August 18, 2025 • 12 mins
Dr. Michael Koren joins Kevin Geddings to explain how having a conversation with a medical professional who is tuned into your personal situation can help you understand the confusing and sometimes counterintuitive world of medical information. Cardiologist Dr. Koren uses the examples of coronary calcium scores and total cholesterol levels, which must be interpreted in the context of individual factors, such as age and HDL/LDL ratio. They then discuss clinical research and how the experience in a clinical research setting is one of shared knowledge, where medical professionals take the time to explain everything you need to know about your health.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Announcer (00:00):
Welcome to the MedEvidence Monday Minute Radio
Show hosted by Kevin Geddings ofWSOS St.
.
Augustine Radio and powered byEncore Research Group.
Each Monday morning, Dr.
Dr.
Michael Koren calls in to bringyou the latest medical updates
with insightful discussions.
MedEvidence is where we helpyou navigate the real Truth
behind medical research, withboth a clinical and research
(00:20):
perspective.
So sit back, relax and getready to learn about Truth
Behind Behind Data Data medicinemedicine and healthcare.
This is!!
Kevin Geddings (00:30):
Dr.
Michael Koren is here with usmedical doctor, cardiologist,
research scientist.
Of course he directs theefforts at ENCORE Research Group
and they have an office righthere in St.
Johns County other locationsthroughout Northeast Florida,
but they're located next to UFFlagler Hospital in the
Whetstone Building here andfolks go there to participate in
some leading-edge clinicaltrials on all sorts of different
(00:52):
health topics and of course Dr.
Koren is a cardiologist so alot of times we tap into his
knowledge of heart health,including we wanted to talk a
little bit this morning aboutcoronary calcium counts,
Dr. Michael Koren (01:09):
Yeah, as I mentioned to you, we just got
back from a little family affairin Connecticut and the
discussion around the dinnertable was about coronary calcium
and cholesterol levels and whypeople are confused about these
things.
Kevin Geddings (01:20):
Yeah, yeah.
So that's a number I guess weget when we have our lab work
done, correct?
Dr. Michael Koren (01:27):
Well, the coronary calcium count actually
comes from a CAT scan.
Kevin Geddings (01:31):
Okay.
Dr. Michael Koren (01:31):
So there's a type of CAT scan that you can
get.
That's a very limited type ofCAT scan with small amounts of
radiation and that establishesthe amount of coronary calcium,
or calcium on your coronaryarteries.
And what that means, Kevin, iswhen you get older, there is a
healing process that occurs, andthis is the way our body heals
(01:54):
atherosclerosis by creatingthese little stable plaques that
eventually become calcified andcan be identified with a CAT
scan.
So this is a normal part ofaging, but it's actually very
different in different peopleand it's extremely predictive of
who's going to get into troublewith heart disease,
(02:14):
particularly heart attacks.
So cardiologists now all thetime use this technology to
determine who's at high risk forhaving a heart attack and who's
at lower risk for a heartattack.
And because this is anage-dependent process, the
numbers always have to be lookedat through the lens of age.
So, for example, somebody who'sin their 30s should really have
(02:36):
zero coronary calcium.
There shouldn't really be anyhealed atherosclerosis per se,
whereas somebody in their 80swill typically have some, and we
hope that number is relativelylow, meaning that there has not
been a lot of healedatherosclerosis.
But this leads to a lot ofconfusion because, for example,
at our family table over theweekend we had somebody who was
(02:57):
in their 80s and I asked themabout their coronary calcium
counts, since they had a workupfor their heart recently, and
they're able to tell me oh, itwas about 75, which is actually
a pretty good number forsomebody who's in their 80s.
But then I had a niece and shewas saying yeah, I think my
coronary calcium count is 20.
Now, that would not be verygood for a 30-year-old, but
(03:20):
there's a lot of confusion as towhy was 75 good for one person
and something in their 20s badfor another person?
And this gets into the wholeconcept is that you really have
to take medical information andput it into the context of the
individual, which doesn't alwayshappen.
It certainly doesn't happenwhen you look things up on the
Internet.
Kevin Geddings (03:38):
Right, right, that's Dr.
