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āThe most overlookedā - OK, but thatās where imaging comes in. If you can see and estimate the amount of harm done by the amount of plaque present, then you are no longer āoverlookingā the consequences of decades of high LDL exposure. That is why itās an important tool - which we need to refine, as itās central in how we look at atherosclerosis. Also, just assessing and knowing the residual risk doesnāt mean you necessarily have the tools to affect it. The damage is done. You have X amount of plaque - you can try to reverse the soft plaque burden, but thereās only one mechanism (if it even works): driving ApoB down to very low levels. And guess what - thatās what you should be doing regardless of what the imaging says. Therefore this residual risk is not actionable - you do what youād have done regardless of how much of this residual risk (plaque) you have or donāt have - if āhaveā drive ApoB low, if ādonāt haveā drive ApoB low to keep it that way, and thatās that.
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As you most likely have seen, I occasionally vacillate on getting a CTTA with CLEERLY. I finally messaged my past cardiologist Dr Yeghiazarians at UCSF (heās the best one Iāve had but he booted me out of his practice 
) and asked himā¦
Regarding all the various imaging options, he said:
ānone of them will change the recommendations from a clinical management standpoint as stated above assuming you are asymptomatic from cardiovascular standpoint.ā
Aka ā¦donāt waste your time and money (for me)
This doesnāt mean I donāt continue to be super curiousā¦and I will most likely continue to vacillate
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This was exactly my point of thinking. If I have no symptoms of any CVD whatsoever and If Iām doing everything right to protect my heart (against CVD) then my thinking is that I MUST continue to be symptom free, which means CVD free. Why bother or why spend considerable amount of money to find out either way when in fact even if it showed I have plaque it would not change a thing in my stack as Iām already doing everything right (i.e. Ezetimibe, PITA, Fish oil, no unhealthy fats in the diet, plenty of veggies, exercise etc.). So, I decided to save the money and continue what Iām doing, and I may never know if I have any plaque LOL.
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