When it comes to cardiovascular disease we are trained as physicians to focus on traditional Framingham risk factors with the goal to lower cholesterol. Statistically noisy, including the updated 2013 guidelines, these methods do a poor job of predicting risk. We need better tools. Disorders of Insulin metabolism including hyperinsulinemia and Insulin resistance are mostly underdiagnosed conditions and yet provide clarity as to the root cause of cardiovascular disease. Dr. Joseph Kraft, the father of the insulin assay, in his career noted that almost 75% of his study population had disorders of insulin metabolism and yet were missed via standard testing. He calls this “diabetes in-situ” and through his work as a pathologist concluded that the damage of diabetes is vascular. “Those with cardiovascular disease not identified with diabetes… are simply undiagnosed” in the words of Dr. Kraft. We will look at traditional cardiovascular risk assessment and compare it to more modern methods, including the insulin assay and advanced CV imaging.
