#292 - Cardiac Imaging Explained: Why You Need a Calcium Score to Know Your Real Heart Risk | Dr. Matthew Budoff & Mike Haney
LEVELS – A Whole New LevelShow Notes
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.
Sign Up to Get Your Free Ultimate Guide to Glucose: https://levels.link/wnl
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 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
Levels helps you see how food affects your health, empowering you with the tools needed to achieve health goals and improve healthspan. Levels Members gain access to the Levels app and continuous glucose monitors (CGMs), providing real-time feedback on how diet and lifestyle choices impact your metabolic health.
Look for new shows every month on A Whole New Level, where we have in-depth conversations with thought leaders about metabolic health.
🔗 Helpful links Watch the conversation: https://youtu.be/os-RNhIS3jQ Find us on YouTube: https://youtube.com/levelshealth?sub_confirmation=1
📲 Connect Connect with Dr. Matthew Budoff on X: https://x.com/BudoffMd https://www.calciumscan.com/
More from LEVELS – A Whole New Level
Heart disease is the leading cause of death, but it’s also one of the most preventable. Decades of research have established a strong causal role for LDL and other ApoB-containing particles in atherosclerosis, and we now have multiple proven ways to lower them. The harder question is how to turn that evidence into a decision for an individual person. Mike Haney talks with Johns Hopkins cardiologist Dr. Seth Martin, a co-author of the new 2026 dyslipidemia guidelines, about what the latest evidence says we should actually measure and act on. The throughline is pragmatic: lower exposure to atherogenic particles earlier and for longer, use additional tests when they can change a decision, and distinguish interesting new measurements from ones that have actually been shown to improve outcomes.
Most of NextLevel starts with a measurement problem: we can see more biology than ever, but we still have to figure out what to do with it. Bioelectronic medicine flips that sequence. We already know how to send electrical signals into the nervous system to change biology, including an FDA-approved vagus nerve treatment for rheumatoid arthritis, even though we still can’t map or read most of the individual nerve fibers carrying those signals.
Most health decisions happen before the science is settled. A study points one way, another points somewhere else, experts disagree about what matters, and even strong population-level evidence may not tell you what will happen to you.
Most medical imaging happens after a symptom, injury, or abnormal test gives a clinician a reason to look. But what changes if imaging becomes a more routine measurement, creating a record of the body before something goes wrong? In this episode of Next Level, Mike Haney talks with Dr. Daniel Durand, chief medical officer at Prenuvo, about whole-body MRI as a test case for a broader shift from episodic medicine toward longitudinal health data. Whole-body MRI is controversial, and Durand is clearly an advocate. The conversation takes the skepticism seriously, then asks a larger question: as measurement gets cheaper, more frequent, and increasingly visible to patients themselves, how should medicine decide what is worth knowing?
Alcohol has spent the last 40 years bouncing between two health narratives: a little is good for your heart, or any amount is dangerous. The science doesn’t really support either slogan. Dr. Tim Naimi has spent decades studying the health effects of alcohol and, just as importantly, why the research is so difficult to interpret. His read of the evidence is less dramatic but more useful: there’s no good reason to start drinking for your health, very low intake may carry little measurable added risk, and risk rises as consumption does. Understanding why earlier studies made moderate drinking look protective helps explain a lot of the whiplashing headlines.