Full Transcript Introduction and the Heart Disease Mission 0:00 Well. Hello everybody. 0:01 Welcome back to Reversing Heart Disease Naturally 0:05 4.0 summit 2026. 0:08 I'm your host Joel Kahn medical doctor. 0:11 And I want to present you actually a two part lecture, 0:15 keeping it, concise so you can take notes, make an action plan, and move 0:21 forward in your battle to never get a heart disease, to identify our disease. 0:26 And most importantly, we do identify to reverse heart disease. 0:29 So I'm going to jump right in here, with part one. 0:33 What I said was going to be two parts. 0:37 And I think you can see my presentation I o war on heart attacks. 0:42 We can call that. 0:43 Woah, War on heart attacks. 0:46 Your battle plan 2026 is up to date, 0:50 as I can make for this special audience of reversing heart disease. 0:53 Naturally 4.0 this summit 0:57 and you can always find me and my clinic and being in Farmington, Michigan 1:01 or Boca Raton in Miami, Florida, based on the sunshine 1:05 you might see on my face, I'm still in Florida, 1:08 so why do we have to focus on heart disease? 1:11 Why even have a heart disease summit? 1:13 Why have a reversing heart disease summit? 1:15 Because we still have a major challenge 1:18 on our hands, and we're not completely winning the war. 1:22 There are fewer heart attacks, and there used to be. 1:24 But deaths from heart disease have not been reduced. 1:27 It's still sad, but the latest American heart Association, statistics are that one 1:33 person dies in the United States of heart disease every 36 seconds. 1:38 And you can see by that picture it can be women, it can be men. 1:41 Tragically, it can be young people. 1:43 And more commonly it's middle age and older people. 1:46 We all have to be on guard. 1:49 And if you're focused on longevity and wellness, 1:53 your number one concern has to be a focus on heart disease 1:56 prevention, detection, reversal, what I call PDR
Why Heart Disease Still Demands Attention 2:00 every 40s if you combine heart attack and stroke, some of the United States 2:06 suffers one of these events, which can be fatal or non-fatal. 2:10 We prefer the non-fatal kind. 2:12 You can see in a very prominent journal called circulation, 2:16 a medical journal, that the 2026 update has been released. 2:20 Now, not to confuse you, they actually report on 2023 data. 2:25 It takes a while to get all this together. 2:27 This is the most up to date data, and you can see in the upper left, 2:32 diabetes or prediabetes now affects over a half of all people adults. 2:38 They live in the United States and 23% have definite diabetes, 2:44 which is going to impair their quality of life 2:47 and unfortunately, possibly their quantity of life. 2:51 We now have a real problem with physical activity. 2:54 Only 26% of children aged 6 to 11 and 14%. 3:00 Can you believe only 14% of children aged 12 to 17 get the recommended amounts 3:06 of physical activity, let alone adults. 3:10 But by the time you're an adult, you probably have some heart disease. 3:13 That's why we're always talking about start early, and get your habits in place. 3:18 And if you have children you're raising, try and teach them about all of this 3:22 in the lower left. 3:23 There is a term you may not heard of called c k 3:26 It's a new syndrome put together by the American Heart Association 3:29 of Cardiovascular, Kidney and Metabolic Disease. 3:34 And if you look at that, overall, 80% of young and middle 3:37 aged adults in United States have some abnormality. 3:40 I know in my clinic, when I start to see abnormalities of kidney function, 3:45 I get very nervous because of the central role of kidneys 3:49 for long term health, longevity, wellness, and generally feeling good. 3:53 So why aren't people more concerned? 3:56 Why did I read an article in the news this morning that said, 4:00 if you're interested in longevity, 4:02 start with your heart and how rare an article that is. 4:05 So if you look 4:07 at Causes of 4:08 death in 2023 all the way to the left, you'll see heart diseases. 4:12 Number one, cancers number two, accidents are number three. 4:15 But if you look very interestingly at the media, where do people get their news. 4:20 Well, some get it from the New York Times, The Washington Post and Fox News. 4:24 This has been updated recently. 4:26 You can see that in the blue strip at the top, heart disease represents 4:31 less than 3% of all media coverage of death, followed by accidents, 4:35 followed by suicide, followed by Covid 19, 4:39 drug overdose, homicide, terrorism.
