When Calcium Kills: What You Must Know About Heart Calcium And CT Scoring

Matthew Jay Budoff, MD, FACC, FAHA

No, it’s a pleasure to be here, thanks for having me on.

Joel Kahn, MD, FACC

So these are really lay up softball questions that you, and I know you more than I, but I think they’re so important. I mean let me just tell you some personal note the first scanner in the state of Michigan where I’ve been most of my career except for cardiology training and such, was in Flint, Michigan and my brother bought it for the hospital. So in Imatron CT scanner in 1995 brought calcium scoring, early detection of silent heart disease to the state of Michigan. I was not at that institution, I was an hour away, but saw what was happening, started to refer to a very expensive test back then and then as you and I know, the technology became widely available on more prolific CT scanners and Imatron as a company and as a expensive option went away largely. There’s a few around, I know they’re still providing studies, so I’ve been deep in this and referring people and you are the world expert. Why do you think a 50 year old man or woman with some risk factors shows up at a good internist, a good family doc and executive physical gets what they got, but nobody brings up, you got the colonoscopy, you got the mammogram, you got the digital rectal, you got the pelvic exam for early detection of cervical cancer, but where’s the heart and then let’s, you know go from that right into what calcium scoring CT imaging might do. But why do you think there’s been from 1995 to now such a slow adoption by the medical community of what is now a very widely available, very inexpensive test?

Matthew Jay Budoff, MD, FACC, FAHA

Yeah, no, you know, it’s remarkable to me. I mean, we screen for everything else except for heart disease, even though heart disease is the number one cause of death for both men and women in the United States so we’re screening for lung cancer and colon cancer and breast cancer and all the way down the list. Yet we just do not look at the heart and I think it’s partly because there was some early pushback unfortunately the entrepreneurs early on advertised this directly to the public, kind of went around the medical societies and the medical societies didn’t like that and pushed back a little bit. But they are firmly on board now there is not a medical society that does not advocate for coronary artery calcium score now since 2018, so everybody’s on board and I think now we just have to keep rolling out the education. We have to keep educating the primary care doctors that this is an important thing to screen for and they’re, as you said they’re widely available and they’re not expensive.

Joel Kahn, MD, FACC

Right, so let’s even go back the observation by radiologists that if you do an x-ray of a leg or a chest, before we had CT scanners, that you could identify calcium and blood vessels. Just talk for a minute about that background that we know that calcium and atherosclerosis are a very common partnership.

Matthew Jay Budoff, MD, FACC, FAHA

Yeah, so you know the word atherosclerosis means hardening of the vessel atheros vessel sclerosis is hardening and that is calcification. So literally the word atherosclerosis means basically calcification of the arteries. The arteries get stiff, they get full of plaque and they get blocked off and patients have a heart attack or a stroke or they get a blockage in their leg and they need their leg amputated. So this goes back to middle ages and beyond when we first started categorizing why people dropped dead so it’s not a new concept, it’s just one that we haven’t been screening for as systematically as we should be.

Joel Kahn, MD, FACC

So, you know, calcium isn’t always bad we need it for our bones, we need for our teeth, but it never normally is in arteries. That’s at least in a way detectable by x-ray imaging it’s never normal to have calcium is that a fair statement?

Matthew Jay Budoff, MD, FACC, FAHA

Very fair, yeah, that’s absolutely correct when you take and I don’t want people to be afraid of calcium supplements, because if you take a calcium supplement 99.9% of that goes into the bones the the bones take up all the dietary calcium. This is scar tissue, this is calcification, it’s not from dietary calcium I don’t want people to avoid eating foods or taking their normal supplements for osteoporosis and as fear of developing these problems in the heart. 

Joel Kahn, MD, FACC

But then those very, very first generation CT scanners, probably in the eighties for head imaging and lung imaging, I mean the heart was basically a blur ’cause the heart was moving, so what was the breakthrough that you were part of and that that great documentary, the Widowmaker movie lays out that I would encourage people to watch online, what was that breakthrough? We mentioned the company Imatron and ultimately Multislice CT but we can see the heart. Tell us about what a revolution that was simple CT imaging of the heart. 

