in this episode, we discuss:
0:00:08 - Ethan’s entrepreneurial work in the cardiometabolic disease space
0:02:03 - Calcium scans (CAC scores) & CT angiography (CTA), & how it informs us about ASCVD risk
0:07:15 - Peter’s historical CAC scores, CTA results, & how one can be misled
0:12:07 - How Peter’s CTA results prompted him to lower his apoB
0:19:39 - Calcium scans vs. CT angiogram (CTA)
0:28:07 - How Ethan makes clinical decisions based on CTA results & plaque burden, & the importance of starting treatment early to prevent ASCVD
0:34:12 - Improved methods of CTA to grade plaque lesions & how it’s shaped medical decisions such as stenting
0:43:31 - Why Ethan favors optimal medical therapy over stenting outside of particular situations
0:57:23 - The need for FFR CTA, & the potential for medical therapy to eliminate ASCVD
1:01:31 - The fat attenuation index (FAI) & other ways to measure inflammation in a plaque
1:04:00 - Statins & exercise may increase the risk of calcification, but what does this mean for risk?
1:10:54 - The root cause of statin hesitation
1:17:07 - Importance of keeping blood pressure in check, defining what’s normal, & whether we should just accept higher blood pressure with age
1:28:59 - Blood pressure variability, how to best measure it, & data suggesting the enormous impact of keeping blood pressure down
1:45:05 - Drugs for treating high blood pressure recommended by the ALLHAT trial
1:48:27 - What the SPRINT trial says about the aggressive treatment of hypertension, & the risks of such treatment
1:54:04 - Confirmatory results in the STEP trial for blood pressure, & how Ethan uses the various drugs to lower blood pressure in patients
2:03:06 - The role metabolic health in ASCVD
2:08:50 - The impact of fat storage capacity & location on metabolic health & CAD