I'm a cardiologist. I've held dying hearts in my hands in the cath lab at 3 AM. And I need to tell you something that changes everything about how we prevent heart attacks. For decades, the entire field was built on one target: lower LDL cholesterol. Statins save lives — that's settled science. But too many of my patients did everything right — took their statins, hit their numbers, lived clean — and still ended up on my table with a ruptured artery. We were treating the smoke while the fire kept burning. The fire is inflammation. And the evidence is now overwhelming. The CANTOS trial proved it first — lowering inflammation independent of cholesterol reduced cardiac events. But the newer data is what keeps me up at night. AI-enhanced CT angiography can now detect inflamed arteries by measuring changes in the fat surrounding your coronary vessels — the perivascular fat attenuation index. Higher inflammation in the fat around even one artery independently predicts cardiac death. When multiple arteries show inflammation, the risk multiplies dramatically — even in patients whose cholesterol looks perfect. This isn't theoretical. This is measurable. Right now. On a scan you can get this month. Low-dose colchicine — a drug that's been around for centuries for gout — is now FDA-approved specifically for reducing cardiovascular events. It works by quieting the inflammatory cascade that destabilizes the plaque sitting in your arteries. A pill that costs pennies is saving lives the statins couldn't reach. And the next wave is already in Phase 3 trials. Ziltivekimab — an IL-6 inhibitor — targets the central inflammatory pathway driving atherosclerosis. Phase 2 data showed a 90% reduction in hsCRP. The ZEUS cardiovascular outcomes trial is enrolling now, with results expected late 2026 into 2027. If positive, anti-inflammatory therapy will become standard in managing heart disease alongside lipid-lowering. The era of inflammation-targeted cardiology is arriving. But it goes deeper than drugs. AI is now predicting heart failure and cardiac events 5 years before symptoms — integrating CT imaging, electronic health records, and genetic data with accuracy that jumps far beyond traditional risk calculators. And polygenic risk scores — a simple genetic test that flags inherited cardiovascular risk — are now formally recognized as a risk-enhancing factor in the 2026 ACC/AHA guidelines. A single blood draw can reveal risk that's been silently building since birth. Decades before the first chest pain. Here's what this means for you right now — today: Ask your doctor for a high-sensitivity CRP test. It's cheap, routine, and measures the systemic inflammation that standard cholesterol panels completely miss. You can have perfect LDL and inflamed arteries that are quietly preparing to rupture. If your hsCRP is elevated, discuss low-dose colchicine with your physician. It's FDA-approved for exactly this. Push for a coronary CT angiography with AI plaque and inflammation analysis if you have risk factors. This isn't the stress test your parents got. This is 3D visualization of your actual arteries — with AI quantifying not just how much plaque you have, but what kind it is and whether the surrounding tissue is inflamed. Consider polygenic risk score testing — especially with a family history of early heart disease. It's now guideline-supported. And the foundation that never changes: move daily, eat real food, sleep 7-9 hours, manage stress, and know your numbers — ApoB, Lp(a), hsCRP, fasting insulin. I left Iran as a child with nothing. I rebuilt everything in a country that gave me the freedom to become a physician. I've spent twenty years watching patients get second chances. The ones who haunt me aren't the ones who died on my table. They're the ones who survived but never acted on what the science was telling them — years before the event that didn't have to happen. You can have perfect cholesterol and still have a heart attack. Inflammation plus genetics can drive plaque rupture in arteries that look "fine" on a standard panel. The myth that normal cholesterol means you're safe has cost more lives than I can count. We now have the tools to detect the fire — not just the smoke. AI to see it. Genetics to predict it. Drugs to quiet it. And the ancient basics — movement, real food, sleep, purpose — to prevent it from starting. Prevention is the new cure. And the science to make it real is no longer coming. It's here.

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🦔Uber's COO Andrew Macdonald said on Saturday that the company is having a harder time justifying its AI spend. After CTO Praveen Neppalli Naga went viral in April for admitting Uber burned through its 2026 Claude Code budget in four months, senior engineering leaders concluded higher token usage was not translating into proportionally more useful product. Macdonald said the link between AI consumption and shipped features is "not there yet." CEO Dara Khosrowshahi confirmed on the earnings call that Uber is slowing hiring to fund its AI spend. Duolingo also walked back its decision to include AI usage in performance reviews last month. My Take Uber is the first major enterprise where the C-suite has publicly admitted, on the record, that the AI productivity story is not closing for them. That matters because Uber is not a skeptic. The company went all-in on AI tooling, set internal targets, and burned through its annual research and development budget in four months trying to make it work. The conclusion from the people running the experiment is that tokens consumed and value shipped are not the same number, and management is finally noticing. Duolingo's reversal lands in the same week for a reason. CEO Luis von Ahn said employees were asking whether they needed to use AI just to use AI, which is Goodhart's Law showing up in a performance review system. When usage becomes the metric, employees optimize for usage, not output. Microsoft canceled internal Claude Code licenses, Google AI Pro stripped credits from paid subscribers, and now Uber is admitting the ROI does not close at scale. The narrative has shifted in the last 30 days from "AI productivity is here" to "AI productivity is harder to measure than we thought." The companies pushing tokenmaxxing internally are now the same companies signaling cost pressure externally. The IPO calendar for OpenAI and Anthropic is going to get a lot more complicated if the largest enterprise customers keep saying this out loud. Hedgie🤗

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