The holy grail
of prevention

For years, I was looking for a method where we could quantify the density of every pixel in a coronary angiogram. When Jim Min showed me Cleerly, I was amazed. I thought, This is what I've been looking for. And I started using it in my patients. And so far it's totally fulfilled the initial promise.

To me, Cleerly really is the holy grail of prevention.

I'm Dr. Arthur Agatston, preventive cardiologist, and I developed the first method of calcium scoring and later, the South Beach Diet.

Most of our practice today is all about healthy aging. We realized what's good for the heart, is good for the brain, good for preventing all chronic disease.

As a cardiologist, starting in about 1980, I learned early that what we thought caused heart disease, high cholesterol, didn't really differentiate people who were getting heart attacks from those who weren't. And there was no good way to lower cholesterol. Low fat diets didn't work.

Then came along the statin drugs and we realized for the first time we could lower cholesterol. But who do we lower it in? Cholesterol wasn't a good enough indicator of who we should be giving it to.

Then came this ultra fast CT technology where you could freeze the motion of the heart and identify and quantify coronary calcium. So that led to the original coronary calcium score. We knew that coronary calcium indicated the total amount of plaque in the coronary arteries. So I thought that would tell us whose cholesterol was getting in to the vessel wall and who needed to be treated with these new magic drugs. What we couldn't do is use it to follow patients from one year to the next. It wasn't accurate enough.

One thing I did learn from coronary calcium was older plaques, very dense, large calcifications indicated stable disease. Less dense, less calcified plaques — or younger plaques — meaning they had formed more recently and indicated high-risk disease. So for years, I've wanted somebody to go to the next technology level where they look at the density of every pixel. And so we can really differentiate the youngest, the most active plaques from the oldest, stablest.

Then along came Cleerly, which was my dream technology, and that identified really three classifications of plaques. The first is the low-density non-classified. The second is medium-density non-calcified. And, the third is calcified. And that tells us the risk stratification for today.

So what Cleerly has done is it allows me to know how all these risk factors are interacting in the individual patient so I can tailor my advice and my treatment to that individual patient. And I can also tell that patient that as we treat you, we're going to have the confidence that we have stopped the disease, that we're doing a good job. With just calcium scanning alone, I wasn't able to do that. So this has been another area where the Cleerly has been of very important clinical significance. How do I treat the patient in front of me.

In the big picture of everything we've learned in recent years, the diseases that lead to heart attack and other chronic disease, they start very, very early. Years and years before you're really at risk for heart attack or diabetes.

Early screening is so important for optimal treatment. The longer you wait, the faster you're progressing and the harder it is to stop.