So I had another patient this past week. Had significant plaque but it was
calcified and stable. And my coaching consultation to them was that, "That's
stable. You just need to keep it there." "Nope, nope. I want it all out." And I said, "I
don't think that's practical but go for it." And as I continue to go through this
discussion with this patient, it made me realize I've not really given the
viewers of this channel any of the scientific evidence, the proof behind
that statement, I could tell that patient was feeling like, "You know, you're just
asking me to trust you." I-want-to-see-it-myself kind of person so that's
actually what we're going to do. We're going to look at one of the classic
studies which show the calcified plaque is much more stable.
Here's the journal. JACC - Journal of the American College of Cardiology. Is
calcified plaque really more stable? And the title on... again April 2004. The
first author was Honda. "Echolucent carotid plaques predict..." excuse me...
"Echolucent carotid plaques predict future coronary events in patients with
coronary artery disease." So well, one thing I would warn you, don't get... if you
look this article up, don't get too bogged down on that term "echolucent." I
was thinking "lucent" means light, so therefore it's the one on the right. I
got it backwards. If you'll notice, all of these
authors are Japanese, I think they've probably picked it. May
be unfortunate term, maybe not. Or I'm just... my wife likes to accuse me of not
speaking English very well anyway. But I work for Toyota for a decade. This was
not the first time that I went I wasted on this one over an hour on bad
translation and I don't know if the translation was bad on my side of the
Japanese side. I will say this: almost every Japanese I've met, their English
was far greater than my Japanese. So I'm not throwing stones. Now let's get back
to soft plaque versus hard plaque. You see two very different types of plaque in
the picture. The one on your left (I believe it's your left) low IBS plaque. This
one as you see, there's an outline a faint outline of plaque and there's a
couple of little shadows in there. On this one the right IBS flat major
calcification. And by the way, there are already plenty of studies which have
been done which show you don't have to measure this plot. Maybe it actually
measured and I'll show it to you in just a minute. Actually I'll show it to you
next. This was their objective measurement of
echogenicity or the amount of white or calcium
in this these plaque images. They had two very very different populations here and
this one the what they call the echolucent plaque or the soft plaque fit with
this dark one up here. These fit with the light ones. So what did that mean?
So it's crystal clear now maybe you're not gonna argue after seeing this that
there's a significant difference on the image.
IMT image of a soft plaque versus a hard plaque or calcified plaque. What did it
mean in terms of events? Well they followed these people for 30 months, 14
months on average, so we're talking a little over a year out of a hundred
about a hundred in each group. 112 people had soft plaque out of
that group, there were 29 events. Did you hear that? let's make sure we understand
that. 112 people followed for an average of 14 months with soft plaque, 29 events.
Yeah. 103 people with calcified plaques again followed for about an average of
14 months for events, so very very different set of risk. And now you
understand why we will constantly say, "Look, if you've got soft plaque, we need
to deal with that issue, you need to deal with that issue. We can't deal with it
alone. We can give you some... you know... we can give you stuff. We're gonna give you
statins. We can give you metformin. But the big stuff is about 30-pound weight
loss you need to do if you need to do that some of the other lifestyle types
of things. So let's look at this from a life table perspective. If the numbers
don't mean that much to you, this is a life table. It's called Kaplan-Meier.
This dotted line is the number event of events that happened among the 103
people with calcified plaque. This solid line dropped every time
somebody in the other population, 112, I think at another event. So as you can see,
soft plaque is very dangerous. If you made it this far, thank you very much for
your interest.
Looking forward to seeing you in Louisville, November 8th and 9th. Get all
your labs, your arterial scan, spend time one-on-one with me, and two days of
intense focus on how to prevent your heart attack, stroke, dementia, blindness,
kidney disease, erectile dysfunction. Looking forward to seeing you there.