One further point is that about half of patients who take a Calcium CT scan will have a zero score, so it’s not particularly uncommon. It’s better news than receiving a high score, but as has been pointed out above, it’s by no means a foolproof predictor of future CHD events. See the following link for more info:

http://www.inspire.com/groups/womenheart/discussion/cac-scanning-will-miss-soft-plaques/

I am a big fan of Jimmy Moore’s overall crusade against useless carbs, and his interesting podcasts. I’m just not sure the jury is quite in on the fat question, which is extremely complicated. I look forward to seeing your movie.

The theory as it’s been promoted and followed is bunk. That theory says high cholesterol – and especially high LDL — causes heart disease. That’s why there’s been so much emphasis on beating down cholesterol, getting it below 200 and getting LDL below 100.

Jimmy defies the Lipid Hypothesis because his LDL is very high by the current definition, but almost none of it is small and dense and he has no plaque buildup.

Thanks, Beth

The MONICA spreadsheets only included data for up to age 75. They were tracking what they’d call premature deaths.

Optimal below 1000
Above optimal 1000 to 1299
Borderline 1300 to 1599
High 1600 to 2000
Very high above 2000

With respect to Moore’s LDL-P of 1453 based on an NMR, this is not a “low risk” particle number. NMR’s own guidelines describe the following risk stratification for LDL particle counts:

Optimal 2000

Second, Moore’s LDL measured in a standard lipid panel (not direct LDL, but rather calculated LDL) as Acanthusbk notes, calculates or estimates LDL by using a formula known as the “Friedwald formula” (so named for its originator). This formula is known to be wildly inaccurate at times, but is generally employed in large population studies because it is quick and cheap and easy to perform. The formula of Freidwald for determining LDL is total cholesterol minus high-density lipoprotein (HDL) cholesterol minus very-low-density lipoprotein (VLDL) cholesterol (estimated as triglyceride divided by 5)– or stated differently: LDL= TC – HDL -(TG/5).

Acanthusbk states that Moore’s LDL is ipso facto inaccurate because it was derived by using Friedwald’s formula. This too is a very large overstatement. Friedwald’s formula has been demonstrated repeatedly to be accurate in fasting samples of individuals where Triglycerides were not elevated. (See, e.g., http://www.clinchem.org/cgi/content/abstract/36/1/15). Admittedly, it’s better to assay LDL concentrations directly rather than using a calculated formula such as Freidwald. But Moore’s reported TG’s were low and not elevated at all. The distortions which occur with the Friedwald formula occur not when LDL is reported to be high, but rather when TG’s (or rather VLDL estimated as a surrogate of TG’s) is elevated.

Third, the use of an NMR LDL-P particle count “divided by 10″ (or simply dropping the last digit) is a method which only has very crude observational support. It is a method used by Dr. Davis frequently to estimate LDL-C but it is by no means directly correlated by direct assay to actual LDL-C. It is merely a way to estimate LDL-C rather than from Freidwald’s formula where no direct assay has been performed.

Acanthusbk is right about one thing: A “0″ CAC score appears to be correlated with a lower risk of an adverse cardiovascular event in asymptomatic individuals with low traditional Framingham risk factors. In such individuals, CAC scores have a 95-99% predictive value. But in individuals whose family history indicates higher risk, combined with elevated LDL levels, there is much research which indicates a moderately higher risk and not as much predictive certainty for a “0″ CAC score.

The point is that Jimmy may or may not be doing ok, even with his “0″ CAC score. I hope he is, because I genuinely like the guy, and he’s brought tremendous energy to health issues. But I stand by my original comments above, despite my personal hope that Jimmy Moore’s risk is indeed low, as Acanthusbk believes it may be.

Here’s what Dr. Davis wrote about soft plaque:

“There is indeed a small percentage of people, probably around 5% of all people who have CT heart scans, who have scores of zero yet have a modest quantity of pure “soft” plaque. These people may be misled by having a zero score. How can these people benefit from better information?

Several ways. First, people like this tend to have very high LDL cholesterols, generally 180 mg/dl or greater. They may have a very worrisome family history, e.g., father with heart attack in his 30s or 40s. This small proportion of people with zero heart scan scores may benefit from [additional testing]….”

Dr. Davis has also said that soft plaque does not convert to hard plaque.

By the way, Jimmy’s LDL of 228 isn’t accurate, instead, divide his LDL particle count by 10, so 1453/10 = 145 LDL.

The LDL value from a standard cholesterol measurement (like Jimmy’s LDL values of 228 & 250) is estimated based on a formula known as the “Friedewald equation” rather than being directly measured, and can be wildly wrong.

See Dr. Davis’ heatscanblog for his many comments about the Friedewald equation. He has called it “a dinosaur that should be retired”.

Looks like Jimmy is doing ok after all.

It is true that the presence of coronary calcium, i.e., calcified plaque lesions, is believed to roughly correlate to approximately 20% of one’s total plaque burden. In other words, if you have a positive Agatston calcium score, that means you also have soft plaques and that the calcium equates to approximately 20% (so you can extrapolate the other 80% based on the severity of the calcified plaque burden).

The opposite though isn’t true. A score of “zero” calcified plaque does not mean Jimmy doesn’t have soft, vulnerable uncalcified plaques, the same type that ruptured and caused the death of Tim Russert and so many thousands of others.

The point of getting a heart scan for coronary calcium is that it clearly identifies those who have coronary calcium, and thus atherosclerosis, and depending on the score, enables one to address the level of aggressiveness with which one will address the issue (frankly, any calcified plaque demonstrates the existence of atherosclerotic disease, and should, IMHO be addressed aggressively).

But getting a score of “zero” doesn’t rule out disease, and given Jimmy’s past history of obesity, his family history of 1st degree relatives dying from heart disease prematurely, it would be foolish of him to take solace in the fact that he had no mature, calcified lesions when he could have diffuse, soft plaques all over. I sure hope he doesn’t because I enjoy listenening to his podcasts and reading his website, but he’s living in a fool’s paradise if he is taking solace solely in his coronary calcium scoring and low concentrations of small dense LDL (as a percentage of total LDL) given his known risk factors.

Interesting. And I’m with you; I hope Jimmy is around for a very long time.

That might flatten the distribution a bit, but I don’t think it would show a meaningful correlation. There are dramatic differences in the death rates in the U.S., Switzerland, France and Britain, but I doubt we can attribute those differences to quality of health care. The U.S. system, despite its many critics, still ranks #1 in the world for “responsiveness,” a.k.a delivering medical treatment in a timely manner, and yet our heart-disease death rate is three times the rate in France.

I don’t know what Jimmy eats, but if he can eat low-carb frankenfoods and still score a zero on a calcium test, it says a lot about how wrong the Lipid Hypothesis really is.

BUNK!

My sister LOVES loves loves LOVES your movie; she keeps lending it out and someday I’m next in line. Scott Miller is creator of Nukem Dukem FYI (and one of the directors at the Immortality Institute). Richard of course ROCKS the Paleo universe and is evolving in ancestral ways…. *wink* Keep up the fantastic work! I’m referring all my peeps to your website which is so full of *haa* BUNK.

Tell your sister I appreciate the P.R.