Matthew Jay Budoff, MD, FACC, FAHA

Yeah, so as you said, CT scanners used to take about a minute to take a picture and in a minute our heart beats about 60 to 80 times. So the heart’s beating away, everything’s blurry in the heart because we need to freeze that image, so we needed a fast camera to take a picture of a moving object. So in the late eighties, scientists at UC San Francisco and Doug Boyd was one of the PhDs that were involved, developed a machine that could take a very, very fast picture in 1/10th of a second. So instead of taking a picture in minutes, it took a picture in a 10th of a second and now we could freeze the heart, see the arteries clearly, and quantify those cal calcified plaques that are sitting in the arteries causing blockages.

Joel Kahn, MD, FACC

So tell the public listening, I had my last calcium score about a year and a half ago, proudly still is zero I’d like to keep it that way for a long time. But what does a person go through now? You know, the actual experience of getting a modern state of the art calcium scoring CT scan?

Matthew Jay Budoff, MD, FACC, FAHA

Yeah, so it is so simple and it’s become so inexpensive relative to where it started so patients basically go in, they can be dressed like they are, they lay down on the table after about one minute, maybe two minutes they’re done. It’s literally they align the patient on the table, they take a couple pictures of the heart and they get ’em off the table. There’s no needles, there’s no injections, there’s no contrast the radiation dose is about the same as a mammogram, so if women are afraid to get mammography for breast cancer, then they probably don’t want to do this. But I would say that’s probably pretty safe test and we do that every year and I would advocate we only need a heart scan maybe once every three to five years so it’s nowhere near that level of risk that a mammogram affords patients and it’s very, very low.

Joel Kahn, MD, FACC

So compared to the effort of going through a colonoscopy or the discomfort of going through a mammogram, which I can’t relate to personally, but according to my wife, it’s not the most joyful thing. This is a nothing burger test and what’s the cost currently in your community at your institution?

Matthew Jay Budoff, MD, FACC, FAHA

Yeah, so we run anywhere between about, the common costs are about 99 to $149 a test so I always tell patients for the price of a good meal you can live longer and have more good meals so it’s not out of range for most of us.

Joel Kahn, MD, FACC

Yeah, we have a series of hospitals that are $75 in Detroit and I know the university hospital in Cleveland does it for free. So if you’re ever near there, you might just walk in and ask if you can get a coronary artery calcium CT scan. they do that as a public service it’s a wonderful thing. I noticed that your most recent publication number 1031 I think it was an editorial why insurance payers should cover the cost, although it’s not very high and people do pay out of pocket in most states of the United States, but why insurers should pay for intermediate risk patients? Tell us a little bit about what that means who’s very low risk maybe can skip the scan, who’s very high risk and maybe already knows of their disease, doesn’t need the scan and who’s that sweet spot that you just wrote about?

Matthew Jay Budoff, MD, FACC, FAHA

Yeah, so very low risk people have no cardiac risk factor so you know the cardinal risk factors that we talk about, high blood pressure, high cholesterol, family history of heart disease, diabetes, smoking, and then age, men or women age becomes the sixth risk factor. So if you’re younger and don’t have high blood pressure, high cholesterol, diabetes, you’re low risk, so we don’t want people coming in in their twenties and thirties trying to get a heart scan because dad or mom had a heart attack when they were 60 or 70 years old. We want them to come in when they’re a little bit older so the very young, what we call the worried well we don’t want scan, those are low risk people, the yield is almost zero and it’s really not worth the time cost or minimal radiation to undergo the test at that point. Very high risk are the opposite they have all those risk factors or most of them they have diabetes and their cholesterol is high and their blood pressure’s high. 