Hidden Atherosclerosis and the Need for Imaging 4:42 Cancer gets a small recognition to at about 4%. 4:45 So the media is not doing a fantastic job. 4:49 The mainstream media, let's say that, my social media channel does a great job 4:54 of covering death as a consequence of heart disease, but the media doesn't. 4:59 And so many people still digest their news from the mainstream media. 5:03 MSM all kinds of ways we could go there. 5:07 So you can conclude without a doubt that education about heart disease, 5:12 current detection paradigms around heart disease, and certainly 5:16 reversal strategies about heart disease are completely inadequate. 5:20 Yes, we have breast exams and mammography and fecal blood testing 5:23 and colon as could be, and chest x rays in lung CT 5:27 scans in smokers are screened for lung cancer. 5:30 But when we get to the heart, 5:32 we're talking about asking questions called risk factors. 5:35 Drawing some blood appropriate probably inadequate, asking for symptoms, 5:41 which are some of the last stages of heart diseases when you feel symptoms. 5:46 And in some situations, like executive clinics, 5:49 you might get a stress test, even though that's actually not recommended 5:53 as an efficient and accurate screening test. 5:56 We don't go far enough. 5:57 We need to fight harder. 5:58 And that's what this is about. 6:00 I want you to look in the upper right of this slide where the yellow arrow is. 6:04 When you do prospective studies like this, 4000 patients study in Madrid. 6:10 Let's go to all the bank workers in Madrid 6:13 around age 45 who say, I don't have any heart disease, 6:17 let's do an ultrasound of their carotid artery to the neck. 6:21 Let's do a CT scan of the heart called a calcium CT scan. 6:25 Let's look in their belly by ultrasound at their aorta. 6:29 And let's look at the leg artery called the femoral artery by ultrasound. 6:33 They look over to the right. 6:35 You can see that more than 50% of people 6:39 have detectable plaque in their arteries. 6:43 When you check early in life, I'd call 45 pretty early in life. 6:47 And it is to some degree related to their blood LDL cholesterol levels, 6:51 so that kibosh is the overwhelming 6:55 presentation you see on social media that cholesterol doesn't matter. 6:58 It matters a lot these days, people. 7:01 And if you look sort of in the middle of the slide where the other longer 7:04 yellow arrow is, you can see overall that 62% of these asymptomatic 7:10 bank workers had plaque in their arteries, men and women. 7:14 And when they came back three years later, repeated the testing, it had increased 7:18 even though they learned they had some vascular disease. 7:21 More of them, 67% had evidence. 7:24 So this is not going to be much different if this were done in the United States, 7:29 maybe worse. 7:30 So we have to apply a very aggressive strategy. 7:33 We can't just think eating broccoli is enough. 7:36 It's great to eat broccoli, but isn't enough. 7:39 We have to test not guess. 7:41 We have to do the equivalent 7:43 of the mammogram for the brass, the colon as could be for the colon. 7:47 We need hard imaging. 7:49 So 400 plus years ago, an English physician, the number one leading 7:53 physician in Europe, Thomas, I am, said a person is as old as their arteries. 7:58 How do you know? 7:59 So the problem is asking questions and putting a stethoscope is not enough. 8:05 As a well known current physician has said Peter Diamandis, the human body 8:10 has an amazing ability to hide disease, which is why you've all heard. 8:15 We heard tragically in Detroit in the last couple of weeks, 8:18 people in their 40s that drop dead without warning of heart disease. 8:22 Tragic. 8:23 They were hiding very serious disease, 8:27 prominent vascular specialist physician Ernest Schaefer 8:31 said probably 40 years ago, the best test for the prediction 8:35 of the risk of atherosclerosis is the demonstration 8:39 of atherosclerosis, which is what they did in that Spanish study. 8:43 I showed you a couple of slides earlier. 8:44 The pace of study demonstrated the atherosclerosis. 8:48 You know, there's disease. 8:50 So how did we used to do it? 8:52 We used to do it by invasive studies. 8:54 I'm just going to take one minute on the history of this. 8:57 But there was a German physician, Werner Foresman, who was convinced 9:01 he could put a catheter in the heart of a living human, make some measurements, 9:05 get the catheter or tube out and not kill the living human.
