At the 10th Annual Symposium for Metabolic Health, held in San Diego in August 2025, vascular surgeon Dr. Lily Johnston delivered one of the most compelling and impactful presentations of the weekend. Her lecture, Plaque, Proof and Prevention: Rethinking Cardiovascular Risk, challenged long-held assumptions about how cardiovascular disease is detected, treated, and prevented—and called for a more proactive approach that uses modern imaging to reveal what’s really happening inside the arteries.
“I scoop this plaque out of people’s arteries every day,” Dr. Johnston told the audience. “And I am here because I need to put myself out of business as a surgeon. The disease I treat is awful, and the operations I offer are slightly less awful—but they still don’t cure atherosclerosis. It’s like putting a Band-Aid on a hole in the Hoover Dam.”
Dr. Johnston contrasted the extensive screening protocols used for various cancers with the near absence of equivalent tools for heart disease—the world’s leading killer. “Cardiovascular disease kills more people than all cancers combined, and we do not screen for it,” she said.
Rather than relying solely on population-based risk calculators, Johnston emphasized the importance of individualized, image-based diagnosis. “We are trying to move away from probabilities and into reality that we can see… The real question you want to know is, do you have disease or not?”
She outlined the value of several diagnostic imaging tools—coronary artery calcium (CAC) scoring, coronary CT angiography (CCTA), and carotid intima-media thickness (CIMT) testing—each offering different insights into plaque presence and progression. “CCTA detects all plaque—calcified and soft,” she explained. “CIMT, when done well, is sensitive to hundredths of a millimeter of change. That makes it a very reliable tool to understand the impact of changes in nutrition, movement, sleep, stress, or medications.”
Perhaps the most memorable moment of her presentation came when she addressed the emotional and behavioral side of prevention:
“You must give people hope that it is possible to reverse plaque. Show your patients the pictures. Interval imaging is motivating.”
Her talk reflected the growing emphasis across the metabolic health community on not only identifying risk but empowering patients and clinicians to take action that can halt—or even reverse—disease progression.
Building Momentum Toward Boca Raton 2026
The strong interest in cardiovascular content has never been stronger, and the connection between the metabolic roots of heart disease is surging. That’s why the upcoming Symposium for Metabolic Health in Boca Raton, Florida (January 23–25, 2026) will devote an entire day and a 1/2 to Cardiovascular Health Fri and Sat.
These days will be dedicated to taking a deep dive into understanding the metabolic drivers of heart disease, and will feature presentations from Dr. Lily Johnston, Dr. Cywes, Dr. Philip Ovadia, Dr. Arthur Agatston, Dr. Eugene Chung, Dave Feldman, Dr. Eric Westman, and Dr. David Diamond.
Beyond cardiovascular health – the rest of the general sessions of the Boca Symposium will once again offer a diverse lineup of science-backed presentations on metabolic therapies, including therapeutic carbohydrate reduction for the prevention, management, and reversal of conditions such as type 2 diabetes, obesity, fatty liver disease.
The Boca program promises to deliver the depth and breadth that attendees have come to expect from LowCarbUSA and the Society of Metabolic Health Practitioners (SMHP).
This conference is Open to the Public, but technical enough to be accredited for up to 22 Continuing Professional Development (CPD) credits, and Continuing Medical Education (CME) credits.
Learn more about the Symposium for Metabolic Health Boca Raton 2026 and the optional CME credits
Catch Up on San Diego 2025
If you missed Dr. Johnston’s presentation—or any of the other sessions from San Diego—you can still access the full conference recordings here and still has the ability to sign up for optional 28 CPD/CME/CMHE credits: sign up for San Diego 2025 Recordings