We know they have heart disease already or at least plaque in their arteries already and we need to be aggressive and we don’t need to scan them to prove that, but it’s everybody in the middle. Maybe a little bit of blood pressure, maybe just a family history and you’re 40 years old as a male or 45, 50 years old as a female and somebody in your family had a problem. Those are the age, that’s the age of atherosclerosis and no doctor, I don’t care how good or how astute they are, can look at you and say, you know what, you don’t have anything going on in your arteries or not unless they have x-ray vision, literally they can’t tell and we don’t know so we need to take a look and then decide how to treat.

Joel Kahn, MD, FACC

And there is that term reassessment and risk reassessment that 45 year old man with a cholesterol 245 or that 51 year old woman with a cholesterol 260 that goes through this inexpensive scan and comes back a perfect zero no calcium score, what does that do to the decision? Here’s your lifelong prescription versus lifestyle approaches and a more gentle non-pharmacologic approach. I mean, what does the science say and what do the societies say about that, now?

Matthew Jay Budoff, MD, FACC, FAHA

Yeah, absolutely and I’m trying to when I’m answering, I’m trying to answer on behalf of what a lot of the society say, not just my personal opinions, they are a lot of societal papers on this. But they all say basically if your score is zero, so it’s like golf, low score wins and zero happens to be no plaque detected at all, which is wonderful. You don’t have a lifetime immunity to developing heart disease, just like a negative HIV test or a negative covid test. Doesn’t mean you can never get those illnesses it just means you don’t have anything now. So we say wait five years and get retested, but in the interim, live healthy, You don’t wanna build up plaque, you don’t wanna start going down that road of heart attack, stroke, stent, bypass surgery or death. So live healthy so we reinforce good behaviors even when you have a score of zero, we say, look you got a zero right now, let’s keep it that way and we’ll test you again in five years.

Joel Kahn, MD, FACC

And that’s usually about the protocol I used to about five, sometimes seven years. Let’s talk for a minute about this the invisible plaque and what a calcium score can’t do So it can’t see a kind of plaque we call noncalcified soft plaque and it can’t see the degree of narrowing in an artery we have to go to more advanced technology. I mean how common have you seen in your practice at calcium score zero and actually a patient end up in the emergency room or actually have a heart attack or a stent because there just happen to be a burden of soft plaque. I’ve got one in my practice that I reassured and then eight months later he reassured me I’d given him bad advice.

Matthew Jay Budoff, MD, FACC, FAHA

Well it is very rare, it’s less than 1% chance of something like that happening over the next five years so it’s not a hundred percent guarantee, it’s a 99% guarantee, but that is excellent because if you were not to do the scan, the best you can do with risk factors and being a good doctor is probably give them a 90% guarantee so this raises that 90% guarantee to a 99% guarantee. So we have every now and then we’ll all have anecdotes of a person who slipped through who had a score of zero and had a heart problem. Some of that is noncalcified, what we call soft plaque that might be sitting in the artery that we can’t see with this simple x-ray and we need to go beyond that. But most of the time it might be just something that floats into the artery and blocks it off that we might not have detected by any test and just some bad luck happened causing a heart attack, it could still happen in in rare cases.

Joel Kahn, MD, FACC

Yeah, a common scenario somebody walks in your preventive clinic wants to talk to you about careful assessment and what the plan ought to be is an ex smoker and mentions that they’re in a low dose chest CT program scanning screening for lung cancer. I mean, how interested are you on getting your hands on either that chest CT report or the actual disc images as opposed to ordering a new calcium score? Because maybe three months ago they did have a CT that included their heart images, some radiologists comment, some don’t comment on the heart anatomy. I mean, have you found that helpful, do you encourage people to, before they plunk down their $150 and one more millisieverts radiation to use a recent chest CT for information?

Matthew Jay Budoff, MD, FACC, FAHA

Absolutely I think that if you had a CT of the chest even of the abdomen, if we see in the aorta the pipe that runs down the body, if there’s a lot of atherosclerosis there, we kind of have our answer as well. So if you’ve had a CT scan for another reason, chest or abdomen or pelvis, we can often take a look at that and look at the arteries, the coronary arteries or the aorta and say, you know what, there’s something there we need to get on top of this. Sometimes I still like to get a calcium score if there’s a modest amount of plaque or if it’s moving a lot if there’s motion artifact. But most of the time that’s suffices to give me the answer to whether I should intensify treatment, get ’em on a cholesterol pill or get ’em on a better diet and exercise regimen or whatever we’re gonna do versus pat ’em on the back and say, you know what it looks good, let’s just keep an eye on things and be healthy for the next few years.