Coronary Calcium Scoring and Risk Prediction 9:09 So who had the first catheter in the heart 9:12 in the 1920s, as an experiment, Doctor Werner Foresman. 9:16 He did the experiment on himself. 9:18 He walked up a flight of stairs with a tube he felt was in the heart. 9:22 After placing it through a vein in his arm, 9:25 he took this chest x ray, confirming that this white line 9:28 ended in the right side of his heart is right atrium. 9:32 He took the tube out. 9:33 He survived, and he changed medicine forever, to the point that he, 9:37 in the middle, along with two other doctors, won the Nobel Prize in Medicine 9:41 for the ability to image blood vessels without the death of this object. 9:46 That's always a good test when you don't, kill the subject. 9:50 But we couldn't really look at heart arteries until this famous physician 9:53 at the Cleveland Clinic, Mason stones, in 1958, 9:58 was doing, iodine based, CT 10:01 and x ray pictures of the aorta and accidentally slipped 10:06 a catheter right into one of the heart arteries, the right coronary artery. 10:09 That's the actual x ray picture in the middle. 10:12 Injected the iodine. 10:13 He thought it was going in the aorta, but it went into the right corner artery. 10:17 Heart artery. 10:18 The patient survived. He had the picture. 10:21 And rather than hide this from everybody, he realized he could work on this 10:26 as a new project. 10:28 And once you see heart arteries, you know, if you have heart disease. 10:31 So that was my specialty for many years, 10:34 dressing up in blue gowns and blue hats. 10:37 That's a picture in 1990. 10:39 And the last time the gentleman 10:40 without a blue hat and me in more current days on the right. 10:44 But many of us have used invasive procedures. 10:48 We don't need to do that anymore. 10:51 And why is that so important? 10:52 Because back about 20 years ago, a very important medical society 10:57 called Shape Society of Heart Attack Prevention and Eradication said, 11:02 maybe we're not treating heart disease right. 11:04 We just give out prescriptions 11:05 for lower cholesterol and do other modifications of blood work. 11:10 But we're not looking at arteries. 11:11 So look at the bright aqua blue box before you write a prescription 11:16 for a long term medication as an effort to prevent heart disease, 11:20 let's find out if there is heart disease with a test. 11:23 And they recommended about 20 years ago. 11:25 You get a CT scan of your heart, not an invasive procedure, a noninvasive 11:30 procedure called a coronary artery calcium score, CT scan. 11:34 And you also look at the carotid arteries, 11:37 which are wonderful arteries for imaging. 11:39 And they identified very early that this simple quick 11:44 hold your breath for 10s and go home CT scan. 11:48 Please write this down called a coronary artery calcium Score Cax. 11:53 Now available in virtually every hospital in the United States 11:56 and around the world. 11:57 Maybe free in Cleveland, maybe under hundred dollars, maybe $150. 12:02 Well, tell you if you're like patient A, B or C, patient 12:06 A, the yellow arrows pointing right at the biggest artery of the arc 12:09 called the widowmaker artery, the left hander descending artery. 12:12 No white spots, no calcification. 12:15 Calcium score zero. Wonderful. Prognosis. 12:18 Patient B has a few white spots. 12:20 The computer software program will give a number, a score. 12:24 Maybe it's 100. 12:25 Not as benign and patient C is playing pickleball, planning a trip to Vietnam, 12:31 and realizes after the scan that he or she is walking around 12:35 with a tremendous burden of completely silent heart disease. 12:40 So simple. 12:40 Does it make a difference? Oh, it makes a big difference. 12:43 This is just one of many, many studies over the years. 12:46 If you look at the top line that says 99.4%, 12:50 that's the 12 year survival of people who have that heart CT 12:55 scan and the score comes back ten or less zeros the best. 12:59 And if you look at the lowest line that goes down and down and down, 13:02 if you come back with a calcium score over 1000, 13:06 only 77% of the people who have 13:09 that score will be alive in 12 years, according to the study. 13:13 I consult on people every week with calcium scores well over a thousand. 13:18 Yesterday was a calcium scored 2700 last week a calcium score 4400. 13:23 But I'm very concerned if your calcium score is two 13:26 or 5 or 12, it's already abnormal. 13:29 And I've seen very dangerous heart disease 13:32 when the calcium score is anything but zero. 13:35 So it took a while from two decades ago 13:38 till 2019 that the the American Heart Association 13:43 finally included this simple, hard c t test in their recommendation. 13:47 So if you look in the red circle or the yellow arrow is 13:51 CAC coronary artery calcium scoring, if you're a zero, you probably don't need
