Writing & Notes
From the clinic.
Essays, observations, and notes from a cardiology practice in Encinitas. Written in plain language, refreshed when the evidence changes.
More Than Half of Adults Have Silent Plaque: What the REACT Study Means for You
A study of 16,808 adults with no history of heart disease found plaque in 57 percent of them, including one in 13 people under 30, and the standard risk calculator flagged almost none. Dr. Damian Rasch on where the plaque was, why women catch up after menopause, why a scan is still the wrong first move under 40, and what to do at 25, 45, and 65.
Read the essayHalf the People With High Blood Pressure Don't Know It: How to Find Out If You're One of Them
A study of 1.4 million adults found 59 percent of people with high blood pressure had never been diagnosed, and half of those on treatment were still above target. The American numbers are no comfort. Dr. Damian Rasch on why you can't feel it, what one reading can't tell you, and how to measure so the number means something.
ReadShould You Start a Statin After 70? What the STAREE Trial Found
A trial of 9,971 healthy adults over 70 found atorvastatin cut major cardiovascular events by 30 percent and did nothing for years lived free of dementia and disability. Dr. Damian Rasch explains why both results are real and how he uses them in clinic.
ReadArchive
2026
- Sep 14 Does Melatonin Raise Your Risk of Heart Failure? What the Study Behind the Headline Actually Shows A study of 130,000 adults with insomnia tied long-term melatonin use to a 90 percent higher rate of heart failure. Dr. Damian Rasch explains why that number is weaker than it sounds, what is known about melatonin and the heart, and what to do if you take it every night.
- Sep 6 The First Lp(a)-Lowering Drug Failed Its Big Trial: What That Means If Your Lp(a) Is High On September 4 Novartis announced that pelacarsen, the first drug built to lower lipoprotein(a), cut the number as designed but did not prevent heart attacks, strokes, or cardiovascular deaths in an 8,323-patient trial. Dr. Damian Rasch walks through the possibilities, from the worrying one (Lp(a) may only be a marker) to the hopeful ones (deeper knockdown, and treating younger people before their first event), and what to do if your Lp(a) is high.
- Sep 1 Is Xylitol Bad for Your Heart? What the New Study Does and Doesn't Show A study presented at the European Society of Cardiology meeting tied higher blood xylitol to more heart attacks and strokes. Dr. Damian Rasch explains what the evidence supports, what the genetic data say, and whether to change anything about your gum.
- Aug 21 Do You Still Need That Beta-Blocker? Five large trials in three years have changed who benefits from a beta-blocker after a heart attack. Dr. Damian Rasch explains where these drugs still earn their place, where the case has thinned, and why you should never stop one on your own.
- Aug 9 Statin-Shy? Why I Still Reach for a Statin First, and What I Do When You Truly Can't Take One Statin fear is everywhere, and some of it is real. Dr. Damian Rasch explains the nocebo effect, real muscle side effects, the excellent statin alternatives we now have, and why a statin's bonus benefits still earn it first place.
- Aug 3 Semaglutide or Tirzepatide for Your Heart? What a New Real-World Study Found A new real-world study called STEER compared semaglutide and tirzepatide in patients with heart disease and no diabetes, and semaglutide came out ahead on heart attacks, strokes, and death. Dr. Damian Rasch explains the finding, where it falls short, and how he weighs the two drugs in clinic.
- Jul 29 A Calcium Score of Zero Doesn't Erase a High LDL: Why I Hesitate to Skip the Statin A coronary calcium score of zero is reassuring for the next few years, not the next few decades. Dr. Damian Rasch explains why he still treats a high LDL when the scan looks clean, where he'll agree to wait, and why his bias follows the more aggressive European guidelines.
- Jul 27 Is Coffee Bad for Your Heart? What the New AHA Caffeine Statement Actually Says The American Heart Association's 2026 scientific statement pulled together what we know about caffeine and the heart. Dr. Damian Rasch translates it: how much is safe, what it means for AFib and blood pressure, the brewing trick that lowers cholesterol, and why energy drinks are a separate story.
- Jul 27 The Drugs That Finally Lower Lp(a): What's Coming and When We'll Know If It Saves Lives A handful of new medicines can slash lipoprotein(a), the genetic cholesterol particle nothing else touches, by around 90 percent. Dr. Damian Rasch explains the drugs in development and the trials that will decide whether lowering Lp(a) prevents heart attacks.
- Jul 26 Your Heart, Kidneys, and Metabolism Are One System: The New CKM Guideline The 2026 AHA/ACC/ADA/ASN guideline treats heart disease, kidney disease, diabetes, and obesity as one connected condition called CKM syndrome. Dr. Damian Rasch explains the five stages, the PREVENT risk calculator, and what both mean for your care.
- Jul 19 Nine in Ten Heart Disease Deaths Are Preventable: What a New National Study Says You Can Control A July 2026 analysis in JAMA Cardiology found U.S. coronary artery disease deaths have fallen by half since 1990, yet 88 percent of the remaining deaths trace back to risk factors we can change. Dr. Damian Rasch breaks down the numbers and what they mean for your own heart.