Michael Koren, of course, withus live.
So if we have, I guess,obviously a low number is not
good, a high number, I guess, isbetter.
If we have a low number andlike your relative who's only in
their 30s with a low number,what can they do to make it
better?
Dr. Michael Koren (03:54):
No, no.
For coronary calcium, just tobe clear.
A higher number is worse.
Kevin Geddings (03:59):
Oh, okay
Dr. Michael Koren (03:59):
And that's a reflection of the amount of
atherosclerosis that has, quote,healed over time.
But the thing about thecoronary calcium, Kevin, is that
it doesn't go away.
So, let's say you had a healedplaque when you were in your 40s
.
Well, that will show up for therest of your life, and so what
you're really looking at is thecumulative story of
atherosclerosis over somebody'slifetime.
(04:22):
So, again, somebody in their80s is expected to have more
calcium than somebody in their30s, and when you look at
somebody in their 30s that hasany calcium, that's something
that would make us concerned ascardiologist.
Kevin Geddings (04:36):
Okay, okay.
So yeah, that number isdependent obviously on age,
because you might have a highernumber if you're 80 years old,
but that's understandablebecause you've lived your life,
right, right.
Dr. Michael Koren (04:47):
There you go, exactly.
So, with all these things, welook at this particular test,
which again is a type of CATscan that uses low doses of
radiation to determine thelikelihood of a heart attack or
other atherosclerotic events,like a stroke or peripheral
disease or an aortic aneurysm.
And this gets confusing topeople, for the exact reason
(05:08):
that we were just discussing isthat the number has to be looked
at through the lens of how oldyou are, but the other thing
that comes up;Is that okay?
So I have a coronary calciumcount of, say, 50 at age 50.
Well, that's not so good.
So let's look at yourcholesterol.
Well then, people look at theircholesterol and again, going
around the dinner table,somebody has a cholesterol of
(05:30):
250, which is a total number ofcholesterol, but their HDL is
100.
Well, that's not so bad.
On the other hand, somebodythere has a cholesterol total of
180, but their HDL is 35 andtheir LDL is 140.
Well, that's not so good.
So then they're telling me well, you told that person that 250
was pretty good, and here you'retelling me my total cholesterol
(05:53):
is 180, and that's kind of bad.
And these are the kind ofthings that get people extremely
confused, and that's why it'sso important to have a
conversation with medicalprofessionals that can break
down these numbers forindividual people and explain
why this number is either betteror not so good for the
particular individual
Kevin Geddings (06:13):
Right, that's Dr .
Michael Koren.
Once again, you can connect withhim and all the work that
they're doing with Leading EdgeClinical Research by going to
EncoreDocs.
com, EncoreDoc s.
c om and Dr.
Koren.
Since we're on the topic ofcardiovascular health, I would
imagine there are a variety ofstudies that people could
participate in if they've hadissues along these lines.
Dr. Michael Koren (06:33):
Absolutely, as we speak, we probably have a
dozen studies that are enrollingpatients with a number of
either cardiovascular riskfactors or known cardiovascular
disease, where we're trying toimprove your odds and reduce the
likelihood of a heart attack ora stroke likelihood of a heart
attack or a stroke.
We're doing this, for example,with GLP-1 agonists which, as
(07:00):
most people know, will help youlose weight, in addition to
lowering your cardiovascularrisk.
That's one area of research, butwe also have other areas of
research where we're directlytreating cholesterol issues, or
lipoprotein( a), which is calleda really really, really, really
bad cholesterol a form of alipoprotein that's more likely
to cause heart attacks andstrokes, and other programs as
(07:21):
well.
We just finished up a reallyinteresting study with patients
that had hypertension, using anew mechanism.
We have other studies now thatare treating people who have
congestive heart failure withmedications that will block the
negative hormones that causepeople with congestive heart
failure to have complications.
So really across the board, ifyou've been diagnosed with
(07:41):
cardiovascular disease, there'sa really good chance you'll fit
into one of our programs.
That would be helpful.
Kevin Geddings (07:46):
Yeah, and you can do that and you can learn
more about those programs andhow you can get, really honestly
, some of the best health careyou'll ever get.
