The case: a 49-year-old man with ApoB treated to 75, Lp(a) under 10 and clean inflammatory markers, but a CAC of 149 with 97% in the LAD.
The group's answer was coronary CTA next, citing SCAPIS (n = 24,791) and SCOT-HEART, where low-attenuation plaque burden above 4% was linked to a fivefold increase in heart attack.
Members then compared plaque analysis platforms: Cleerly for plaque morphology, HeartFlow for virtual FFR, and Caristo for perivascular inflammation, not yet FDA-approved in the US. Photon-counting CT is coming but is currently limited to a few centers such as Mayo, MGH and NIH.
Key takeaways
- A concentrated LAD calcium score warrants CCTA even with good lipids.
- Choose the plaque analysis platform for the question you are asking.
From Buzz in the chat, the longevitydocs™ Sunday newsletter, June 28, 2026. Member discussion, not clinical guidance.
Originally published in The Longevity Medicine Intelligence newsletter.
