My Cardiologist Breaks Down My Heart Tests: What Your Cholesterol, Calcium Score & Labs Really Tell You with Dr. Michael Twyman

Dhru Purohit (0:00)

Hi everyone, Dhru Purohit here. So a lot of you who have followed me for a long time know that heart disease is something that I care a lot about. Part of this is because cardiovascular disease remains the number one killer for both men and women. A lot of people don't know that, but yes, it's the biggest killer for men and women, but it's also, like many of you, it's personal for me. Heart disease runs in my family. I've had multiple grandparents pass away earlier than I feel is their genetic potential from heart disease. And interestingly, I learned a few years ago that my dad, I've always known that he had high LDL, high cholesterol, in the classic sort of medical sense. And it was like when he was 35 years old and my family moved to El Paso, Texas for a few years, because he got promoted, that a doctor there, when he was around like 30, 35 years old, he recommended that he go on a statin at the age of 35 to manage his high cholesterol. I don't even know if they were looking at LDL then, I'm sure they were. But yeah, he's been on a statin since he was 35 years old, now he's 75, that's crazy. So as I got older and was gearing up to turn 40 and paying attention to more of my own numbers a few years ago, I wanted to understand what actually matters when it comes to cardiovascular health and what is my true cardiovascular risk because this space has exploded. There's so many more things beyond just looking at cholesterol, which obviously we all know doesn't tell the full story and even going a little bit beyond LDL, which of course that we've learned on this podcast is important and there's nuances that are there. So the question for me was, what should I be paying attention to beyond a standard cholesterol panel? And how can I look at that cholesterol panel LDL? And now we're all paying attention to Able B. How can I look at that in context? And most importantly, how much plaque do I actually have in my arteries? Because, you know, these are all proxies, cholesterol panels, all proxies. They're decent proxies, but how much plaque you actually have in your arteries. So I went on a search that search led me to Dr. Michael Twyman. Now, Michael Twyman, some of you have heard him on this podcast before, but those of you that are not familiar, he's a board certified cardiologist. He's a former Navy medical physician and the founder of Apollo Cardiology in St. Louis. And over the years, he's become my personal cardiologist and somebody that I've sent multiple members of my own family to. Now, again, I mentioned you might recognize Michael because he's been on the podcast a few times. As recently as just a couple of weeks ago, we had him on to talk about lipo protein little a, why it's in the news, why we should be paying attention to it. But the nuances that are there, if you missed that episode, still worth paying attention to. And after that conversation, I thought it was a perfect time to bring back one of my favorite episodes we've ever done together. So I flew a couple of years ago to St. Louis to see Dr. Twyman. And I basically said, give me your program, give me the most comprehensive look at my cardiovascular health that we can possibly get, which was easy, because that's exactly what he takes every patient through. So in this episode, we actually pull all my labs and go through them together. We took a look at my advanced Boston Heart Panel, which is one of the most comprehensive heart blood panels that you could possibly do, including my own APOB numbers, my LDL particle numbers, my inflammation, my insulin resistance, my fatty acids, and even markers that can help you determine whether you're producing too much cholesterol or reabsorbing too much cholesterol, which is part of the equation when it comes to heart health. We also look at my genetics, which by the way, this was one of the most fascinating tests that's out there. I had never met any other practitioner that was running this test, and Dr. Twyman runs us through the results of this test, and precisely what these results show us about what medications, if I decide to go down that path, what medications might or might not make sense for me when it comes to my heart health. And most interestingly, we pull my CLEALY CCTA. Now, a CCTA, or a coronary CT angiogram, lets doctors actually visualize the coronary arteries, and then clearly, which is a software system, uses AI to analyze those images that you get from a CCTA and qualify and quantify the amount of plaque that's there, including both calcified plaque, which is the hard plaque, and the soft plaque that a standard coronary calcium score or CAC score can miss. And soft plaque, by the way, can be one of the most dangerous forms of plaque, especially as we age. And the big reveal is, I give him permission to show you how much plaque was actually in my heart. I was nervous when I did this test originally three years ago. I was nervous about what it would show because I had been on a ton of different diets. And right before seeing Dr. Michael Twyman, I was trying a modified version of a high fat, I won't even say ketogenic, but keto inspired diet. And I remember one time I went into my doctor at the time, this is maybe like 7, 8 years ago, and I got for the first time my APO-B done. And it came back like through the roof. It was like 300 So I was so scared because I thought, man, being on this high saturated fat diet for a while, keto inspired, putting coconut oil and MCT oil in my coffee, which was a big trend that everybody was doing back in the day. Did I damage my heart? Did I put all this plaque in my heart? And I'm only freaking 40 years old, not even at the time that I was doing this test. And I was worried, what was it going to show? And Dr. Twyman kind of walks you through that. Now, here's the thing. I love being transparent about my lab results because my goal in this podcast isn't to tell you what to do. It's to show you the questions that I'm asking for my own health or sometimes my parents' health or my family's health and how I'm navigating things even when they don't look perfect. And hopefully today's podcast will give you better questions to take back to your own medical team. And by the way, if you have the resources and you're looking for this level of cardiovascular testing, which actually isn't like something crazy expensive, it's pretty standard when it comes to, if you've ever worked with a functional or integrative doctor, I've had an incredible experience with Dr. Twyman and his team at Apollo Cardiology. I have no affiliation with this clinic. I'm simply a fan of great doctors. And when I find one, I love telling people and I love letting them know. In fact, I think I hear from Michael every so often. Most recently, I heard of a listener who flew all the way from Australia to go see him because he and his wife had a history of cardiovascular disease in their family, and they wanted some answers. So yeah, if you have the resources, check out Apollo Cardiology, and if you don't have the resources for this testing, that's exactly why I'm making conversations available like this for free. So let's jump in to my conversation with Dr. Michael Twyman, which was originally run three years ago, but is so relevant, especially if you missed the episode. We're going to tackle some of the biggest myths about heart health, and we're going to set up and do a deep dive into my own cardiovascular labs and how much plaque I have in my own heart.