A couple of us here at theradio station have participated
in this clinical research withENCORE Research Group.
We highly recommend theexperience.
You could have fun actually Goto EncoreDocs.
com EncoreDocs.
com and I should mention,there's compensation involved as
(08:06):
well and, speaking ofcardiovascular health, when
you're looking for informationabout all this stuff, there's a
great resource online for them,right?
Dr. Michael Koren (08:15):
Yeah, that's our MedEvidence! platform and
thanks for bringing that up, andI'll give you another example
of why MedEvidence! is soimportant and general
information on the Internet maybe suspicious.
So at the dinner table againthere was discussion about
statins and people asking me doI think statins are good or bad?
(08:36):
And this is very typical, Kevin.
Everybody looks at things atlenses.
Is something good or bad?
And this is very typical, Kevin.
Everybody looks at things atlenses something good or
something bad?
Well, asking a cardiologist,especially a preventive
cardiologist, if statins aregood or bad is like asking a mom
with a four-month-old ismother's milk good or bad?
So statins are something thatare a wonderful class of drugs
(08:59):
that prevent heart attacks andstrokes.
Do they sometimes cause alittle hiccup here and there?
Sure, like anything else, butoverall there's no question that
statins are a very, veryimportant part of how we reduce
cardiovascular risk,particularly in patients at high
cardiovascular risk.
But here's the funny thing isthat around the dinner table
(09:19):
people say oh, I heard statinsare bad.
Well, that's just crazy.
If you read anything that saysstatins are bad, you need to
immediately cross that websiteoff your list of viewing
opportunities.
On the other hand, if somebodysays well, sometimes people can
have intolerance of statins andwhat are the?
Alternatives.
Well, that's an interestingquestion.
And we actually have an answerfor that at the research offices
(09:42):
.
So that would be a legitimatequestion.
But here's the other reallyinteresting thing, Kevin.
There's been some informationout there that says, oh well,
statins will increase coronarycalcium counts and that must be
a bad thing.
Well, actually that's a goodthing, and the reason it's a
good thing is, as I mentioned,is that the coronary calcium
count is a reflection of healedatherosclerosis.
(10:05):
So something like statins thathelps atherosclerosis to heal
will, of course, in the shortrun, increase your coronary
calcium count.
So again, this is where thingsget confusing for people.
Something that causes healingwill also cause a number to go
up that people will sometimesassociate with a bad outcome.
(10:26):
In fact, it is not a badoutcome.
It's a medicine doing what itcould be doing to reduce your
risk.
So I know that could be veryconfusing, but that's why coming
into the research setting andhaving a conversation with a
professional that trulyunderstands these things and can
present these things to youthrough the lens of your
personal experience is reallyvital.
(10:47):
It can't be replaced byanything on the internet or with
artificial intelligence at thispoint.
Kevin Geddings (10:51):
Yeah, and you can do that very easily here
locally by calling 904-730-0166.
That's the number for ENCOREResearch Group here in our part
of Northeast Florida,904-730-0166.
I know it's hard to rememberphone numbers when you're
driving around, but go to thewebsite EncoreDocs.
com that's E-N-C-O-R-E Docs.
(11:13):
com.
And of course, MedEvidence! isavailable to you to answer all
kinds of questions and areliable resource online, which
it's hard to put.
Those words all in the samesentence.
Medevidence.
com that's MedEvidence.
com, Dr.
Koren.
Any closing thoughts thismorning?
Dr. Michael Koren (11:30):
It's go get good information for people who
are listening.
Now.
There's so much information,much information.
Again, I was actually blownaway during our family
discussion about all theinformation people are getting
from sources, be it TikTok ortheir friends on Instagram or a
number of different places.
Be suspicious about any kind ofinformation that's promoting a
(11:53):
particular product, particularlysome of these supplements, and
get objective information,whether it's on that evidence or
in other places.
It's so important becausepeople actually make very poor
decisions based on poorinformation.
Kevin Geddings (12:10):
Yes, absolutely All right.
Well, good stuff, Dr.
Koren.
