niCVRI formerly CVRF So Cal

CVRF So Cal is now niCVRI heart care through research, education, imaging and innovation. Beverly Hills, CA and New York, NY -based.

[niCVRI formerly CVRF So Cal @CVRF_SoCal]

https://t.co/neidBl9K4W

[niCVRI formerly CVRF So Cal @CVRF_SoCal]

@Drlipid @nationallipid @society_eas @ASPCardio @ESC_Journals @atherosociety @FamilyHeartFdn @fhpatienteurope @TheEndoSociety Congratulations

[niCVRI formerly CVRF So Cal @CVRF_SoCal]

@RonKarlsbergMD We are proud to be part of Confirm2 !

[niCVRI formerly CVRF So Cal @CVRF_SoCal]

@datsunian @UCLAHealth @uclaCVfellows @kinan_bachour @BiancaLavelle @repettigiuliana @kewatson @netta_doc @gcfmd @DOM_UCLA @dgsomucla @uclaimchiefs @IntMedAbel @arafiqmd1 @MichaelR21 @ShayV_MD Congratulations to these most amazing physicians. Our research foundation remains available to interact with all of you and help us move the needle and healthcare.

[niCVRI formerly CVRF So Cal @CVRF_SoCal]

@datsunian @UCLAHealth @uclaCVfellows @kinan_bachour @BiancaLavelle @repettigiuliana @kewatson @netta_doc @gcfmd @DOM_UCLA @dgsomucla @uclaimchiefs @IntMedAbel @arafiqmd1 @MichaelR21 @ShayV_MD Congratulations to these most amazing physicians. Our research foundation remains available to interact with all of you and help us move the needle and healthcare.

[niCVRI formerly CVRF So Cal @CVRF_SoCal]

@Heart_SCCT @ErsozluSara @Sot_Evangelou @Kfarooqi @AdyOrbach @rooshaparikh @SiddharthT22 @AnamWaheed05 @mirvatalasnag @purviparwani @iamritu The very best meeting to learn about how to diagnose and treat coronary artery disease! #plaquedirectedtherapy @RonBlankstein

[Ronald P. Karlsberg MD FACP FAHA FACC MSCCT | @RonKarlsbergMD]

Certainly, this is a fascinating development. However, when it comes to coronary CTA, spatial resolution remains a critical constraint.

For coronary CTA, we expect spatial resolution to be at least approximately 0.23 mm. Whole-body ultrasound tomography is likely closer to an effective spatial resolution of 1–3 mm, which substantially limits its applicability for detailed coronary artery imaging.

This is analogous to MRI: while highly valuable in many cardiovascular applications, it generally does not provide adequate spatial resolution to carefully define small, rapidly moving coronary arteries.

The technology is promising, but for coronary CTA specifically, spatial and temporal resolution remain the key barriers. #coronaryCTA

[Ronald P. Karlsberg MD FACP FAHA FACC MSCCT | @RonKarlsbergMD]

Keep in mind that the rate of plaque progression varies at different stages of the disease. The rate of progression before calcium is generally very slow, so any study must consider the baseline value. Even the keto study showed that baseline plaque volume was the major determinant of progression, not bloodwork, which is compatible with the multifactorial cause of coronary artery disease. The Nature study provides an excellent baseline for average untreated patients. Comparing progression without considering baseline plaque volume is fraught with errors. Finally, single-patient studies have little relevance due to the complex personal nature of coronary artery disease, and each patient would respond differently to diet and environmental changes. Publishing a single patient provides potential misleading data but is useful for generating hypotheses. It is unlikely that any diet will be causing significant changes with the very low plaque values frequently discussed in this thread.
#plaquediredtedtherapy

[Heart_SCCT @Heart_SCCT]

On this industry sponsored episode, host @PraveenRangana9 is joined by Dr. Brandie Williams & Dr. Nanette Evans who share how they brought advanced CCT imaging to a small-town community w/ a vision to improve access & reduce delays in diagnosis.

https://t.co/15xFdCo0g5

[niCVRI formerly CVRF So Cal @CVRF_SoCal]

@MarbanLab @rrogerslab @NIH @jgoldhaber Congratuations !

[Ronald P. Karlsberg MD FACP FAHA FACC MSCCT | @RonKarlsbergMD]

@ASPCardio @CardioNerds Yes — so true, and it has been true for decades. Finally, this topic has gone viral.

As the saying goes, this “overnight success” is now well into its second decade.

Weighing the Costs of a CT Scan’s Look Inside the Heart — The New York Times https://t.co/8dapba0yzs

[Ronald P. Karlsberg MD FACP FAHA FACC MSCCT | @RonKarlsbergMD]

I do not have the details regarding the Cleerly
@cleerlyhealth withdrawal. As one of the original independent investigators in this field, and among the earliest investigators with multiple publications in coronary plaque imaging, the explanation remains opaque to me. Someone may know the reason, but I do not. Our @niCVRI have performed numerous studies and the very first with sequential studies and we have validated the metric so I remain curious about this issue? Garbage in garbage out or what?

