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the reason I think is that most are still stuck in the traditional yet redundant paradigm of screening (where these metrics apply)
but not for shared decision making where a major goal is "subtraction" of therapies
that's where the true value of CAC testing is via #PowerOfZero
Made this argument almost a decade ago in this editorial https://t.co/iQOUTvHiK9
Great points by @khurramn1 regarding the #PowerOfZero 👇
“…a standard we do not apply to any other risk marker.”
Have u ever wondered why ppl easily ask this rhetoric “cac zero is not zero risk” without ever thinking..
1.When was CAC zero ever zero risk?
2. Is there any thing zero risk?
3.Does normal CCTA means zero risk?
4. Does ldl<55 means zero risk?
5. Is PREVENT<3% Zero risk?
6. Is age<20 yr zero risk?
7. Would folks revert back to calling “CAC zero is zero risk” if another large cohort shows for example the risk with CAC zero is <5% in prevent 5-10% ( which btw is also wrong)
Remember nobody ever advocated “CAC zero is zero risk”
but has become a defensive mechanism for those who cant come to terms to the Power of zero 😊 …. a standard we do not apply to any other risk marker.
So I hope u got what’s wrong with this disingenuous message
Also don’t think this is official @JACCJournals position..but worried it will be perceived as such
On the other hand I have no issues @ShoaClarke making his case or interpreting the findings through his lens.
never concerned now about disagreement on interpretation of science….that is exactly what we should be doing
@MichaelJBlaha @rblument1 @Sadeer_AlKindi @RonBlankstein
All things CT!! Excellent Grand Rounds today by our very own cardiac imaging stalwart, Dr. Tayal on coronary CTs which turns “I feel fine” into a prevention clinic referral.🫀
#powerofzero #preventivecardiology
In geometry, there are parallel, intersecting or skew lines. The distance is the perpendicular distance from any point on one line to the other. The shortest distance btwn such lines is eventually zero. #PowerOfZero
Be honest: which do u prefer parallel or intersecting?
@khurramn1 on #powerofzero #acc26
Is it worth getting a #yessct
(2a class) beyond a CAC score(class 1) for Risk assessment?
SCAPIS trial:
PCE + CACS=0.764
PCE + CACS+CCTA=0.779
P value signif but if
CAC = Zero, Event Rate is 0.5% 🆚 If Normal CCTA with no Plaque: 0.45% https://t.co/cDFDkFCF8g
@MichaelJBlaha and I had shown this 16 yrs ago in our first #PowerOfZero paper
This issue is not relative risk but what’s the absolute difference with higher LDL if CAC zero
Minimal if any hardly that moves needle for risk management decisions
Even with zero coronary calcification, higher LDL-C still matters for cardiovascular risk. Read the result of Western Denmark Heart Registry in #EHJ.
https://t.co/788WZEghQz
#LDL #CardioRisk #cardiotwitter @ESC_Journals @escardio
CAC is useful in some cases but combination of aggressive hype, sloganeering, & over promotion (including by non docs) leads to many cases where it isn't helpful but *is* possibly harmful
Sadly, energy driving this is often for the wrong reasons - opening door to CCTA, plaque analysis & further testing-treatment cascades
“The main objective of this study was to determine the prevalence of significant CAD [coronary artery disease] (≥70% diameter stenosis) in patients with ZCS [zero calcium score] and prognostic value of the latter in a large cohort of patients with stable symptoms over a long-term follow-up.”
![ApoDudz's tweet photo. “The main objective of this study was to determine the prevalence of significant CAD [coronary artery disease] (≥70% diameter stenosis) in patients with ZCS [zero calcium score] and prognostic value of the latter in a large cohort of patients with stable symptoms over a long-term follow-up.”](https://pbs.twimg.com/media/G2TPKBPXEAA6H0a.jpg)
S 205. Barry L. Zaret young Investigator award 🏆 #ASNC2025 #CVNuc @MyASNC
4. Dr. Maria Alwan @almallahmo @MethodistHosp
🌟Does all of the patient with 0 CACS have the same prognosis?
👉No. Adding MFR there's is an incremental prognosis value in symptomatic pts with 0 CACS 🔥
In symptomatic adults with a coronary artery calcification (CAC) score of zero, elevated levels of low-density lipoprotein (LDL) cholesterol were associated with increased risks for noncalcified plaques and future coronary heart disease events, especially in those younger than 45 years. https://t.co/DxX7fLp2DQ
Career Phenotypes in Prev Cardiology!
A timely conversation for me! @ASPCardio
🫀Dr. Nassir talks clinical research
@khurramn1
✨know your why
✨seek answers ➡️ close knowledge gap & improve guidelines
✨build upstream & downstream support
✨a radical idea #powerofzero
When it comes to CAC, #keepitsimple
Know when to use #PowerofZero to identify very low risk groups and help focus rx on those who need it most.
Dr @khurramn1 helped summarize CAC testing from theory to practice
#ASPC2025 @ASPCardio @MichaelJBlaha @rblument1 @CiccaroneCenter
@khurramn1 speaking at the @ASPCardio Training Academy on CAC in #CVPrev
🫀 Risk factors foundational but is it precise?
🫀CAC can enhance CVD risk prediction
🫀 #powerofzero
@WilliamZoghbi @FaRodriguezMD @HMethodistCV
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