard always report muscle pain uh fatigue cognitive fog you know that is not quant you know a coincidence you know it is it is a direct relationship to a coQ10 deficiency right so um there's there's a bunch of them but that's really the one that I'm really kind of usually um um a little concerned about yeah so I'm just curious like if you're a patient you're hearing this right and a lot of us don't understand everything that you're you guys are saying um so if you're a patient and you've got high cholesterol and your doctor's just saying hey just take this statin and they're not they're just a regular primary care doctor they're not in the longevity space and you're hearing this podcast for the first time what do you do?

SPEAKER_02 26:25

I think we have to be careful and give a little bit of a uh this is the this is debatable um a little bit of a break to the majority of primary care providers that are out there because we're talking I mean when I was a primary care provider I was seeing 25 to 30 patients a day. I had seven minutes per patient. So it wasn't like I had the opportunity to discuss with them every time I saw them. So there are certainly ways to make that work in primary care. Doing group visits is a huge way to be able to teach lifestyle modification to teach and managing inflammation that sort of thing uh it does take some of the burden off those people's and so there's ways to accomplish it but let's give a little bit of a little bit of grace to the providers who are out there doing this. This is a challenge to this is a because it's a whole body therapy that we're we're trying to or therapies that we're trying to accomplish uh you know when someone comes in with erectile dysfunction and I say hey I think you have a problem with your cholesterol now we're talking about a huge thing that we're dealing with. If I'm doing that as a primary care, the first thing I'm gonna do is say here's your statin because that's all I have time for. And I respect that because that's what I was now that I have time I have time to look at the other facets of patients' lives and intervene where possible to prevent the onset or prevent the progression of these things by doing all the lifestyle interventions, by natural things like berberine, bergamot, vascanox, artericil, GLP1s, so many things managing their stress levels that I have time to do. So given that that there is a discrepancy there, we just have to be honor that I do if you have if the ability to to do the things that you to come and see a one of the providers like us, anyone here and Craig who's not able to be with us today, then there are lots of things that we can do to help with moving that needle that may include your statin or not, depending on you as a whole person, as opposed to just looking at your cholesterol panel saying, yep, it's high see you later here's your statin um but that's that's because that's what we do and giving them a little bit of grace. What about you, um Abid, do you have any insights around that?

SPEAKER_03 28:48

I think we have to really be uh nuanced in what we what how the thinking goes now I mean there's the so the first question you got to ask is oh we're not you know we're not dealing cholesterol is not the problem it's plaque. So let's look we have the technology now to look at the problem the problem is plaque in the past and this is how the association was created cholesterol was associated with atherosclerotic events. So that humans are creatures of habit once that was made and it took a few decades that association is there and it's hardwired in all of us all the doctors you know have this hardwired now maybe the whole population but we can now look at plaque. So the first thing to say to your provider is okay my cholesterol is high do I need to do something about it what's the actual evidence that I have plaque should I get a uh you know ideally get a CT ordering angiogram but clearly and then if they have plaque then we talk about what to do to treat them. Then we can start looking at some of the other other some of the other options even now you know I still have patients that just flabbergasted me. They look amazing on their labs. I get imaging and they look horrible and then the opposite happens I get patients that look like absolute nightmares and I expect that they're gonna have they're gonna be on death's door and they've got nothing so so you know we've got to see there we still don't understand the complete evolution of plaque and the only way to bridge that gap is by getting imaging. So let's look at what the problem is instead of looking at a surrogate marker like cholesterol. So that's the first thing once we establish whether they have plaque or not then we can go down the road of what needs to be done. And and and you know when we look at our population now too it's so much more heterogeneous than 20 30 years ago when these studies were done. And we've got everything from biohackers to longevity you know fanatics uh coming to our practice. And then meanwhile at the other end of the spectrum you've got metabolically challenged full-on diabetics with A1Cs up you know all up higher higher than 12. So like this is everybody that's that's being looked at. So we've got to look at context, look at who is the patient in front of us and do they have plaque and what is their situation.

SPEAKER_02 31:17

How interesting all the things that we are coming up against with in light of COVID, right? In light of the damage to the glycocalyx and the vascular structures that that are purely because of that. Even if we had COVID five years ago and we're not continuing to be exposed to new COVID, let's say you just never got another episode of it, having had that baseline exposure and potentially senescent cells secreting that ongoing storage of spike protein and of the virus itself, you know, we're we're continuing to be exposed to this virulent factor. And then the fact that our other chronic viruses get triggered by that this is one of the reasons why we're seeing this plaque go, the risk of plaque and the plaque formation go up and why it's so important that we do things like scanning, like looking at more detailed uh things.