Joel Kahn, MD, FACC

And the patient brings you the report of their chest CT, their lung ct and the radiologist was sharp and mentioned moderate coronary calcification. Is there any way to take that image and retrospectively do a calcium score or you just can comment mild, moderate, extensive calcification?

Matthew Jay Budoff, MD, FACC, FAHA

No, you can actually get a number there’s actually a company that’s, it’s called a heart lung where they’re gonna look at these existing scans and actually quantify the calcium if you want and then you can get an actual number and it’s pretty good. There’s cases where there’s a lot of motion where it might not be ideal, but most of the time you can get a pretty accurate score and then use that as kind of a baseline to see what happens over time.

Joel Kahn, MD, FACC

Okay, that’s, that’s really important information and how about Joe or Jane walk in your clinic, they’ve had a heart attack, they’ve had a stent, they’ve had a bypass and the primary care doc ordered a calcium score or they ask about a calcium score. What would your advice be to that person I mean that’s the ultimate high risk person it’s not really a matter of risk, it’s a already a known diagnosis, but why does that fairly large group not need a coronary calcium scan?

Matthew Jay Budoff, MD, FACC, FAHA

Yeah, so if people have established heart disease, whether they’ve had a a heart attack or a stent or bypass, we already know there’s plaque in the arteries and getting a calcium score shouldn’t change anything ’cause they should already be being treated aggressively. What we do in those cases, especially if they have some symptom, is we do the next test up, which is called a CT angiogram that’s similar to a calcium score except we do have to start an IV and we do have to get dye into the heart so it’s a little bit more complicated, a little bit more, more expensive, but it’s largely almost a hundred percent covered by insurance. There are a few HMOs that don’t do it but every major payer in the US covers a CT angiogram, like a noninvasive angiogram and then we can look into the stent or look into the bypass graphs and see if they’re working or not, if they’re open.

Joel Kahn, MD, FACC

And we’ll be talking with James Min, a colleague of yours about CT angiography and advances in detail. We fight in Michigan to get a insurance approval for a coronary CT angiogram and somebody with known Corona artery disease it’s crazy. It’s on their algorithm but that’s a different story than problems you go through, we usually win it’s a fairly heated phone call I have to make but unfortunately. How about Bob or Brenda that have seen you, you’ve got them on their lifestyle plan ’cause their calcium score was 300 or 400, they’re asymptomatic and they’re doing great with all that. Do you expect the calcium score to go down and you reorder one expecting it to go 300 to 200 or forget about it as they say in the Sopranos?

Matthew Jay Budoff, MD, FACC, FAHA

Well, so I would say any test, any test in the world, if it’s not gonna change what you’re doing, you don’t need to do the test. So if they’re already on great therapy, they’re already doing great and you’re not gonna change anything, getting another look is not gonna help. ‘Cause if it comes out the same, it’s not gonna go down but if it comes out the same number, let’s say they were 300 score and now they’re about 300 score, that’s great we can pat ’em on the back and feel good. But if it comes back and it goes up a little bit and now it’s 400, what do we do? We’re already doing all the things we can do so it doesn’t often add a lot. Now I have a lot of patients though that have a score, they wanna start slow, they wanna start with just a few lifestyle changes. They don’t really wanna do major things, they don’t want to go plant based, they don’t wanna start medication and then I do repeat the score in a couple of years and if it’s going up by more than 20% per year, so I look at the score and if it’s gone up by more than 20% per year I say, you know what, we are failing, you are laying down more plaque, we gotta double down now we gotta do something else.

