Can vitamin K2 slow coronary artery calcium? A new JAMA Cardiology randomized trial found that MK-7 may reduce CAC progression over 2 years — but the real story is more complicated.

TL;DR: In this randomized trial, people with symptomatic coronary artery disease and CAC scores between 50–400 took either MK-7, a form of vitamin K2, at 360 mcg daily or placebo for 2 years. The MK-7 group had slower progression of coronary artery calcium and calcium mass, with no major safety signal. But this study did not prove fewer heart attacks, fewer stents, or lower mortality — so this is interesting, not a miracle. Especially important: do not start vitamin K supplements without medical guidance if you take warfarin/Coumadin.

Article link: https://jamanetwork.com/journals/jamacardiology/fullarticle/2850256

In this video, I break down the VitaK-CAC trial: who was studied, what dose was used, what happened to CAC scores, why plaque calcification is biologically complicated, and what I would — and would not — take away from this as a vascular surgeon.

⏰ Chapters
0:00 - New vitamin K study: why this matters
0:39 - The paper: MK-7 and coronary artery calcium
1:42 - Vitamin K1 vs K2, why MK-7
2:13 - What the VitaK-CAC trial tested
3:08 - Calcified plaque vs total plaque burden
3:28 - Study design: randomized, placebo-controlled, double-blind
4:41 - Who was included and excluded in the trial, plus why it matters
6:32 - What “symptomatic CAD” actually meant here
8:47 - The intervention: 360 mcg MK-7 daily
9:13 - CT scans, CAC scoring, and calcium mass
10:59 - How vitamin K status was measured
12:29 - Primary outcome: CAC progression, not heart attacks
13:03 - Statistical methods and “fast progression”
16:44 - LDL levels, statins, and a possible data discrepancy
18:25 - Baseline characteristics of the study population
22:12 - Adherence, adverse events, and vitamin K blood levels
23:31 - Matrix Gla protein: did MK-7 do what it was supposed to?
24:58 - Primary results: CAC progression slowed with MK-7
26:21 - Why the effect is exciting but modest
29:17 - Fast progressors: no significant difference
30:07 - Calcium mass and intention-to-treat analysis
32:02 - Secondary outcomes: plaque type and stenosis
33:32 - The big question: is less calcification always better?
35:40 - Discussion: promising, but clinical significance unknown
37:13 - Why MK-7 does not “remove” existing calcium
38:23 - Vitamin K biomarkers and possible under-dosing
42:25 - Study limitations
43:41 - Funding, conflicts of interest, and final takeaways
44:48 - My clinical take on vitamin K2/MK-7

This video is for education only and is not personal medical advice. Do not start, stop, or change supplements or medications based on YouTube — especially if you take warfarin or any medication affected by vitamin K. Talk with your own clinician.

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___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

In this Q&A session, Dr. Lily Johnston dives into complex viewer questions regarding cardiovascular health and emerging medical research. She covers the impact of hormone therapies on LP(a), the nuances of managing cholesterol after a heart attack, and how to interpret advanced imaging like CIMT and Calcium Scores.

The episode concludes with a fascinating look at a novel, experimental microsurgical approach for Alzheimer’s disease being studied in China, which aims to improve the brain's waste clearance through lymphatic connections. Dr. Lily breaks down the mechanistic rationale, the early clinical data, and the significant physiological and ethical concerns surrounding this "brain plumbing" surgery.

Timestamps
00:00 – Intro: Meet Dr. Lily Johnston, Vascular Surgeon & Cardiometabolic Specialist.
00:16 – Q&A 1: Can hormone replacement therapy (HRT) or testosterone reduce LP(a)?
02:53 – Q&A 2: Recovery after a STEMI—Statins vs. PCSK9 inhibitors and the role of Colchicine.
06:49 – Q&A 3: How to distinguish between stable and inflamed plaque using CIMT tests.
09:34 – Q&A 4: High Calcium Score (CAC) vs. CIMT results—Is a heart cath or CT angiogram next?
12:39 – Q&A 5: Does starting Menopausal Hormone Therapy (MHT) late increase cardiac risk?
16:48 – Addressing the "Omega minus-3" nomenclature (A quick biochemistry deep dive).
17:53 – Q&A 6: Does taking Phosphatidylcholine improve fish oil absorption?
19:02 – Q&A 7: Krill oil vs. traditional fish oil.
20:47 – Deep Dive: Deep Cervical Lymphovenous Anastomosis—A surgical treatment for Alzheimer's?
25:40 – Reviewing clinical evidence and controversies of Alzheimer's surgery.

