See the plaque, not just the risk

A coronary CT angiogram is one of the most valuable tests we have for heart disease. In one scan it shows soft plaque, hard calcified plaque and stenosis, which is narrowing of the arteries. A calcium score only sees the hard plaque, so it can miss disease that's still early and soft. A lot of people get excited about their ApoB, and I understand why. It's an important marker and worth tracking. But a blood test tells you about risk. It doesn't show what's actually happening in the arteries of the heart. Two people with the same ApoB can have very different scans, and the scan is what shows whether disease is already there and how much. I think this is how cardiovascular health should be approached, starting with the risk markers and then actually looking when it makes sense. Right now cost and insurance coverage keep it out of reach for a lot of people without symptoms. Over time I hope that changes and it becomes easier for the average person to get.