Joel Kahn, MD, FACC

Yeah I wanna emphasize that’s your published data that in your database the calcium score went up by average about 20% per year I’m sure there was a lot of variability and you might shock the listeners if you tell what your observation was about the rate of rise of the calcium score if you’re on a statin medication. What happened to that?

Matthew Jay Budoff, MD, FACC, FAHA

Yeah, so you know the statins do something really good, which is take the soft and early plaque and turn it into later stable plaque, but part of that is more calcification so it actually raises the calcium score now usually by about 10%, maybe 15% per year. So even if they’re on a statin and they’re going up I calculate their rate of change and it’s 32% a year, that’s more than the statin then I think, okay they’re on a statin but we’re still seeing plaque, what do I do next, do I increase the dose? We have about six medicines that have proven to add onto statins to lower risk further maybe I’ll add one of those therapies. So even if they’re on a statin, I sometimes repeat the scan if I’m going to up the ante and put ’em on Icosapent Ethyl, Vascepa, fish oil or if I’m gonna put ’em on a new cholesterol medicine or one of the injectables to get their LDL even lower.

Joel Kahn, MD, FACC

Real aggressive approach yeah, I actually had just yesterday a chiropractic physician I only get to see once a year who came in really upset and he had stopped all his medicine, all his lifestyle approaches ’cause his original calcium score was 400 and his primary care doc ordered a second one. I didn’t know about this and it went 400 to 500, a little bit more than 20% a year and he figured this is a failure because it hadn’t been explained that one, it does go up and number two it will go up a little faster on a statin.

Matthew Jay Budoff, MD, FACC, FAHA

Yeah.

Joel Kahn, MD, FACC

And I really slow him and calm him down and say and he is scheduled for a coronary CT angiogram, he had some SD depression on a treadmill stress test so there’s more than enough reason to do that. We’ll get the real data but I think people do expect that if we ever repeat it it might go 400 to a hundred or zero and how about I follow closely the chelation literature, the TAC one trial of IV chelation and then we await the TAC two trial I’m not sure how far out that is, but I’ve not seen any commencing data that a calcium score goes down with intravenous EDTA therapy over and over. Are you aware of any.

Matthew Jay Budoff, MD, FACC, FAHA

No, you know it’s really unfortunate. I worked with the group on TAC one and for TAC two we actually built in, in the protocol serial calcium scans to answer that question and they had some budget cuts that those years at the end at the National Institute of Health and they cut out the calcium scores.

Joel Kahn, MD, FACC

Wow.

Matthew Jay Budoff, MD, FACC, FAHA

So I don’t think we’ll ever see good data unfortunately. Yeah, we tried to re-add it and get a grant going and it was just logistically it didn’t happen. We worked pretty hard on that and unfortunately we won’t have that answer but I don’t believe, I think calcium, once it’s embedded in the arteries of the heart is scar tissue and it’s not gonna go anywhere.

Joel Kahn, MD, FACC

Right.

Matthew Jay Budoff, MD, FACC, FAHA

So you don’t want more scar tissue, so I don’t want it to perpetually go up by a lot but once it’s there it’s not going from 400 down to 100. I don’t believe that can happen.

Joel Kahn, MD, FACC

Yeah and I don’t see it either I’ve actually had a couple people come to me, I’ve just done 30 weeks of IV chelation, which costs a fortune in a lot of time and why my calcium score go up and it sometimes I’ve, they brought me these studies that has gone up. I don’t understand ’cause there actually are data points as you know that chelation may have some clinical benefit in peripheral vascular disease and coronary disease, but we have no idea what it does specifically to coronary anatomy. 

So if we’re not bullish about chelation in the last few minutes, if you carry a lot of titles, you undoubtedly carry the title, the king of Kyolic garlic and just share since we, this is a summit about reversing heart disease naturally there’s not too much more natural than aged odorless garlic tablets. How did you get interested and what have you contributed multiple times to literature that I’m fascinated by all my patients are on Kyolic garlic, in fact this exact brand, but how did you get down that road?