SPEAKER_03 32:13

So what is Clearly? So Clearly is a uh an AI-based platform, it's a cloud-based platform that looks at the CT corner angiogram images and is able to differentiate pixel by pixel the density of the tissue and that tells us the density of the tissue tells us how inflamed it is the so the way CT scans work is if it's got a lot of water in it, it's less dense. And if it's got l, you know if it's got very little water in it, if it's calcified it's very dense. So it uses that spectrum um you know like when something gets swollen when you hurt yourself it swits swollen is because the water is filling those cells and you get getting swollen. That's basically the concept. So it's using that on a CT scan level in a in a millimeter level to look at what is going on in the wall of the artery in the tissue surrounding it and then see is that plaque inflamed not inflamed or calcified and so it gives us very specific uh cubic millimeter measurements that we can track over time. And what it gives us above say something like a calcium score which just looks at calcium doesn't look at any of the cholesterol or any of the tissue tells us what's inflamed and that's really what isolates people who are at risk for heart attacks sudden heart attacks.

SPEAKER_00 33:35

And and my hope is you know now that clearly is now being covered by Medicare like I mean my goal is like and I know I've talked to Dr. Hussain about this numerous times. I mean I've known him clearly for years but you know as a family nurse practitioner that I mean I was a little intimidated by the scan to be honest. And but it's just that you know rinse and repeat and now we finally have a facility in Albuquerque because for years I was having to send patients either to Dallas or Scottsdale. I mean it was just because I couldn't get a local cardiology group because you know of to to get the protocol that clearly needs as far as the dye contrast the you know the per second that need to to be injected. But I mean it's been a game changer and just you know listening to you guys every time like obviously I'm not as well as you know Dr. Hussein is interpreting them but it's one of those things that I mean there's just been a handful probably four or five patients since we've come back from um calm that in February that we've done clearly on and it's just that rinse and repeat and you know my hope here in my community in Albuquerque is that now that it's being covered even though we don't do insurance people aren't as scared with it now. Now it's like okay yeah I'll do it because I mean with Medicare you can almost always get it covered now.

SPEAKER_04 34:58

So let's imagine you show up you got high cholesterol and then it's total number and then you now you're starting to break it down you're getting into all the things that Dr. Hustain talked about Dr. Free talked about Christy you talked about and now we're at this point in time at what point in time does this you know does the CT scan and clearly enter the picture? Is this after you've tried to control uh you've had to do some sort of intervention around the cholesterol and that you're you're not responding or you're trying to figure out how much you know you want to know where the plaque is right out of way. What what's the order of things? How does it sequence up?

SPEAKER_03 35:31

For me it's it's upfront it is it's not right away it's so you've come in and you've gotten uh you know you've cholesterol is high maybe we have some other markers that are high it's the next test that I need to get to differentiate what treatment I need to start because what I see on that scan has a very clear clear clearly directs me the on how it is I need how aggressive I need to be with treatment. It has a clear impact on that because if there are if there's only calcified plaque then the treatment's very different than if they have inflamed low density plaque because that's a you know hot uh hot artery that needs to be cooled it's highly inflamed and those treatments are different there is some overlap but there's there are some treatments that are different that we need to start quickly. So it's it's early on.

SPEAKER_02 36:24

It's also great to show them to if you see the scan, the report for the scan, it's it's sort of a um they take the artery itself and they in the in the image they lay it all lay it out as though they were able to lay it out and they show you where the plaque is. So being able to take that diagram and show it to the patient and say, look at how this is where your big plaque is, this is where your calcified less concerning plaque is this is where your really concerning plaque is look at how much of this stretch of of artery is compromised with plaque. So the blood flow isn't getting so great. This is where I'm concerned this is why I need you to do this more aggressive therapy and some of the other anti-inflammatory all the other things that we're doing.

SPEAKER_04 37:07

And maybe at that point in time some propane injections to calm your cortisol down because at that point in time you might be going holy smokes I'm in bad shape.

SPEAKER_02 37:19

Hey Frank I wonder if you would talk to us about the uh FDA approval or removal of the black box warning for testosterone for coronary artery disease.

