Why You Need a Calcium Score to Know Your Real Heart Risk | Dr. Matthew Budoff

madman · 2026-02-12T22:36:41-0600

Heart disease risk isn’t just about cholesterol. In this episode of A Whole New Level, Dr. Matthew Budoff explains why coronary artery calcium (CAC) scoring may be the most important test most people aren’t getting—and why imaging your arteries directly can reveal risk that blood tests alone can miss.

Drawing on decades of research and data from the landmark MESA study, Dr. Budoff explains how calcium scoring predicts real cardiovascular events, how plaque actually forms and progresses, and why some people with high cholesterol never develop plaque—while others with “normal” labs do.
This episode focuses on how to measure your actual cardiovascular risk, not just estimate it.

In this episode, we cover:

Why CAC scoring is one of the strongest predictors of future heart events
Why cholesterol is critical—but only explains about half of heart disease risk
Why do some people with very high LDL have zero plaque, and others with normal labs have dangerous plaque
Why CAC is best understood as the “tip of the iceberg” of total plaque burden
When to escalate to CT angiography and advanced imaging
How plaque regression is possible—and what interventions actually drive it
The future of cardiac risk prediction: Lp(a), inflammation, and AI-driven plaque analysis

This conversation reframes heart risk around what’s actually happening inside your arteries—not just what shows up in bloodwork.

What Dr. Matthew Budoff & Mike Haney discuss:

[01:35] — Coronary calcium is the strongest predictor of heart events
[02:38] — What a high calcium score actually means for risk
[04:00] — Why rising calcium is not “healing."
[11:07] — The role of fat tissue and inflammation in plaque formation
[16:37] — Why do many people with high cholesterol have no plaque
[17:55] — Why imaging is the only way to truly know your risk
[37:07] — Calcium as the “tip of the iceberg” of total plaque burden
[~52:00] — Why CAC is the practical first step before advanced imaging
[~1:02:00] — When CT angiography adds critical information
[~1:14:00] — How plaque regression actually happens in the real world
[~1:22:00] — The next frontier: Lp(a) and inflammation as treatment targets

madman · 2026-02-12T22:37:24-0600

Thread 'Examining the Interplay of Coronary Calcium and Osteoporosis'

Dec 25, 2024

*Budoff urged clinicians to prioritize bone density screening for postmenopausal women and men over 65, using existing CT imaging when DEXA scans are unavailable. By recognizing the dual risk of cardiovascular disease and osteoporosis, Budoff suggested healthcare providers can implement earlier interventions to improve patient outcomes

Matthew J. Budoff, MD describes bridging the gap between atherosclerosis and osteoporosis through advanced Imaging techniques....

madman · 2026-02-12T22:39:27-0600

Post in thread 'Is it the TRAVERSE Trial or a Travesty?'

Jul 16, 2024

Dr. Budoff was one of the authors that contributed to this paper.

Testosterone Therapy and the Risk of Cardiovascular Disease - Excel Male Health Forum

Abstract The debate over the cardiovascular (CV) implications of testosterone therapy (TT) have resulted in diverging safety recommendations and clinical guidelines worldwide. This narrative review synthesizes and critically evaluates long-term studies examining the effects of TT within the...

www.excelmale.com

madman · 2026-02-12T22:40:24-0600

Post in thread 'Testosterone increases soft plaque buildup?'

Jun 30, 2022

Fernando Almaguer said:
I was watching a video by Dr. Brad Stanfield on Youtube and he mentioned the benefits over risk for someone who truly is testosterone deficient. Saying that these individuals do need HRT but the majority of men do not. Ok, then he said that studies show soft plaque increases that cannot be seen on a calcium score test. Just curious about anyone on the forums thoughts on soft plaque and the dangers/management of said plaque.