We did some of the original validations studies in our lab and I can attest to the accuracy with epeated demonstrated. Just for example see the example below of single patient reproducibility. Regarding plaque progression, you are reading the data correctly, with one important qualification: the rate of progression varies with the stage of disease.

Therefore, a slower progression rate — and a lower percentage of rapid progressors — would be expected in earlier-stage disease. Conversely, both the rate of progression and the percentage of rapid progressors would be expected to increase at later stages regardless of diet.

'The Nature CT study is arguably one of the earliest studies in the literature evaluating untreated disease, and it may serve as an important baseline for understanding how the disease begins.
The keto patients are likely being studied later in the course of disease, when baseline disease burden is already higher and the expected rate of progression would be faster. #plaquedirectedtherapy
@ethanjweiss @theproof

[niCVRI formerly CVRF So Cal @CVRF_SoCal]

We already have a form of targeted gene silencing in cardiovascular medicine with drugs like inclisiran, an siRNA therapy that interferes with hepatic production of PCSK9, thereby lowering LDL cholesterol. Importantly, this effect is durable but not permanent and does not alter DNA.

So while newer gene-silencing and gene-editing technologies are exciting, they still need to find their proper role in the therapeutic pyramid for coronary artery disease — alongside lifestyle intervention, statins, ezetimibe, PCSK9-directed therapy, and other emerging approaches. #plaquedirectedtherapy @MrLipids #cholesterol

The key question is not only whether we can silence a target, but where, when, and in whom that intervention adds the most clinical value.

[Ronald P. Karlsberg MD FACP FAHA FACC MSCCT | @RonKarlsbergMD]

https://t.co/C8GVFeuNHc

[niCVRI formerly CVRF So Cal @CVRF_SoCal]

@Briankelpstout @Tellit007 @RonKarlsbergMD No worries. The evidence base for statins is strong. If you develop any symptoms or have concerns, we can discuss alternative approaches. If you experience side effects, please let your physician know, as there are now excellent alternatives available. #plaquedirectedtherapy

[Ronald P. Karlsberg MD FACP FAHA FACC MSCCT | @RonKarlsbergMD]

Hi Dave — thank you for the kind words on our NATURE-CT publication.

You asked a fair question: how would Keto-CTA look if we only looked at the people with CAC ≤ 100, just like we did in NATURE-CT? Any comparison using the original KETO-CTA data is no longer valid. The paper was formally retracted by JACC Advances at the authors’ own request. The retraction notice is here:
https://t.co/pvKMrffHKB
Even setting the retraction aside, the plaque progression rates in the keto/LMHR group were much higher than the healthy rates we reported in NATURE-CT:

~18.9 mm³ median NCPV increase vs ~4.9 mm³ annualized in NATURE-CT.

This faster plaque progression is the adverse effect directly linked to the very high ApoB/LDL-C levels caused by the keto diet.

The public should be warned that this is likely a dangerous approach, especially for those who show rapid plaque progression as defined by OUR study.

Standard of care guidelines from the ACC and AHA recommend lowering ApoB and LDL-C to reduce heart disease risk. They advise against allowing sustained high levels like those seen in keto dieters. Caution is essential.

We can now define and treat rapid progressors even before calcium is present, as documented in our First-in-Human paper: https://t.co/dlu3XTpT3D

This is further supported by performing serial imaging—an approach we first described in 2013 in Atherosclerosis: https://t.co/p3pXNyAOVc

We subsequently confirmed this over 13 years using current technology in our 2022 paper on serial analysis of coronary artery disease progression by AI-assisted coronary CT angiography: https://t.co/4Iq0OFaXbe

We all agree that baseline plaque strongly predicts future plaque. But decades of research also show that sustained high ApoB/LDL-C drives atherosclerosis progression.

In this group who chose the keto diet often against "standard of evidence advise", close lipid monitoring and careful risk assessment are essential. Keto is likely harmful to arteries for most people, even if some tolerate it well.

Looking forward to continuing open discussion. Best

Ron Karlsberg MD FACP FAHA FACC MSCCT
(Lead author, NATURE-CT)@realDaveFeldman @DLBHATTMD @MichaelAlbertMD @CMichaelGibson @RonBlankstein @chamath @ethanjweiss

[niCVRI formerly CVRF So Cal @CVRF_SoCal]

We are proud to support this research. The ability to define who does—and does not—need early treatment is central to the future of prevention. It allows us to avoid treating millions of people who may never develop clinically significant disease, while directing early intervention toward those at highest risk. We are hopeful that more granular genetic risk assessment will help identify these high-risk subgroups even before imaging becomes necessary. @pnatarajanmd @RobertKennedyJr @chamath

[niCVRI formerly CVRF So Cal @CVRF_SoCal]

@RonKarlsbergMD We are pleased to support this amazing event that features the future talent of the field @Heart_SCCT

[Ronald P. Karlsberg MD FACP FAHA FACC MSCCT | @RonKarlsbergMD]

https://t.co/QB0iT02WWs

[niCVRI formerly CVRF So Cal @CVRF_SoCal]

@Radha_AI This video is a most extraordinary, splendid video! Enjoy the precise chronological narrative of Artificial Intelligence!