Sign up for more information on my own practice here: https://corsighthealth.com/

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
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Sleep Mask: https://amzn.to/48fSJV5
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___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

#MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota

Can you have a heart attack with “normal” labs and no warning signs? Or are we missing the warning signs because our thresholds are too late and our prevention model is too reactive?

Today I react to a fascinating video from Dr Brad Stanfield, BUT STICK AROUND because then we take a deep dive into the actual JACC paper behind the headline that “99% of people who had a heart attack had at least one warning sign beforehand.”

We break down:

* Why “normal” isn’t always optimal
* The difference between diagnosed risk factors vs actual exposure
* Why blood pressure of 128/82 may still matter
* The hidden role of insulin resistance and metabolic syndrome
* ApoB vs LDL-C vs non-HDL cholesterol
* Why prevention needs to start decades earlier
* The problem with reactive medicine
* What Jim Fix’s story actually teaches us about cardiovascular disease

This is not a message of fear. It’s a message of agency.

Because clogged arteries rarely appear out of nowhere. Most of the time, the body whispers long before it screams.

⏰ Chapters ⏰
0:00 The “99% of Heart Attacks” claim
0:57 Did people really have NO risk factors?
2:23 Why “SMURF-less” heart attacks confused cardiology
3:02 Are our thresholds too high?
4:21 Insulin resistance may be the missing link
5:14 The massive 9-million-person study
5:57 Over 99% had at least one non-optimal risk factor
6:50 Diagnosed risk factors vs actual exposure
7:18 The underdiagnosis problem in medicine
8:02 Why billing data can be misleading
10:13 Cardiovascular risk is continuous, not binary
11:42 Prediabetes still damages arteries
13:43 Why granular patient data matters
14:50 The tragic story of Jim Fix
16:47 “The second most common symptom is denial”
17:31 Exercise didn’t cause his heart disease
19:17 Why this data is actually hopeful
20:03 Reactive medicine vs prevention
20:32 “I lost weight… isn’t that enough?”
22:03 How aggressive should prevention targets be?
23:50 ApoB explained simply
25:29 My take on ApoB vs LDL-C
28:05 Deep dive into the JACC paper
35:28 Which risk factor was most common?
37:21 Most patients had MULTIPLE risk factors
39:26 Does this only apply to older people?
41:34 What happens when we use standard clinical cutoffs?
43:43 Why non-HDL cholesterol matters
45:47 The boring prevention advice still wins
46:38 Residual risk after lifestyle transformation
47:00 Why the fundamentals still matter most

High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljohnstonmd/store-start

Sign up for more information on my own practice here: https://corsighthealth.com/

Other tools for optimal health (note these are affiliate links):
Home BP Cuff: https://amzn.to/49Cq7rh
Sonicare Toothbrush: https://amzn.to/3KllfMS
WaterPik: https://amzn.to/4894Xi8
Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d
Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS
Intake Breathing Nasal Support: https://amzn.to/48dfQQ1
Personal Blender: https://amzn.to/4pyNGGl
True Nutrition Protein: https://oken.do/q2xzqeqw
Glass Meal Prep Containers: https://amzn.to/4ocEPJ2
Sleep Mask: https://amzn.to/48fSJV5
Air Purifier: https://amzn.to/4puzTQZ

___________________________
🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

This video is for educational purposes only and does not constitute personalized medical advice. Please discuss your individual health risks, labs, medications, and treatment decisions with your own physician.