After ten years of near-perfect blood tests on a plant-based diet, I decided to go a step further. I got a coronary calcium score and a CT angiogram to see if heart disease might still be quietly developing. What I discovered challenged my assumptions about lifestyle, genetics, and prevention, revealing how even those of us who seem “healthy” can still show early signs of cardiovascular disease.
In this vulnerable and evidence-packed episode, I walk through my scan and blood test results and speak with cardiologists Dr. Thomas Dayspring and Dr. Dan Soffer about what they mean. If you have a family history of heart disease, elevated ApoB, or are wondering how much diet alone can do, this episode is essential listening.
What We Cover:
- My family history and motivation for heart testing
- What my CT angiogram and CAC scans show
- My ApoB and lifetime cholesterol burden
- My results: 61 mm³ of soft plaque, 1.8% PAV, CAC score of 4
- Interpretation with Dr. Dayspring and Dr. Soffer
- Impact of dietary tweaks (like coconut yoghurt) on my LDL-C
- Should I start medication? What would the options be?
- Transparent discussion on risk, prevention, and ego
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Links and Resources
- Normal LDL-Cholesterol Levels Are Associated With Subclinical Atherosclerosis in the Absence of Risk Factors
- Age- and Sex-Specific Nomographic CT Quantitative Plaque Data From a Large International Cohort
- Plaque Begets Plaque, ApoB Does Not: Longitudinal Data From the KETO-CTA Trial
- The Proof EP 371: Keto Diet, High Cholesterol & Heart Health | Breaking Down the Keto Cholesterol Study
- Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA)
- Impact of Lipids on Cardiovascular Health: JACC Health Promotion Series
- Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association
- Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial
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More about Dr Dan Soffer
Dr Soffer is a full-time clinician and educator Associate Professor of Clinical Medicine in the Associated Faculty of the Perelman School of Medicine at the University of Pennsylvania in the Department of Internal Medicine and Division of Translational Medicine and Human Genetics. He is the Director of Education for Preventive Cardiology and Clinical Lipidology at the University of Pennsylvania and co-Director of the Preventive Cardiology Fellowship program at Pennsylvania Hospital and co-director of the SOM Foundations of Culinary Medicine course.
He is a clinical lipid specialist whose focus is Preventive Cardiovascular Medicine. He is a Diplomate of the American Board of Internal Medicine and American Board of Clinical Lipidology, and Fellow of the National Lipid Association (NLA) and American College of Physicians (ACP) and he is a Member of the Academy of Master Clinicians at Penn Medicine.
Dr Soffer’s educational focus is on the impact of atherosclerosis on individuals, the community, and society, and the role of lipids and lipoproteins in this process, along with a special interest in inherited disorders of lipids and lipoproteins. His approach to education is to translate complex science into legible clear language and images that do not require advanced education to understand.
He is involved in multiple education activities at the University of Pennsylvania, the National Lipid Association (NLA), the Philadelphia Lipid and Atherosclerosis Club (PLAC)/Philadelphia Cardiovascular Institute, and commercial continuing medical education as well.
He is involved with multiple NLA activities including leadership, administration, education, meeting planning, and editing. He was President of the National Lipid Association (2023/2024) and President (2018/2019) of the Northeast Chapter of the NLA (NELA). He was co-editor of the NLA journal LipidSpin (2015-2020) and is an Associate Editor of the Journal of Clinical Lipidology as well as co-Director and lecturer for the Foundations of Lipidology course for the NLA. He is also the co-director of the Philadelphia Lipid and Atherosclerosis Club (PLAC). In addition to clinical medicine, teaching, writing, and editing, he also participates as an investigator in ongoing clinical research with lipid-modifying pharmacotherapies and population health initiatives.
He earned BA and MD from the University of Pennsylvania and Internal Medicine residency was completed at the Hospital of the University of Pennsylvania, and has practiced his entire career (since 1997) at Penn.
Dan has been married to Gwen since 1990 and they have three grown children together, Maddie, Ben, and Joe, and one Cavapoo named Petunia.
More about Dr Thomas Dayspring
Thomas Dayspring, who resides in the Richmond, VA area is a Fellow of both the American College of Physicians and the National Lipid Association and is certified in internal medicine, and clinical lipidology. After practicing in New Jersey for 37 years, in 2012 he moved to Virginia and served as an educational director for a nonprofit cardiovascular foundation and later as a Chief Academic Advisor for two major CV laboratories until mid-2019. Currently he is a virtual cardiovascular educational research assistant & clinical lipidologist at a prestigious national practice. Career-wise he has given over 4000 domestic (all 50 states) and international lectures, including over 600 CME programs on atherothrombosis, lipids/lipoproteins (and their treatment), vascular biology, biomarker testing, and women’s cardiovascular issues. He has authored several manuscripts and lipid textbook chapters and performed several podcasts. Until 2019 he was an Associate Editor of the Journal of Clinical Lipidology. He was the recipient of the 2011 National Lipid Association’s Presidents Award for services to clinical lipidology. He has over 25K followers on his educational Twitter feed (@Drlipid). He is a Social Media Ambassador for the European Atherosclerosis Society.