Dr. Michael Koren (12:11):
We appreciate your time this morning Be safe
out there and we'll speak withyou next week.
You have a great week, Kevin.
Announcer (12:15):
Thanks for joining the MedEvidence! podcast.
To learn more, head over toMedEvidence.
com or subscribe to our podcaston your favorite podcast
platform.
Welcome to the MedEvidence Monday Minute Radio
Show hosted by Kevin Geddings ofWSOS St.
.
Augustine Radio and powered byEncore Research Group.
Each Monday morning, Dr.
Dr.
Michael Koren calls in to bringyou the latest medical updates
with insightful discussions.
MedEvidence is where we helpyou navigate the real Truth
behind medical research, withboth a clinical and research
(00:20):
perspective.
So sit back, relax and getready to learn about Truth
Behind Behind Data Data medicinemedicine and healthcare.
This is!!
Kevin Geddings (00:30):
Dr.
Michael Koren is here with usmedical doctor, cardiologist,
research scientist.
Of course he directs theefforts at ENCORE Research Group
and they have an office righthere in St.
Johns County other locationsthroughout Northeast Florida,
but they're located next to UFFlagler Hospital in the
Whetstone Building here andfolks go there to participate in
some leading-edge clinicaltrials on all sorts of different
(00:52):
health topics and of course Dr.
Koren is a cardiologist so alot of times we tap into his
knowledge of heart health,including we wanted to talk a
little bit this morning aboutcoronary calcium counts,
Dr. Michael Koren (01:09):
Yeah, as I mentioned to you, we just got
back from a little family affairin Connecticut and the
discussion around the dinnertable was about coronary calcium
and cholesterol levels and whypeople are confused about these
things.
Kevin Geddings (01:20):
Yeah, yeah.
So that's a number I guess weget when we have our lab work
done, correct?
Dr. Michael Koren (01:27):
Well, the coronary calcium count actually
comes from a CAT scan.
Kevin Geddings (01:31):
Okay.
Dr. Michael Koren (01:31):
So there's a type of CAT scan that you can
get.
That's a very limited type ofCAT scan with small amounts of
radiation and that establishesthe amount of coronary calcium,
or calcium on your coronaryarteries.
And what that means, Kevin, iswhen you get older, there is a
healing process that occurs, andthis is the way our body heals
(01:54):
atherosclerosis by creatingthese little stable plaques that
eventually become calcified andcan be identified with a CAT
scan.
So this is a normal part ofaging, but it's actually very
different in different peopleand it's extremely predictive of
who's going to get into troublewith heart disease,
(02:14):
particularly heart attacks.
So cardiologists now all thetime use this technology to
determine who's at high risk forhaving a heart attack and who's
at lower risk for a heartattack.
And because this is anage-dependent process, the
numbers always have to be lookedat through the lens of age.
So, for example, somebody who'sin their 30s should really have
(02:36):
zero coronary calcium.
There shouldn't really be anyhealed atherosclerosis per se,
whereas somebody in their 80swill typically have some, and we
hope that number is relativelylow, meaning that there has not
been a lot of healedatherosclerosis.
But this leads to a lot ofconfusion because, for example,
at our family table over theweekend we had somebody who was
(02:57):
in their 80s and I asked themabout their coronary calcium
counts, since they had a workupfor their heart recently, and
they're able to tell me oh, itwas about 75, which is actually
a pretty good number forsomebody who's in their 80s.
But then I had a niece and shewas saying yeah, I think my
coronary calcium count is 20.
Now, that would not be verygood for a 30-year-old, but
(03:20):
there's a lot of confusion as towhy was 75 good for one person
and something in their 20s badfor another person?
And this gets into the wholeconcept is that you really have
to take medical information andput it into the context of the
individual, which doesn't alwayshappen.
It certainly doesn't happenwhen you look things up on the
Internet.
Kevin Geddings (03:38):
Right, right, that's Dr.
Michael Koren, of course, withus live.
So if we have, I guess,obviously a low number is not
good, a high number, I guess, isbetter.
If we have a low number andlike your relative who's only in
their 30s with a low number,what can they do to make it
better?
Dr. Michael Koren (03:54):
No, no.
