Full methodology and references at plaqueyears.com! More to come soon. Mobile app in progress. @CardioMDPhD @DrOstfeld @ASPCardio @escardio @NEJM @JACCJournals #cvPrev #ESCCongress

This is NOT a validated clinical risk score. It is intended for educational and clinical discussion purposes only. Show it to your patients as a visual aid, use it to teach your trainees. It should not replace individualized risk assessment or clinical judgment.

You can also model treatment. Add a statin → drops LDL by ~50% Add ezetimibe → another ~20% Add a PCSK9i → another ~60% The calculator shows you how the trajectory changes, how projected MI age can be delayed, and how many years of healthy life treatment potentially buys.

The thresholds from the literature, using Mendelian randomization and cohort data: ⚠️ ~5,000 mg/dL·years → risk of MI exceeds 1% 🔴 ~8,000 mg/dL·years → cumulative plaque burden at mean age of first MI jacc.org/doi/10.1016/j.jacc.…

Introducing: Plaque Years The cholesterol equivalent of pack-years. Years of LDL exposure, integrated from birth to present. Just enter age and LDL and see a visual representation of risk. You can even add past LDL values to get a more precise exposure.

The REACT trial presented at #ESCCongress is a real world demonstration of this. Silent atherosclerosis was present in over HALF of adults without known ASCVD. It was detectable in early adulthood, and became more prevalent and extensive with age. doi.org/10.1056/NEJMoa260905…

Atherosclerosis is accumulation over time. LDL depositing in arterial walls isn't a snapshot in time, its a progressive life-long exposure. That cumulative exposure is what actually predicts plaque burden, but we have been ignoring the area under the curve.

Think about pack-years for smoking. 1 pack/day × 20 years = 20 pack-years. We don't just ask "do you smoke?" We ask how much and for how long. Why don't we do the same for cholesterol?

In cardiology we obsess over a static LDL value, but this result in isolation does not appropriately convey a patient's risk. Why? Because we never actually quantify a patient's cumulative atherogenic burden. I built a calculator that does → plaqueyears.com 🧵

Blizzard of 2006: sledding in Central Park Blizzard of 2026: placing a TVP after a cardiac arrest They grow up so fast…

Very proud to finally have this important review published in @crfshj. Big thank you to @AndreaScotti21 and @azeemlatib for their mentorship!

On my last day as chief I was also honored to present my mentor @UlrichJordeMD with a teaching award for subspecialist of the year as voted by the @montefioreIM house staff! So well deserved 👏🏼👏🏼👏🏼

That’s a wrap on chief year! Thankful for everyone who made it a rewarding year, both professionally and personally. T-minus 2 weeks til 🫀

@arorashMD you were on our minds this block

Two more weeks of attending time in the books! Rifampin induced thrombocytopenia, necrotizing pancreatitis, bleeding ulcers, septic shock, and a LOT of influenza. Thankful for this team 🙌🏻

In the months that followed 9/11, when I was 6 years old, I made this placard that now hangs in my grandma’s house. A short 23 years of education and training later... I can finally say I am going to be a @MonteHeart doctor and a #MonteLifer! @EinsteinDeptMed @montefioreIM

Just finished my first two weeks as an attending on a busy general medical service - 45 patients over the 2 weeks - best part of chief year yet! @montefioreIM

Finally got to present a case I had saved from intern year! 22F with uncontrolled DM1, fever, and AMS - would you cover for listeria? 🧀🧠👀 – at Queens, NY