The Screening Cascade: How a Calcium Scan Becomes a Stent You Never Needed
It usually starts with good intentions. A patient with no symptoms — or stable, predictable symptoms — gets a coronary artery calcium (CAC) scan “just to know.” The score comes back elevated. Nobody sleeps well after a four-digit calcium score. What happens next follows a script I have watched for twenty-five years. The elevated score […]
Excess Niacin, NAD Boosters, and Heart Disease Risk: What New Research Shows
Niacin — vitamin B3 — has a long history in cardiology. For decades we prescribed it to raise HDL and lower LDL. The numbers moved. Then the outcome trials came back: no fewer heart attacks, no fewer deaths. Niacin quietly fell out of favor, and most of us moved on without asking the obvious question […]
ApoB vs LDL Cholesterol: The Number Your Doctor Probably Isn’t Ordering
Most people have been trained to watch one number. Their LDL cholesterol goes up, and they worry. It goes down, and they relax. I think that’s the wrong number to watch. Atherosclerosis isn’t caused by cholesterol floating loose in the blood. It’s caused by particles carrying cholesterol getting stuck in the artery wall. Every one […]
The Sleep Apnea Connection Nobody Checks Before Treating AFib
I spent years in the electrophysiology lab ablating atrial fibrillation. Over time I noticed something that changed how I approach the disease: a subset of patients came back. Same arrhythmia, same symptoms, sometimes within a year. When I looked at what those patients had in common, the answer was often sitting in plain sight. They […]
Stents During a Heart Attack Save Lives. Elective Stents Are a Different Question.
This is the single most important distinction in modern cardiology, and almost no patient has it explained to them. During a heart attack, an artery is blocked, heart muscle is dying, and every minute counts. Opening that artery with a stent saves lives. This is one of medicine’s genuine triumphs, and nothing below applies to […]
Insulin Resistance and Your Heart: The Root Cause Hiding in Plain Sight
When people think about heart disease, they think about cholesterol. When I look at a patient’s labs, one of the first things I look for is something most standard checkups barely mention: insulin resistance. It’s one of the most powerful — and most overlooked — drivers of heart disease, and it’s usually at work for […]
Why I Think Coronary Calcium Scans Are a Bad Idea
The coronary artery calcium (CAC) scan — usually reported as a “calcium score” — is one of the most popular heart tests around, and I’m going to take an unpopular position: in my experience, for most people, a calcium scan does more harm than good. After more than two decades as a cardiologist and electrophysiologist, […]
Do You Really Need a Statin? A Cardiologist’s Root-Cause View of Cholesterol
Few questions come up more often in my consultations than this one: “Do I actually need to be on a statin?” It’s a fair question, and the honest answer is more nuanced than either side of the internet will tell you. As a cardiologist and board-certified cardiac electrophysiologist, I don’t belong to the “statins are […]
The Truth About Fish Oil and Your Heart
By Andrew Rudin, MD Few supplements generate more confusion than fish oil. For years it was recommended almost universally for heart health; more recently, headlines have warned that it might do nothing — or even cause a heart-rhythm problem. As an electrophysiologist who cares about getting this right, let me offer a more honest, more […]
Inflammation and Your Heart: A Root-Cause View
By Andrew Rudin, MD For decades, heart disease was explained almost entirely in terms of cholesterol clogging pipes. That story isn’t wrong, but it’s incomplete — and the missing piece is inflammation. As a cardiologist who works from the root cause outward, I’ve come to see chronic, low-grade inflammation as one of the central drivers […]