Advanced CT Angiography and AI Plaque Analysis 13:56 prescription medication, which is what this group argued about 20 years ago. 14:01 We have even more data. 14:03 We have, in essence, about 10,000 research studies on CAC 14:07 as coronary artery calcium score. 14:09 But in a randomized study just published in 2025, 14:13 our newest really prospective study, 14:16 if a family doctor knows the calcium score or the patient has the study, 14:21 but the data is kept from the family doctor, 14:24 there's a difference in the outcome over the next few years. 14:27 And in fact, there's an improvement in care and improvement in the status of 14:32 heart arteries. 14:32 At three years of follow up, if the doctor knows 14:36 about the abnormal score and treats it appropriately, when you know 14:40 your artery score, you know your risk and you know what path you should take. 14:44 Of course, it's not just medication, it's everything 14:47 related to lifestyle you're learning about in this wonderful summit. 14:51 Or at least I hope you agree with me. Wonderful. 14:54 And they 14:55 actually in the same study in March of 2025, 14:59 they not only looked at calcium scoring, but they looked at three years. 15:04 Did your arteries get better or worse? 15:06 Remember we're talking about reversing heart disease naturally summit. 15:09 And maybe you say a CT 15:11 scans that natural I understand that but you have to make a diagnosis. 15:15 So once you made a diagnosis with the calcium score at three 15:19 or follow up, there was less plaque in the arteries of patients whose family 15:24 doctor knew the results because they did treat those patients more aggressively. 15:29 And you can say treat everybody aggressively. 15:31 Well, I agree with diet and exercise, but you're not going to be putting people 15:35 on powerful prescription drugs 15:37 if they don't have heart disease, at least not recommended. 15:41 The newest excitement is all about AI. 15:43 You can, for example, have a cough. 15:46 Your family doctor says, go get a chest CT scan. 15:49 I'm worried about your cost now using I even though I chest CT 15:53 scan is not a heart test, you do see the heart in the middle of the scan 15:58 and without any preparation, 15:59 they now can calculate that coronary artery calcium score. 16:03 They can look at your aorta, see if it's calcified. 16:05 They can look at your valves, see if they're calcified. 16:08 This is just becoming mainstream that a routine chest CT scan. 16:13 And if I recall there may be 40 million of these here in the United States 16:17 will also provide heart prognostic information. 16:21 Maybe clean heart arteries. 16:23 I have patients all the time that come to me for their cholesterol in 280, 16:27 and they tell me when I asked detailed questions, 16:29 they had a chest CT scan in the last three months. 16:32 For some reason I get that CT. 16:34 I look at the images either online or on a CD, 16:38 and I can see the heart arteries and if they're clean, we're going to work 16:42 for a long time on diet, exercise and maybe supplements. 16:47 So lower the cholesterol. 16:48 We're not going to use prescription drugs if at all possible, am I? 16:52 Patients generally like that? 16:54 All right. 16:55 What about the carotid arteries? 16:56 Well, about 25 years ago it was developed that you can do an ultrasound 17:01 of these big arteries that are straight and go right up to the brain. 17:05 And you can use some, computer software imaging analysis called CMT, 17:10 carotid interval media thickness ultrasounds. 17:14 And if you can find one, go get one done. 17:16 We do them in my clinics, but they're hard to find. 17:19 There are a few companies that go around the country offering these. 17:23 Most universities, sadly don't offer this simple, radiation free technique. 17:28 So action! Stop there. 17:31 You should write down is of course do your colon cancer 17:34 screening and eat to prevent colon cancer. 17:37 We know that's a whole food plant based diet. 17:40 Do your mammogram or your 30 gram and eat to prevent breast cancer. 17:45 We know that's a whole food plant based diet with a lot of that broccoli 17:48 I mentioned. 