SPEAKER_06 37:31

That was last February right it was last February I believe right that was it was like our the first calm and it was funny because we had we had a Shalin with the CEO of uh Kaisotrex and he was on stage and he's like he got his phone he's like you're never going to believe what happened. Yeah it was finally took that testosterone morning off for cardiovascular disease there's this argument that's happening um like for certain diagnostics that I keep on seeing coming up like someone was arguing about the Dutch test that does like hormone metabolites and they're saying well this test isn't recognized by the Society of endocrinology and this isn't you know in the guideline and it's like my goodness if we wait for these things to come on a guideline we will be decades late and people will suffer. You know and this is like the perfect case like Abid when he did his uh module when you did your module in that certification course you had like a whole 30 minutes on like how ridiculous having a black box warning for cardiovascular disease was the the evidence was out there for like for decades right um and then finally the FDA thankfully um came on and took that black box warning off but just imagine how many people didn't get uh testosterone therapy because of that black box warning um and uh so that was that was really exciting there's been uh there's we we always talk about about the FDA but the FDA has done some pretty cool things uh recently I got a question for Abbott what do you think about since cardiovascular disease is the leading cause of death in the US should we providentially lead with you know maybe testing offering clearly whenever insurance will pay for it right away as a as a as a way to have better visibility or or a good make it make it part of an assessment a longevity assessment for every patient's coming into your practice or any practice going forward.

SPEAKER_03 39:18

Yeah I mean that's what we do at uh at BLI Boulder Longevity Institute so I mean it's uh if you're seeing me I make sure that you're having a uh a clearly at some point and same thing with Dr. Yurth so you know it's it's vital for our for our overall vascular assessment because like you know there we can I can do all the blood tests uh available and and even you know now I think with the cardio zoomer uh that that's probably the most state of the art uh serum and uh analysis we can do from a vascular standpoint uh probably get a pretty good idea of what their vascular health is but there's still a gap and uh and I and I and getting a uh a CCTA with clearly really is the is the the way to bridge that gap. And so it yeah and if if the number one cause of death and really the one of the biggest fears patients have is that they're gonna drop dead suddenly of a heart attack or cancer, you know that's a that's one of the a surefire way to be able to determine if that patient has that risk. And so it you know it's the biggest limitation to our longevity. So yeah it it it should be part of a uh you know any longevity clinic's assessment uh anyone that's any clinic that's just doing a calcium score is not is not doing their patients a service especially in a a situation where it's concierge cash based medicine where they're willing to pay um you know if it's if you're talking about community health then doing uh a C C a calcium score may be a reasonable idea but it's still missing the mark um and but we can't use it as a screening test for the large scale population. So that's where the challenge comes in but at least something to image because even with a calcium score in that population if it's high then we know they're a high risk patient and then we can reflex them to a higher higher uh uh uh detailed modality of testing so it's uh to answer your question yes I think it should be part of that and um the push for clearly right now is to you make it more widely available.

SPEAKER_06 41:28

Yeah.

unknown 41:28

Dr.

SPEAKER_06 41:29

Abbott are you are you retesting to see how treatment is going and how frequently are you doing that?

SPEAKER_03 41:34

I'm definitely retesting. I don't do it uh with I I wait at least a year. Uh depends on yeah yeah because because plaque takes a lot of time to uh to develop and reverse now I I have seen cases where we see significant plaque reversal within a year to two years but that's with really aggressive lipid lowering and very specific soft plaque or inflammatory plaque. So those are the two situations if there's a high soft plaque burden and if there is high amounts of inflammatory plaque I will rescan them in a year. Otherwise I start treatment and then I won't do it for two years, three, you know, depending on how significant uh the the plaque burden is there there is some debate out there about the accuracy of clearly and you know it goes to the nature of AI-based technology um and you know it's not perfect so but it is much better than we've had before and it it really helps us to make decisions about people that we would never had information on before.

SPEAKER_06 42:40

A 10 year risk calculator that was pretty absurd. It was uh you know what's my what's my risk of something happening in the next 10 years which was kind of weird to have it's like I'm pretty sure we all want to live a little bit longer than 10 years. So I'd like to know my risk after that. Because the I I remember putting my data into that risk calculator and um no matter what I put in there because I was in my 30s uh when I did it it's you know I couldn't I couldn't put values bad enough for it to be uh risky but I think they updated that recently to extend extend the 10 years but I thought that you guys both brought up great points uh I think Dr. you'd you brought it up also was that um we've just had these old markers before that we just got so used to and tied into and we've just we just never kind of evolved. I see this a lot with even other markers where I mean even for strength or uh you know uh studies where they do sit and stand tests or they do waist to hip ratio we have to remember that they use those biomarkers because it was the easiest thing to study. It doesn't mean that it's like a superior biomarker, right? Like if you can get a visceral fat level that's gonna be way better than a waist to hip ratio even though all the studies will tell you the waist to hip ratio is what shows you. But we just we've gotten better. And it's like LDL is great but that's that's what we were measuring back then. We that some of those studies weren't measuring APOB. And um and now we're in this this uh Um on the side when it comes to actual these this imaging that Dr. Hussein's talking about. So um Yeah, we just gotta we gotta pivot a little bit faster as a as a profession, but I think I think we are getting better at it.

