Patrick Altman

Issue trackers were built for an era of handoffs. At @linear, we’re building for an era of agents, context, and execution.

This summer on #136 of @theallinpod, I hijacked science corner to discuss heart health. I suggested everybody over 40 do a Calcium CT Scan & if your score is non-zero you should likely be taking a statin. Many have shared ++ stories how this impacted them, so wanted to follow up. Heart disease is the number one killer in the US - accounting for 25% of all deaths. And unlike many causes of death, it is largely preventable. But we do a lousy job of education / prevention - which leads to people learning about the problem after it is too late. So what did I learn, what am I doing, and what are the Besties advising each other? First, data is power. And most of us have bad data. The common refrain I hear when I ask friends over 40 what they are doing to avoid heart disease - “I am good, my cholesterol is low.” And why not? We have been trained by doctors to believe that cholesterol is the magic biomarker that determines whether you will have a heart attack. WRONG. Approx 75% of individuals who experience heart attacks have normal or low LDL cholesterol levels. So it is true that cholesterol plays a significant role in the formation of arterial plaque - but don’t take false comfort in your cholesterol scores - they don’t look inside your arteries. Get a Calcium CT Scan. This is a low dose, non invasive, super simple CT scan of the chest that takes about 5 mins and costs $300-500. It DOES look inside your arteries and tells you much more definitively whether or not you have calcium (aka plaque) that may cause a heart attack. Your doctor may tell you that this is not required since you are healthy & have low cholesterol. Thank them & schedule it anyway - it may save your life. A calcium score (CAC) score of zero means no calcium; 1-10 is considered low, 10-100 moderate, and so on. So what did I find? I am fit (low body fat index), exercise routinely, eat healthy and have had generally low cholesterol with my LDLs slowly going up to 130 in the last couple years (maybe as a result of my protein heavy diet). My CAC was zero in all arteries but 77 or moderate in my LDA (the left descending artery). What next? Fortunately, I was able to learn from two leading cardiologists. What do they do for themselves, their family & friends? They agreed that cholesterol readings alone are an insufficient standard of prevention. Their standard? A CT Calcium Scan over the age of 40 - and if the reading is non-zero, they immediately prescribe a statin under the theory that statins are incredibly safe and reduce future plaque build up by inhibiting a key enzyme in the liver critical to the production of LDL cholesterol. So I immediately started 10 mg of Crestor daily (zero side effects) and within 7 weeks my LDL dropped from 130 to 75 (optimal) with zero changes to diet. The end? For many - yes - and they advised me that this along w staying fit would already make a BIG difference in reducing future plaque build up and avoiding problems. But was there more to learn? Yes. It turns out that not all plaque is equally bad - soft plaque is the most dangerous; intermediate less so, and hardened plaque is good. To learn more I did a Contrast-Enhanced CT Scan - which took about 25 mins and helped visualize different types of plaque. While they saw that most of it was hardened, we leveraged a new technology pioneered by Dr. Jim Min and his company @Cleerlyhealth that is using AI to statistically analyze the pixels in the Contrast CT. The determination was much more precise - 114 units of plaque (below avg for men my age) split evenly between hardened plaque and intermediate plaque. Zero of the soft plaque. Their new goal for me? Zero new plaque by driving LDLs down w/ the use of statins. And over 2-3 yrs seeing the intermediate plaque calcify naturally to hardened plaque so that I am effectively back to zero bad plaque. And the best part - we now have the picture & data to track the progress.