17:49 But don't ignore the heart. 17:50 In fact, the heart should be number one. 17:52 Get a calcium score CT scan, get a carotid IMT imaging study. 17:57 All right. 17:58 But as we come towards the middle to end of part one of this two part 18:03 presentation, I have to educate you about a breakthrough 18:08 of tremendous importance in cardiology and heart disease imaging. 18:13 And that's the fact that in 2010, it was developed 18:17 that you can put an IV in the arm of a human. 18:20 You could give iodine through the IV, 18:23 you could see the heart arteries and a CT scan with an injection of iodine. 18:29 But this wasn't a simple calcium score. 18:31 Because of the iodine injection, you can now see the entire artery. 18:35 You can actually report narrowing. 18:37 And you can also see something called soft plaque, not just hard calcified plaque. 18:42 So with this ccta coronary angiography, 18:46 we can see a person on the left who has no soft or hard plaque. 18:50 And then we can see going from left to right all the way 18:53 up to very severe plaques. 18:56 But the limitation was mainly that this was read 19:01 by eyeball visual estimate. 19:03 And that is called subjective. 19:06 So last year it became routine that we could now use AI software. 19:11 The AI software is made by several different companies. 19:14 I tend to use one called clearly that when they have the CT 19:18 scan with the iodine dye injection, the whole test takes about two minutes. 19:23 It does up the radiation exposure and it does increase the cost. 19:27 But we can now tell what kind of plaque is in the heart arteries. 19:32 Soon we'll be able to tell what kind of plaque is in other arteries 19:34 around the body. But right now, the software's for the heart. 19:37 We can tell if there's dangerous, 19:39 high risk free heart attack plaque called low density non calcified plaque. 19:43 That's a red plaque. 19:44 And the image on the left we can see 19:47 if the plaque contains a lot soft non calcified structures. 19:52 Those are color coded yellow in the pictures. 19:54 In the middle are we can actually see that there is plaque but it's low risk plaque 19:58 because it's all calcified plaque all the way to the right. 20:01 Very important breakthrough. 20:03 So this is a patient I see regularly in my clinic 20:07 for about a decade. 20:08 He's an accountant. 20:09 He's still working for about another four years. 20:11 He has no symptoms. 20:13 Twice he's gone for the corona artery. 20:15 Calcium score. 20:16 It started out abnormal at 11 of eight.
Clinical Examples, Study Data, and Future Screening 20:19 But, six years after the calcium score had risen to 86. 20:23 Not a world record, but not normal. 20:25 His carotid age said he was like a 76 year old. 20:28 Even though when we first did it, he was only 57. 20:32 So he was having atherosclerosis and he was working on his diet 20:36 and his exercise and a stress in his sleep. 20:38 And he was on both, supplements and prescription drugs. 20:42 And he really cared. 20:43 And he kept coming back in a doc. 20:45 I want to know how I'm doing. 20:47 So we have now done two of these advanced corner CT angiograms 20:52 with iodine dye injections and even though I tried to put arrows, 20:56 I just want to report you that the picture on the left 21:00 is from October 2022, and the picture on the right is from April 2025. 21:05 So not quite three years. 21:07 The exact same test. 21:09 They just changed the way the report looks and we have shrunk his plaque. 21:13 This is the most accurate way in the world to measure it. 21:15 He used to have 457 cubic millimeters of plaque. 21:20 Now he has 407, 457 down to 407. 21:25 And we've particularly shrunk what's called the soft black. 21:29 The red arrow on the left said he had 320 cubic millimeters of soft black. 21:34 Now he has 200. 21:35 So we have really reduced his risk. 21:38 Very proud of that. 21:40 How common when you use these advanced CT scans with eye imaging. 21:44 Do you see plaque. 21:45 This may be the largest report in the world. 21:47 If you look to the left 4855 people, no symptoms, just showed up 21:53 at a very exclusive executive clinic where they do this test routinely. 21:58 And you can see only 11% of people were normal. 22:02 74% of people had mild black, 22:05 and about 12 to 13% of people 22:08 asymptomatic had severe plaque. 