being cleerly blocked

for those that question the efficacy of pcsk9 inhibitors after only ONE DAY OF REPATHA-
ldl-c one day of pcsk9- 25 down 44% from 12/14
cholesterol one day of pcsk9- 73 down 28% from 12/14
triglycerides one day of pcsk9- 59 down 14% from 12/14

Good stuff - keep us advised, please!

Congrats on 0 LDNCP, but what about the other non-calcified plaque?
Based on your information, it seems you have been on a statin which appears to have helped with your low density results. Have you tried PCSK9i?

BTW my last CAC score was 1883 (down from 1923 the year before) after 21 years on statin. So, I am hoping that CLEERLY will show similar LDNCP results. Still fighting to get it approved- same story here in NC where cardiologists "refuse" to prescribe. What's with these SOC doctors who refuse patients requests?

Finally got RX from telehealth doctor, but trying to find imaging center that will cooperate. Closest CLEERLY search found one in Charlotte and one in Richmond, 160 + miles from me.

Using Biomarkers is a fools errand. Getting a quantitative analysis of the actual plaque and it's "vulnerability" is the real deal. Thanks for sharing your journey.

laketahoebob,

Yours is the only report I have ever seen of someone who had a CAC score go down ... it was only 2.1%, but still the FIRST. Was this scoring done at the same facility with the same device? If so, this is interesting for sure.

I am not convinced that the CAC score actually went down. There is always a standard deviation or error band on any measurement. You are correct that the scores were performed in different facilities and different scanners.

However, my conclusion is that the dramatic increase from a my 35 CAC score in 2001 to the 1907 score in 2019 (performed on different scanners) was real. The "decrease" in my 2020 CAC score was hopefully caused by the lifestyle (I lost 25% of my body weight), dietary and medication changes over the 1-1/2 year period between CAC scores.

I also use CIMT to track plaque progression in my carotid arteries. During the 2019-2020 period, my CIMT did not change significantly. The analysis showed some plaque progression in the carotid arteries but "all" was deemed to be calcified and stable. This is somewhat contradictory of the CAC score stabilization.

There are a number of "real" reductions in plaque volume measured with Q-CCTA (Quantitative CCTA- CLEERLY), presumably caused by interventions between the Q-CCTAs. In most of these cases the calcified plaque increased as the dangerous non-calcified plaque decreased.

I am endeavoring to have my 2020 CCTA analyzed by CLEERLY and then compared to a new CLEERLY Q-CCTA later this year to see what has happened to my plaque during the 2-1/2 year lifestyle, medication and dietary interventions.

Thanks - yep, I understand the CLEERY process. Obviously, their scans and process will not directly align with CAC scores, especially when the other CAC scores were obtained with different equipment.

An increase from 35 to 1907 over 20 years is not unexpected - but, even that is in excess of what some say is expected - on the order of 15% per year which would equal around 575 or so. To get to 1907 the year over year increase would be around 25%/year.

I have read hundreds of threads about CAC scores - none have ever gone down, but most of them were comparing scores around 3-5 years apart, and most used the same facilities for the scoring.

Many of those reporting made significant lifestyle changes as you have - but, again, none reported lesser scores. My sense is that the lifestyle changes you made have slowed the increase, but other factors are likely present.

Frankly, even if your CAC score stayed the same over a period of 18 months it would highly unusual.

Please keep reporting on your findings.

One significant change from 2001 was the initiation of Atorvastatin in 2001. The approximate annual increase was about 52%/yr in the first 10 years, 40%/yr in the next 7 years, and -1.3%/yr in the last 1.8 years. Guessing that much of the first 10+ years might have been catch up to stabilize the prior soft plaque built up over many years.

The thing is- all of this information is really not what is at the core of my coronary status or prognosis. CLEERLY seems to be the tool that can quantitatively show my disease status and help me understand what has been accomplished so far, and what might need to be done going forward. It's just hard to find cardiologists and/or imaging sources to perform the CLEERLY analysis. Also, want to have my 2020 CCTA analyzed, but same problem, no one has agreed to analyze.

LTB,

Agree - amount of calcified plaque would increase with statins. One could surmise that once the available plaque is reduced, there could be a flattening of the curve.

My understanding is that CLEERLY requires a different CT data set, so this forces one to their approved facilities/organizations ... this was the dead end I faced.

That might be possible, but it would be a surprise. My data set was taken on a 256 slice scanner and was submitted to HeartFlow about a month after the scan for further analysis with no problem.

No CLEERLY imaging center has said anything about incompatibility, only that they would not submit any data not created by their own center. Likely just want to drum up their own business. However, I will try to follow up. Thanks.

It sounds like there's been a positive development in your situation with Humana! It's great that the practice manager reached out to you and seemed sympathetic to your concerns. Cancelling the appointment with Hearthealth in hopes of getting the referral for free seems like a strategic move given the circumstances.

It seems like things are looking up, and hopefully, this resolution will bring you closer to resolving the issue you've been facing. Keep up the proactive approach, and hopefully,
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