Matthew Jay Budoff, MD, FACC, FAHA

Yeah, you know it was a very interesting, one of the hematologists, one of the blood doctors came up to me and he said, I’ve been working with this company, we’re doing some safety studies to make sure you can take it with blood thinners and that people don’t get bleeding problems. But it really has a lot of cardiac benefits that have been shown in Japan, but nobody’s really done any studies in the US.

Joel Kahn, MD, FACC

Yeah.

Matthew Jay Budoff, MD, FACC, FAHA

So I started, I approached the company and they supported a small trial and I was very agnostic I had no idea if it would work or not, but I said I’ll do the study, I did the study and it worked. So it was a small study and it lowered plaque the soft plaque and it slow slowed the calcium.

Joel Kahn, MD, FACC

CT angiogram.

Matthew Jay Budoff, MD, FACC, FAHA

CT angiogram and calcium score we did both and the calcium score slowed compared to placebo, so it slowed the progression of plaque it didn’t reverse it, but we saw a little bit of reversal in the coronaries on the CT angiogram and I said, you know what, that’s interesting but it’s a very small pilot study. Let’s do a little bit of a larger trial now and really prove the point and we did another study and it worked and then they wanted to keep doing trials. So then we did a trial in firefighters and it worked, it even lowered anxiety levels, which was very interesting, stress and anxiety levels in the firefighter group, we measured that because there’s also some data outta Japan, this drug in Japan that Kyolic is considered a prescription drug practically. 

So it has to go through the registration process of a much more advanced protocols than what we do with other dietary supplements in the US where there’s really, you could just put something out on the shelf basically today so it’s very well validated. I think there’s over a thousand publications now on that product so if you wanna a garlic supplement that has data behind it, Kyolic is the one and over six trials now we’ve seen market slowing of the calcium score, so it definitely helps with calcification progression. It’s not gonna cause regression but it’s gonna slow the plaque and we’ve seen reversal on some of those CT angiograms that you’ll talk to Dr. Min about where we can actually see less of the soft plaque. The noncalcified plaque starts to go away with Kyolic very interesting data.

Joel Kahn, MD, FACC

Yeah and I mean patients do well, I’ve had two out of probably 2000 patients that claim they smell a little garlicky taking two a day and they drop to one a day and they do fine. But everybody else, plus there is randomized, there are randomized studies of dropping blood pressure with the same product.

Matthew Jay Budoff, MD, FACC, FAHA

Yep.

Joel Kahn, MD, FACC

Mildly dropping LDL cholesterol with the same product and I can’t even imagine that there’s a any risk in any situation ’cause what was the conclusion with the hematologist? Any a patient on XARELTO adding an Kyolic garlic? I wouldn’t be concerned but.

Matthew Jay Budoff, MD, FACC, FAHA

No, there was no problem with warfarin or with with XARELTO one of the newer anticoagulants, he tested both, so no safety issues. Although the surgeons will probably ask you to stop the garlic a couple days before the operation, which is fine I think that’s, that’s prudent. It does have a tiny bit of blood thinning property, which is probably good for us for health and preventing heart disease. But, but when you’re getting operated on, you don’t want your blood too thin out so it has a very mild effect there and the last thing, which I think is very interesting and I wish we did a study on it, it has remarkable garlic has remarkable benefits on infection both bacteria and viral infections. So we didn’t study covid per se, but it is been historically and I’m talking about now thousands of years of research going back, considered an anti-infective therapy. 

So I think they’re, I have I as you do, I have a vast majority of my patients are on it. I’m a huge advocate of it because the science backs it up, not because of anything that I’ve done personally, but the thousand papers really make it worthwhile and it’s so easy to take and it’s well tolerated it is odorless. So I can’t think of anybody who’s complained of the garlic smell but it really, you don’t smell like a clove of garlic in most cases may maybe there’s a couple people who tease that out.

