For intros, my Doctor is a very progressive concierge physician. Ive had no issues with getting Acarbose from, or other tests performed multiple times from her. However, I sent a message asking for a CAC, Lp(a) and hsCRP and this was the response;
“The Lp(a) and CAC score are intended particularly to stratify risk of dyslipidemia/hyperlipidemia in younger patients and patients with dyslipidemia who do not meet strict requirements for statin medication. The value of CAC score is honestly quite limited; essentially it is beneficial if it shows absolutely no calcium in the arteries, but any positive score simply indicates that you have calcified plaque but not the degree of the plaque and thus the utility is limited.
Lp(a) is a type of inherited higher risk LDL cholesterol that I often check in patients with elevated LDL, which you do not have.You ultimately have no indications for either of these tests because your lipid panel was perfect. Ultimately even if you had plaque in the artery of a mildly elevated Lp(a) I would not start you on any form of medication for this because there is no indication based on your lab results.
Additionally, the statin medications that we use for dyslipidemia actually increase Lp(a).
The value of a test is not just in providing information but in providing information that is actionable/that would result in a change of plan which I don’t believe these would for you in particular.”
Peter Attia seems to agree with your doctor - he finds that CAC scores are pretty limited in their application. See here:
A CAC score above zero tells you that there’s been a bad enough break-in to require repair. However, a lot can go on in the disease process leading up to that point that goes unnoticed by a CAC scan. Additionally, a CAC scan does not necessarily identify the plaques that might do the most damage.
in addition to the above about CAC score, i think LPa is a useful number because you only need to get it once - it’s largely a result of genetics and will give an indication if you have a genetic disposition to CVD. i now get testing for Apob instead, which many experts view as the gold standard for CVD risk and can be altered through diet and meds.
Your concierge doctor’s comments reminded me of an unpleasant exchange i had with a gastroenterologist when she ordered a glucose tolerance test. i noted that Dr Attia suggested getting tested for insulin at each passing hour as well as BG. “There’s no reason for such a test because there is nothing you can do to change your insulin levels,” she said. unlike your doctor she flatly refused to order the test.
i changed doctors.
Yeah. Im fortunate enough to be able to pay for a physician who’s willing to allow some experimentation – on the flip side of that, she knows Attia, Huberman and Greens work and wouldn’t come close to prescribing me Rapa.
Comparing people with CAC of less than 100 Agatston score vs. greater than 100, the chances of death by heart attack go up 9,2 times. Seems like a cheap ($60) extremely predictive test to me. Yes, a score of zero doesn’t mean you’re risk free. The way Peter Attia himself was alerted to his possible non-zero CVD risk was by a CAC scan, as was I (537) and my older brother (1523). We both got extremely serious about lipid control after this test. Or you could wait until you first present with CVD symptoms. 30% of the time, that symptom will be death.
You can easily get Lp(a) and hsCRP tested through Marek for about $50 total. Your Lp(a) level is good to know, and it it can be high even with low LDL-c, I have high Lp(a), of about 190 nmol/L while my LDL-c is about 60 mg/dl. This cardiologist I’m working with is planning on having me do a stress echo test, which I don’t believe will be helpful. He was negative on the CAC score for radiation reasons, and suggested that I wait until I’m 50 (currently 37).
Ultimately I expect he won’t put me on any medication, so I will probably buy it myself and try to get LDL-c down into the 30-40 mg/dl range and test periodically at Marek to reduce residual risk.