For coronary calcium, just tobe clear.
A higher number is worse.
Kevin Geddings (03:59):
Oh, okay
Dr. Michael Koren (03:59):
And that's a reflection of the amount of
atherosclerosis that has, quote,healed over time.
But the thing about thecoronary calcium, Kevin, is that
it doesn't go away.
So, let's say you had a healedplaque when you were in your 40s
.
Well, that will show up for therest of your life, and so what
you're really looking at is thecumulative story of
atherosclerosis over somebody'slifetime.
(04:22):
So, again, somebody in their80s is expected to have more
calcium than somebody in their30s, and when you look at
somebody in their 30s that hasany calcium, that's something
that would make us concerned ascardiologist.
Kevin Geddings (04:36):
Okay, okay.
So yeah, that number isdependent obviously on age,
because you might have a highernumber if you're 80 years old,
but that's understandablebecause you've lived your life,
right, right.
Dr. Michael Koren (04:47):
There you go, exactly.
So, with all these things, welook at this particular test,
which again is a type of CATscan that uses low doses of
radiation to determine thelikelihood of a heart attack or
other atherosclerotic events,like a stroke or peripheral
disease or an aortic aneurysm.
And this gets confusing topeople, for the exact reason
(05:08):
that we were just discussing isthat the number has to be looked
at through the lens of how oldyou are, but the other thing
that comes up;Is that okay?
So I have a coronary calciumcount of, say, 50 at age 50.
Well, that's not so good.
So let's look at yourcholesterol.
Well then, people look at theircholesterol and again, going
around the dinner table,somebody has a cholesterol of
(05:30):
250, which is a total number ofcholesterol, but their HDL is
100.
Well, that's not so bad.
On the other hand, somebodythere has a cholesterol total of
180, but their HDL is 35 andtheir LDL is 140.
Well, that's not so good.
So then they're telling me well, you told that person that 250
was pretty good, and here you'retelling me my total cholesterol
(05:53):
is 180, and that's kind of bad.
And these are the kind ofthings that get people extremely
confused, and that's why it'sso important to have a
conversation with medicalprofessionals that can break
down these numbers forindividual people and explain
why this number is either betteror not so good for the
particular individual
Kevin Geddings (06:13):
Right, that's Dr .
Michael Koren.
Once again, you can connect withhim and all the work that
they're doing with Leading EdgeClinical Research by going to
EncoreDocs.
com, EncoreDoc s.
c om and Dr.
Koren.
Since we're on the topic ofcardiovascular health, I would
imagine there are a variety ofstudies that people could
participate in if they've hadissues along these lines.
Dr. Michael Koren (06:33):
Absolutely, as we speak, we probably have a
dozen studies that are enrollingpatients with a number of
either cardiovascular riskfactors or known cardiovascular
disease, where we're trying toimprove your odds and reduce the
likelihood of a heart attack ora stroke likelihood of a heart
attack or a stroke.
We're doing this, for example,with GLP-1 agonists which, as
(07:00):
most people know, will help youlose weight, in addition to
lowering your cardiovascularrisk.
That's one area of research, butwe also have other areas of
research where we're directlytreating cholesterol issues, or
lipoprotein( a), which is calleda really really, really, really
bad cholesterol a form of alipoprotein that's more likely
to cause heart attacks andstrokes, and other programs as
(07:21):
well.
We just finished up a reallyinteresting study with patients
that had hypertension, using anew mechanism.
We have other studies now thatare treating people who have
congestive heart failure withmedications that will block the
negative hormones that causepeople with congestive heart
failure to have complications.
So really across the board, ifyou've been diagnosed with
(07:41):
cardiovascular disease, there'sa really good chance you'll fit
into one of our programs.
That would be helpful.
Kevin Geddings (07:46):
Yeah, and you can do that and you can learn
more about those programs andhow you can get, really honestly
, some of the best health careyou'll ever get.
A couple of us here at theradio station have participated
in this clinical research withENCORE Research Group.
We highly recommend theexperience.
You could have fun actually Goto EncoreDocs.
com EncoreDocs.
com and I should mention,there's compensation involved as
(08:06):
well and, speaking ofcardiovascular health, when
you're looking for informationabout all this stuff, there's a
great resource online for them,right?
