New to the board - MI event w Cardiac Arrest. 3 years later…

You have certainly educated me, Greg, I must ask you...what is a Cleerly analysis?
I have had heart disease since my early 50s and never heard of this test. One stent for my right coronary artery which was blocked 100% in 2013. Now at 50% blocked but they won't restent until 70%.
I have been to a top rated cardiology department in NYC years ago and their recommendation was a LDL no higher than 50 (not 30s). And actually to the Mayo Clinic in Cleveland for cardiology and this testing never mentioned. Again it was recommended to get my LDL lower. Currently I take ezetimibe (Zetia) 10 mg. and rosuvastatin (Crestor) calcium 40 mg. It was recommended to take these medications in the evenings for better effectiveness.
Last lab work my LDL was at 50. My cardiologist was pleased.
I hope you get some good input here, Greg, and welcome to the forum!
All the best to you.

Current theory is blockage damages the heart but no one truly knows what causes a heart attack!

Hi Greg, soft plaque has a thin covering that is more likely to rupture and cause immediate blockage. Soft plaque isn't evident on the CAC CT that I have. I wonder if the Clearly is more advanced. Calcified plaque can intrude on the arterial space and causing gradual obstruction, or it can extrude from the arterial space and not cause obstruction. Oh, you can get rid of the soft plaque, they say that you cannot get rid of the calcified plaque, so you're in luck.
You might ask for APOb https://www.health.harvard.edu/heart-health/is-an-apob-test-a-better-way-to-check-your-cholesterol.
Repatha is a PCSK9 inhibitor that is very effective. It caused me too much digestive disturbance, so now I'm looking at the latest-- enlicitide .an oral PCSK9 inhibitor, that you might like better than the injections.
Best wishes.

Hi @aquarium5, and welcome to Connect. What an experience you’ve had, from the MI and cardiac arrest to now trying to better understand what may have been going on in your arteries at the time.

Your comment that 93% of the plaque identified by the Cleerly analysis was non-calcified caught my attention, especially after you had a calcium score of only 1 six months before your MI.

During my own cardiac workup several years ago, one of my cardiologists talked with me about why he was concerned about plaque in arteries that were less narrowed. He explained that the amount of calcification or narrowing doesn’t necessarily tell the whole story and talked about the role that blood flow and non-calcified plaque can play. That conversation has stayed with me. It also helped me better understand why treating my high lipids mattered, even when the amount of narrowing or calcification didn’t necessarily look alarming. This has been the foundation for me. Since, I have been learning that all cholesterol treatments are not the same, higher dosages are not necessarily better/more effective, etc.

What has your cardiologist told you about the significance of the non-calcified plaque found on your Cleerly analysis? Has it changed how your cardiologist views what happened three years ago or how your coronary disease will be followed going forward?

I hope others who have had Cleerly or similar coronary plaque analysis will join you and share what they learned from their results.

Cleerly anaylis is AI reading your CT angiogram. A CIMT will also tell you your soft and calcified plaque but finding a place to do it can be a challenge.
My understanding is: Soft plaque is the dangerous plaque because it is small plaque can infiltrate the artery walls, stick to the walls easier and break off easier. Calcified plaque is like concrete that is rarely dangerous because it doesn't break off causing clots. Inflammation, usually insulin resistance, will cause the 'fire' in our arteries that will cause the soft plaque to become dangerous. I am insulin resistance so am cutting foods that inflame my arteries like carbs, sugars, and processed foods. I mostly eat proteins and veggies. Already after about 4 months my HDL went up and Triglycerides went down which is great. Unfortuantely for 1/3 of people on low carb your LDL goes up - I am one of those. I agreed to a low dose of statin because my LDL particle count was so high with small LDL particles vs the safer large aka fluffy LDL particles.
this is what I have learned so far. Not every one agrees with this thinking but I do. Many still put all the emphasis on cholesterol. But I have met and watched youtube videos of thinking it is both cholesterol and inflammation causing heart disease. I leaned toward that - it all works together.