Honestly man, I know youâre sceptical, but it seems like youâre missing the forest for the trees here.
You have a positive CAC, which is growing yearly.
Youâre talking about lead chelation and heavy metals, but youâre also sitting there with a LDL-C of 115 mg/dl or maybe 150 mg/dl and not treating it.
This makes absolutely no sense because the evidence of ApoB causing ASCVD for you is orders of magnitude stronger than the evidence for heavy metals. With ApoB of 90/LDL-C of 115 mg/dl you can easily build enough plaque to cause a heart attack and kill you - in fact, thatâs pretty much the average trajectory that kills the average person in their 70âs or early 80s. A level of 150mg/dl accelerates process that even more and kills you earlier.
Your body actually isnât that smart. Humans are the only species who have LDL-C this high. We get atherosclerosis from ânormalâ or âaverageâ circulating LDL-C, and no other species does this. That appears to be more of an evolutionary glitch more than anything deliberate or advantageous. It looks like LDL-C might play some sort of role in the response to bacterial infection, and Lp(a) doesnât have any obvious biological function but maybe can assist with wound healing. But, looking at the bigger picture, heart disease kills 1/4 of all people and bacterial infection and wound healing just isnât that big of a deal in 2025.
There are people with genetic disorders of PCSK9 walking around with almost no circulating LDL-C/ApoB for their whole lifetime, and they have no heart disease, but also have no other deficits. There are also people who have reduced their LDL-C/ApoB to negligible levels with medications and they also donât suffer from anything.
Also, there is value in the Cleery vs CAC. In your case, your CAC score is increasing every year, but is that because youâre continuing to lay down more plaque, or maybe this is a âgoodâ thing because your soft plaque (i.e. vulnerable to rupture and kill you) is actually stabilising? Without the full CTCA, you donât know. (IMO, if your LDL-C is 115-150mg/dl, youâre building plenty of plaque and some of it is calcifying.) CTCA can see the soft and calcified plaque. However, if youâre determined not to treat your high LDL-C then I agree it wouldnât add value. But if you have an open mind, and you can actually see the soft and hard plaque, maybe it will push you over the edge into dealing with the LDL-C?
That all sounds absolutely awesome. I think youâre adding years to his life!!