SPEAKER_00 44:12

To that point of like just, you know, a patient is listening to this right now and is confused about cholesterol or and even a provider. I mean, this week alone, I've sent two patients to Dr. Abid's YouTube page. I mean, he has some phenomenal content out there. And and you know, to be honest, I go back and listen to it. And I mean, it really, I mean, I I want to personally thank you for that because it's not only helped beyond health, but it's helped my patients. And I literally, I mean, at least two patients this week I sent a few of your videos um of just education so that we don't have this fear around cholesterol because we have, I mean, we we have some clarity on it. Yes, there's still a lot of unknown, but we don't we don't need to have this fear around cholesterol.

SPEAKER_04 44:59

Well, we covered a lot of ground here, and it's one of those things where I know I'll go back and watch this episode probably two and three times, just try to absorb it all. Um, for you guys, it's probably super easy to to just um flow with it. But I think for again, from a patient perspective, there's a lot to unpack here. And I really want to thank Dr. Hussein for joining us today. Uh, we hope that you'll come back and join us again in the future uh as we cover um more topics that uh that sort of fit into um the the wheelhouse of the things that you talk about on a regular basis. I think you guys all made great, great points and um and shed some new light on this topic. I love what Frank said. I mean, hey, if it's you know, it's if that's the number one prescribed drug uh that we have out there, um, then that's that's telling us something. And um it's something to dig deeper into. Just before we go, any final thoughts from anyone? Anyone want to chime in and give their their last thought on this?

SPEAKER_03 46:03

I I think that uh it's uh our population is getting more challenging. It's not getting easier. You know, it's it's important to remember that we're getting you know, people that are more educated, they are doing all the things right and they're still showing up with disease, and then we have people that uh that are that have all the information at their fingertips and still choose not to do it. So it makes the the disparity even wider. So we have to get whatever information we can to try and see who's in front of us.

SPEAKER_04 46:32

Dr. Free, that that thing that you mentioned with regards to COVID, the uh spike protein showing up, that's maybe not something that anybody's really been talking about. That's pretty heavy duty. Um any any closing thoughts on that one? Like, what do you do?

SPEAKER_02 46:47

This is uh evolving science. It's evolving. The the testing isn't even available yet. I um I think being going in to see your doctor, getting evaluated for what we can treat or what we know is and I and I love what uh Dr. Hussein said earlier about we're we get so much from a CBC, CMP, lipid panel basic things, those ratios, we can we can take those and get a lot of information. So being proactive in realizing that there are things beyond, maybe at this point beyond our control, that are being uh currently evaluated and and um assessed for how we can intervene, that I think that's where we are, is that getting realizing there is a potential risk. And even if you feel well, that adaptation can masquerade as health.

SPEAKER_04 47:40

Wow, that is profound. Adaptation can masquerade as health. So, in other words, I have adapted to feeling so fatigued, so crummy for so long that that become my new normal that I think that's how I should feel when in fact I'm way off. Um, and so it was really incumbent upon the patient to take action. I think for the longest time, patients were really just disconnected from their own health. Maybe COVID woke us up to the fact that we all need to pay better attention to our health and really dig deep into really understanding where we are. And now it seems like we have more and more tools to do that every single day. Guys, you know, it's time to wrap up, but again, another phenomenal episode from an amazing group of people that I'm just so honored to actually spend this time with you guys. Um I want to thank you and to all the listeners um or viewers, uh, please remember to like, share, and subscribe, especially this one. Um, if you have family members, if you think about it, one out of every two people, right, Frank, um, are gonna are gonna be dealing with um some sort of heart issue, right? Dr. Hussein, is it one out of every two people are gonna be dealing with some sort of heart disease? Sure. Yeah. Yeah. I mean, it's this is an episode that you want to share so that you can get the information out to people to help them understand what, hey, what might be the next steps for you? What might be the thing that you'd want to do uh to take the action that is appropriate for you in your health and your life? All right, guys, that's the end of the show. Thank you so much. Really appreciate you coming on, Dr. Hussein, and thanks to everyone else as usual. And we'll see you on the next one.