Dr. Michael Koren (08:15):
Yeah, that's our MedEvidence! platform and
thanks for bringing that up, andI'll give you another example
of why MedEvidence! is soimportant and general
information on the Internet maybe suspicious.
So at the dinner table againthere was discussion about
statins and people asking me doI think statins are good or bad?
(08:36):
And this is very typical, Kevin.
Everybody looks at things atlenses.
Is something good or bad?
And this is very typical, Kevin.
Everybody looks at things atlenses something good or
something bad?
Well, asking a cardiologist,especially a preventive
cardiologist, if statins aregood or bad is like asking a mom
with a four-month-old ismother's milk good or bad?
So statins are something thatare a wonderful class of drugs
(08:59):
that prevent heart attacks andstrokes.
Do they sometimes cause alittle hiccup here and there?
Sure, like anything else, butoverall there's no question that
statins are a very, veryimportant part of how we reduce
cardiovascular risk,particularly in patients at high
cardiovascular risk.
But here's the funny thing isthat around the dinner table
(09:19):
people say oh, I heard statinsare bad.
Well, that's just crazy.
If you read anything that saysstatins are bad, you need to
immediately cross that websiteoff your list of viewing
opportunities.
On the other hand, if somebodysays well, sometimes people can
have intolerance of statins andwhat are the?
Alternatives.
Well, that's an interestingquestion.
And we actually have an answerfor that at the research offices
(09:42):
.
So that would be a legitimatequestion.
But here's the other reallyinteresting thing, Kevin.
There's been some informationout there that says, oh well,
statins will increase coronarycalcium counts and that must be
a bad thing.
Well, actually that's a goodthing, and the reason it's a
good thing is, as I mentioned,is that the coronary calcium
count is a reflection of healedatherosclerosis.
(10:05):
So something like statins thathelps atherosclerosis to heal
will, of course, in the shortrun, increase your coronary
calcium count.
So again, this is where thingsget confusing for people.
Something that causes healingwill also cause a number to go
up that people will sometimesassociate with a bad outcome.
(10:26):
In fact, it is not a badoutcome.
It's a medicine doing what itcould be doing to reduce your
risk.
So I know that could be veryconfusing, but that's why coming
into the research setting andhaving a conversation with a
professional that trulyunderstands these things and can
present these things to youthrough the lens of your
personal experience is reallyvital.
(10:47):
It can't be replaced byanything on the internet or with
artificial intelligence at thispoint.
Kevin Geddings (10:51):
Yeah, and you can do that very easily here
locally by calling 904-730-0166.
That's the number for ENCOREResearch Group here in our part
of Northeast Florida,904-730-0166.
I know it's hard to rememberphone numbers when you're
driving around, but go to thewebsite EncoreDocs.
com that's E-N-C-O-R-E Docs.
(11:13):
com.
And of course, MedEvidence! isavailable to you to answer all
kinds of questions and areliable resource online, which
it's hard to put.
Those words all in the samesentence.
Medevidence.
com that's MedEvidence.
com, Dr.
Koren.
Any closing thoughts thismorning?
Dr. Michael Koren (11:30):
It's go get good information for people who
are listening.
Now.
There's so much information,much information.
Again, I was actually blownaway during our family
discussion about all theinformation people are getting
from sources, be it TikTok ortheir friends on Instagram or a
number of different places.
Be suspicious about any kind ofinformation that's promoting a
(11:53):
particular product, particularlysome of these supplements, and
get objective information,whether it's on that evidence or
in other places.
It's so important becausepeople actually make very poor
decisions based on poorinformation.
Kevin Geddings (12:10):
Yes, absolutely All right.
Well, good stuff, Dr.
Koren.
Dr. Michael Koren (12:11):
We appreciate your time this morning Be safe
out there and we'll speak withyou next week.
You have a great week, Kevin.
Announcer (12:15):
Thanks for joining the MedEvidence! podcast.
To learn more, head over toMedEvidence.
com or subscribe to our podcaston your favorite podcast
platform.
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