Joel Kahn, MD, FACC

Yeah man, I agree I think it’s a powerful, powerful natural agent. Last question we started with the inquiry, why has the primary care world so slowly adopted this amazing test? I think we’ve got a lot of people excited if they’ve never had it to ask for it, it usually does require a prescription from a healthcare practitioner a few places you can just walk in and get it and a skeptic might say, show me the randomized study that outcome is different if you apply calcium scoring to a large population. So as this airs the DANCAVAS trial, and I think I got that acronym right, was presented in Barcelona and published I think in the New England Journal Medicine, 45,000 Danish men age 65 to 75 randomized to getting screening, including a calcium scoring asymptomatic men or no screening. Unfortunately the women did not get included maybe the risk wasn’t high enough and it seemed like in the 65 to 70 year olds they proved a benefit to screening asymptomatic people. Just comment on that a bit would you have chosen that age range? I think there’s a reason they did and how is that gonna impact adoption of this?

Matthew Jay Budoff, MD, FACC, FAHA

Yeah, so they chose that database on aneurysms and that they had showed a previous benefit for aortic aneurysms and that’s an older disease and that’s probably too late and what they saw basically was if you below age 70 there was an 11% reduction in death. The literally the original proposed title to the New England Journal of Medicine was that that screening reduces mortality all cause mortality by 11% in patients under the age of 70 and New England journals a very conservative journal and didn’t run with that title but it did work the 70 and older no benefit ’cause it’s probably too little too late once you’re in your seventies. 

The other problem that they had, which was really to me still I don’t understand and I’ve spoken to them, they included people who had known heart disease, the people who we talked about before who already had a heart attack or already had stents and bypass and obviously there was no value in that group. So if you get rid of those patients, it’s probably about a 14% reduction in death in the clean population. You get another 5% benefit by eliminating people who already have known heart disease ’cause they didn’t derive any benefit either. So if you really get to the screening population, there’s a pretty robust benefit for screening.

Joel Kahn, MD, FACC

Okay, yeah, and I think we need to inform our primary care population and the public that we now have a randomized study that proves the concept that you introduced and others introduce SHAPE society still in existence.

Matthew Jay Budoff, MD, FACC, FAHA

Yeah, you know, Morteza Naghavi who formed the SHAPE Society’s a cardiologist at a Houston and he actually is doing that heart lung that I mentioned earlier. He’s trying to bring the ability of taking these millions of lung scans that are done, CT scans of the lung that are done for all different reasons, lung cancer screening, chest pain in the emergency department and deriving a calcium score using AI and being able to provide patients with a number that they can then use to inform their health. Kind of getting a free scan off of existing data. So very clever and and he’s still working and SHAPE is still going and just just to talk about one success SHAPE was able to convince Texas, the state of Texas legislature to mandate heart, scanning and calcium scoring coverage. So if you live in the state of Texas, it is state law that they have to pay for a calcium score if you’re intermediate risk so we’re making some progress, but it’s gonna be one state at a time I think for the foreseeable future.

Joel Kahn, MD, FACC

We’re going back 15, 18 years for the SHAPE Society. We’re finally getting there. It’s a exciting time and again, I gave a shout out to this documentary online, the Widowmaker movie that tells a story of the Texas legislature and how they finally approved it so everybody go look that up. Well Doc Budoff tremendous gratitude, I honestly believe you probably have saved some lives with the comments you made today ’cause I think people will now have the ammunition to ask their primary care, their healthcare practitioners to get this scan and change their lifestyle. I mean change anyways but some people need a kick in the rear as we all know, a little scare factor that they’re walking around with plaque and if you’re lucky enough to be a zero, don’t go down the cheeseburger path. You know, as you said, stay a zero they had double zero club or I’ve now got three zeros every 10 years, so I’m not sure I’m gonna do it the fourth time But that includes a clearly CT angiogram recently, just for the fun of it, seven millimeters of plaque, pretty low.

Matthew Jay Budoff, MD, FACC, FAHA

That’s great.

Joel Kahn, MD, FACC

Yeah but anyways, I wish you a great day. Thank you for your time, Professor.

Matthew Jay Budoff, MD, FACC, FAHA

Thank you so much for having me, it’s been an honor.