- Jul 16 A New Cholesterol Pill Is Here: What Lipfendra's FDA Approval Means for Your Heart On July 16, 2026 the FDA approved Lipfendra (enlicitide), the first once-daily oral PCSK9 inhibitor. Dr. Damian Rasch explains how it neutralizes PCSK9, lets your liver clear LDL naturally, and why a once-a-day pill changes cholesterol care.
- Jul 12 A New Shot for Very High Triglycerides: What Olezarsen's FDA Approval Means for Patients The FDA approved olezarsen (Tryngolza) in June 2026 as the first therapy to reduce triglycerides and acute pancreatitis risk in adults with severe hypertriglyceridemia. Dr. Damian Rasch explains how it works, who it's for, and what patients with very high triglycerides should know.
- Jul 6 Do Calcium Supplements Raise Heart Attack Risk? Why I Steer Most Patients Toward Food First Calcium pills are one of the most common supplements my patients take, yet the heart data give me pause. Dr. Damian Rasch explains why supplemental calcium may raise cardiovascular risk, why dietary calcium does not, and the few times a supplement still makes sense.
- Jul 1 Medicare Now Covers GLP-1s for Weight Loss: Who Qualifies for the New $50 Bridge Program Medicare's GLP-1 Bridge started July 1, 2026. Dr. Damian Rasch explains who qualifies for $50-a-month Wegovy, Foundayo, or Zepbound and how to get it.
- Jun 22 Your Mammogram May Soon Flag a Heart Warning: What Breast Arterial Calcification Means Maryland will soon require mammogram reports to tell women about breast arterial calcification (BAC). Dr. Damian Rasch explains what BAC is, why preventive cardiologists watch it, and how it parallels a coronary calcium score.
- Jun 15 What the 2026 Cholesterol Guidelines Actually Change for Patients The 2026 ACC/AHA Dyslipidemia Guideline replaces the 2018 version with a lifelong-prevention frame, a new PREVENT risk calculator, and universal Lp(a) testing. Dr. Damian Rasch translates what changes for patients.
- Jun 7 The Lp(a) Number Above 175 nmol/L: New NIH Data on Why Standard Treatment May Not Be Enough New SCAI 2026 data pooling 20,070 patients from three NIH trials shows that lipoprotein(a) above 175 nmol/L drives cardiovascular risk that standard treatment doesn't erase. Dr. Damian Rasch explains what to do about it.
- Jun 1 A New Pill for Stubborn High Blood Pressure: What Baxdrostat's FDA Approval Means for Patients The FDA approved baxdrostat (Baxfendy) on May 18, 2026, as the first aldosterone synthase inhibitor for hypertension. Dr. Damian Rasch explains how it works, who it's for, and what patients with resistant high blood pressure should know.
- May 25 Beyond Leqvio: The One-Time Cholesterol Treatment Now Heading to Phase 2 Lilly's VERVE-102 cut LDL cholesterol by 62% with a single dose in Phase 1. Dr. Damian Rasch explains what gene editing means for cholesterol care, how it compares to Leqvio and Repatha, and what patients should actually expect.
- Mar 29 Atrial Fibrillation (AFib): A Cardiologist's Complete Patient Guide Diagnosed with atrial fibrillation? Dr. Damian Rasch explains AFib symptoms, causes, stroke risk, treatment options including ablation, and how to manage AFib long-term.
- Mar 29 Heart Palpitations: A Cardiologist's Guide to Causes, Concerns, and Care Feeling your heart race or flutter? Cardiologist Dr. Damian Rasch explains heart palpitation causes, when they're harmless vs. concerning, and when to see a doctor.
2025
- Oct 29 Protecting Your Heart While Fighting Breast Cancer: What Every Woman Should Know This October Breast cancer treatments can put stress on the heart. Dr. Damian Rasch on cardiotoxicity, GLS imaging, and how to protect both your life and your heart.
- Aug 14 Side Effect Spotlight: Amlodipine and Swollen Ankles The surprising truth about why your heart medication is making your ankles puffy (and what you can do about it). Dr. Damian Rasch explains.
- Aug 6 FDA Breaks New Ground: Leqvio Now Approved as First-Line Cholesterol Treatment FDA approves statin-free, pill-free cholesterol control that simply restores your natural LDL-clearing ability. Dr. Damian Rasch on the Leqvio first-line label update.
2019
- May 28 Do Statins Actually Cause Diabetes? Separating Medical Facts from Internet Fear Worried about statin-induced diabetes? Dr. Damian Rasch explains the real numbers behind statin diabetes risk and why this medication still saves lives.
- May 28 So What's the New Deal with HDL Cholesterol? Doctors used to say high HDL cancels out bad cholesterol. We were wrong. Dr. Damian Rasch on why HDL is no longer a treatment target.
- May 28 Understanding Your Ejection Fraction: What Those Numbers Really Mean That 55% on your heart test doesn't mean your heart is only half-working. Dr. Damian Rasch explains what ejection fraction really measures.