22:11 Now all the pictures to the right show 22:14 is that as you get older, the odds of you have severe plaque go up a lot. 22:19 So if you show up at this clinic over age 70 and you're a man, 22:22 the odds are close to 60%. 22:25 You're going to have moderate or severe plaque without symptoms. 22:29 And if you're a woman, it's closer to about 14%. 22:33 That's just a statistic from one of the biggest samples there is. 22:37 Does doing a study like my patient, 22:39 they account change behavior and outcome. 22:43 Now we have a randomized study published journal 22:46 American Medical Association Cardiology June 2025. 22:50 But they took 400 people and they did these advanced CT studies at baseline. 22:56 And they repeated them. 22:57 They gave the results to half of the participants and the doctors. 23:01 The other half didn't know the results. 23:03 Isn't that a crazy study? That's how they do it. 23:05 And they identified just like the calcium score. 23:08 But now using the more advanced angiogram tests that when the treatment is guided 23:13 by a CT scan, you get better outcomes, no doubt about it. 23:19 And in November of 2025, at the European Society of Cardiology, 23:24 more data was presented that these advanced AI studies 23:28 predict the risk of heart attack better than anything else 23:31 that they studied in comparison, including even the calcium score. 23:35 You get more information from these advanced CT and your parents. 23:39 Well, why isn't this used routinely yet? 23:41 Because we need the study I'm showing you here to be finished. 23:45 The transform study is a randomized comparison 23:48 of using these eye CT angiograms 23:52 versus just knowing their cholesterol, blood pressure, and, blood sugar 23:56 for primary prevention of heart attack strokes and death. 24:00 So there are 7000 people 24:03 and well, more than half have already entered this study. 24:06 They're at risk with elevated blood sugars or actual diabetes, but they do not yet 24:11 have any known symptomatic heart disease like a heart attack or a bypass, you know, 24:17 and again, they're all getting the advanced study with the eye. 24:21 But half of the doctors in the patients won't get their results 24:24 to the end of the study. 24:25 3 or 4 years later, half of them get it right away. 24:29 And the doctor has been instructed to treat them 24:32 based on how much disease is found and the clearly, 24:35 there actually are already suggested what I'll call algorithms. 24:40 What do you do if you don't find any disease? 24:42 Well, you don't start typical prescription drugs. 24:46 Or if you go all the way to the right 24:48 where it's in red and they called stage three. 24:51 What do you do if you find stage three asymptomatic heart disease, 24:55 you throw everything at them. 24:57 The only thing I don't love about this 24:58 slide is they're not talking about lifestyle. 25:01 They're assuming that patients are getting education about exercise, 25:04 fitness, sleep, stress management and lab based nutrition. 25:09 But they're focused in this picture on lifestyle. 25:12 Is there any downside to see damaging? 25:14 There is I'm always honest about that. 25:17 A relatively recent study looked at an analysis, computer based analysis, 25:23 that with the 93 million CT scans 25:26 performed in 2023 and 62 million patients in the United States, 25:31 there might be an uptick in cancer from the X-ray exposure, predominantly 25:37 in children, because children get exposed to x rays from CT scans, 25:41 and they got their whole life to worry about DNA damage, older people. 25:45 It's an issue, but not as much. 25:47 There are some vitamins 25:49 that have been suggested to protect the body during CT imaging. 25:53 Not completely proven. 25:55 And my final comment in part one on this war on heart attacks, er, 25:59 reversing heart disease naturally some 4.0 is there is a new generation 26:04 of CT scanners that are being installed at major medical centers and universities. 26:09 They're called PC photon counting, CT scanners 26:12 and amongst other improvements they exposure to less radiation. 26:16 So we have, great opportunities to identify accurately 26:21 the burden of atherosclerosis if you have none. 26:24 It's a victory. 26:25 I've been through all of these tests, and I have no atherosclerosis in my heart. 26:30 Arteries. And I'm in my mid to late 60s. 26:34 But that's relatively uncommon. 26:37 And we have the technology to identify it accurately. 26:39 So thank you very much for listening to part one of this presentation.
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