I came across this on X:
https://x.com/afshineemrani/status/2063733038283149671
It is a cardiologist posting about women’s cardiovascular health and the differences from men, so I thought it worth posting.
Key point: “Here is the brutal truth about why women’s heart disease remains under-diagnosed and under-treated: for decades, we have screened, tested, and treated women using a template built for men.”
Here is the longer substack (free) article:
She Was Having a Heart Attack. They Sent Her Home With Anxiety Meds.
Here is Dr Emrani’s method for treating this. I was pleased to find I have already had the carotid ultrasound artery scan, which found no CVD. (Cost me GBP 118 in UK last year).
Afshine Emrani MD FACC
@afshineemrani
·
May 20
2/5 Coronary CT Angiogram with AI plaque composition analysis. This is the single most important upgrade in cardiac prevention in the last decade. It visualizes your coronary arteries in 3D, quantifies your total plaque burden, and — critically — uses AI to tell me exactly how much plaque is soft, lipid-rich, and rupture-prone versus stable and calcified. Why this matters: non-obstructive plaque causes most cardiac events. Your arteries can look “clear enough” on a stress test while harboring the exact kind of soft plaque that ruptures without warning. This test finds it. Medicare just started reimbursing AI-enhanced plaque analysis. If you’re over 40 with any risk factors, ask for this by name: coronary CT angiogram with plaque composition analysis. If soft plaque is found early, we can stabilize and often reverse it with aggressive statins, PCSK9 inhibitors, GLP-1s, and lifestyle intervention. I’ve seen it happen in my practice.
Afshine Emrani MD FACC
@afshineemrani
·
May 20
3/5 Coronary Artery Calcium score. A quick, low-radiation CT scan that measures calcified plaque in your heart arteries. Takes minutes. Costs roughly $100 out of pocket in most markets. Here’s why cardiologists call this the most prognostic test in preventive cardiology: A zero score means extremely low 10-year risk — even if your LDL cholesterol looks concerning. It’s been called “the power of zero.” A high score means it’s time to escalate prevention immediately — regardless of how you feel. This single test reclassifies risk better than any traditional calculator. I’ve had patients whose standard risk score said “low” but whose calcium score revealed significant disease. Without this test, they’d have walked out of my office reassured and wrong. Advanced lipids — ApoB and Lp(a). Standard LDL cholesterol measures cholesterol content inside the particles. ApoB counts every single atherogenic particle hitting your artery walls. A 2024 analysis found 54% of patients had dangerous ApoB levels that standard LDL completely missed. Lp(a) is 100% genetic. Test it once in your lifetime. 1 in 5 Americans are elevated. It triples heart attack risk independently. The 2026 ACC/AHA guidelines now recommend universal screening.
Afshine Emrani MD FACC
@afshineemrani
·
May 20
4/5 Three more tests most doctors never order: Carotid ultrasound with plaque imaging. No radiation. Highly accessible. Shows soft plaque early and tells me whether disease is building in the neck, the heart, or both. I use it alongside the CT angiogram to map the full picture —
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Afshine Emrani MD FACC
@afshineemrani
·
May 20
5/5 If any of these tests come back concerning, the plan is personalized and aggressive: Statins and PCSK9 inhibitors for lipid-driven plaque. GLP-1 agonists for metabolic drivers and plaque stabilization. Structured Zone 2 cardio plus resistance training. Sleep optimization. Dietary overhaul — whole foods, omega-3s, elimination of processed sugars. Aggressive oral hygiene — because gum disease drives the same systemic inflammation that destabilizes arterial plaque. 90% of heart attacks are preventable with the tools we already have. The old model — wait for symptoms, run a stress test, hope for the best — is how we lose people. Plaque doesn’t wait. It builds. It inflames. It ruptures. And by then, we’re reacting instead of preventing. Print this list. Take it to your next appointment. Ask for: CCTA with AI plaque analysis CAC score ApoB and Lp(a) Carotid ultrasound ApoE4 genotype DEXA body composition Your arteries will thank you. Your family will thank you.
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