Q&A: coronary calcium scoring; insurance coverage for Wegovy/Mounjaro; berberine & weight loss; & blood pressure variability

A March mashup of your questions! 💥

ICYMI 👉

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The first question (on coronary calcium scores) is free for all subscribers. Questions 2-4 (on insurance coverage for Wegovy/Mounjaro; berberine for weight loss; & blood pressure variability) are for paid subscribers only. If you would like a paid subscription but it’s not in your budget, please message me directly.

Click here to submit your questions (about anything) for future Q&A posts!

Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.

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QUESTION #1: CORONARY CALCIUM SCORES

I've seen more and more people talking about getting calcium scores (CAC) lately. When do you typically recommend those? I've seen doctors say everyone should "know their baseline" and get one regardless of risk factors but is that true?

-Mia

Hi Mia,

A coronary calcium score CT scan (or CAC) can help determine the presence or absence of cholesterol plaque in the coronary arteries, the blood vessels that supply blood to the heart muscle. The presence of cholesterol plaque in these arteries is called coronary artery disease (CAD). Risk factors for the development of CAD include age, genetic factors, high blood pressure, high cholesterol levels, cigarette smoking, diabetes, obesity, physical inactivity, and a high-stress lifestyle.

The accumulation of cholesterol plaque can, over time, impair blood flow to the heart muscle. This can result in a heart attack, where part of the heart muscle sustains permanent damage from the absence of adequate blood flow. It can also cause chest pain or “angina,” which is pain as a result of transiently insufficient blood flow to the heart muscle. CAD is a leading cause of death globally.

A CAC is essentially a CT scan or sophisticated photograph of the coronary arteries. It can help risk stratify patients—i.e., help identify who is at increased risk for heart attack and cardiovascular disease—to help direct treatment. Patients who are at low risk for CAD—that is, patients without hypertension, diabetes, cigarette smoking or other cardiac risk factors—usually don’t need a CAC test and rather should focus on preventing disease by maintaining a healthy lifestyle and having regular checkups of their cholesterol, blood pressure, etc. People at high risk for CAD should already be treated aggressively for presumed or existing heart disease with, for example, lifestyle changes and medications. In short, it’s patients at “intermediate risk”—for example, patients for whom we’re on the fence about starting a statin medication—who should be screened with a CAC.

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QUESTION #2: INSURANCE HEADACHES FOR WEGOVY/MOUNJARO

I have obesity - I have struggled with my weight my entire adult life and nothing works. I don’t care what any doctor says but diet and exercise aren’t enough for people like me. I have tried EVERY diet. I exercise 4days a week but my insurance won’t cover Wegovy or Mounjaro. What gives?

-Kathy

Dear Kathy,