By Paula Span, KFF Health News

A long list of Lynda Hollander’s paternal relatives had heart disease, and several had undergone major surgeries. So when she hit her mid-50s and saw her cholesterol levels creeping up after menopause, she said, “I didn’t want to take a chance.”

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A cardiologist told Hollander that based on factors like age, sex, cholesterol, and blood pressure, she faced a moderate risk of a major cardiac event, like a heart attack, within the next 10 years.

Doctors typically counsel such patients about the importance of diet and exercise, but Hollander, now 64, a social worker in West Orange, New Jersey, didn’t have much room for improvement. She was already a serious runner, and although “I fall off the wagon once in a while,” her diet was basically healthy. Attempts to lose weight didn’t lower her cholesterol.

Her doctor explained that a coronary artery calcium test, something Hollander had never heard of, could provide a more precise estimate of her risk of atherosclerotic heart disease. Her doctor explained that a coronary artery calcium test, something Ms. Hollander had never heard of, could provide a more precise estimate of her risk of atherosclerotic heart disease. A brief and painless CT scan, it would‌ indicate whether the fatty deposits called plaque were developing in the arteries leading to her heart.

When plaque ruptures, it can cause clots that block blood flow and trigger heart attacks. The scan would help determine whether Hollander would benefit from taking a statin, which could reduce plaque and prevent more from forming.

“The test is used by more people every year,” said Michael Blaha, co-director of the preventive cardiology program at Johns Hopkins University. Calcium scans quadrupled from 2006 to 2017, his research team reported, and Google searches for related terms have risen even more sharply.

Yet “it’s still being underused compared to its value,” he said.

One reason is that although the test is comparatively inexpensive — sometimes up to $300, but often $100 or less — patients usually must pay for it out-of-pocket. Medicare rarely covers it, though some doctors argue that it should.

Patients with a CAC score of zero — no calcification — have lower risk than their initial assessments indicate and aren’t candidates for cholesterol-lowering drugs. But Hollander’s score was in the 50s — not high but not negligible.

“It was the first indication of what was going on inside my arteries,” she said.

Though guidelines vary, cardiologists generally offer statins to patients with calcium scores over zero, and suggest higher intensity statins when scores exceed 100. At over 300, patients’ risks approach those of people who’ve already had heart attacks; they may need still more aggressive treatment.

Hollander has taken a low dose of rosuvastatin (brand name: Crestor) ever since, supplemented by a non-statin drug, a shot called evolocumab (Repatha).

This is the way calcium testing is supposed to work. It’s not a screening test for everyone. It’s intended only for selected asymptomatic patients, ages 40 to 75, who have never had a heart attack or a stroke and are not already on cholesterol drugs.

The test helps answer a pointed question: to statin, or not to statin.

If a doctor calculates the 10-year risk of atherosclerotic cardiovascular disease at 5% or lower, drugs are unnecessary for now. Over 20%, “there’s no doubt the risk is sufficiently high to justify medication,” said Philip Greenland, a preventive cardiologist at Northwestern University and co-author of a recent review in JAMA.

“It’s the in-between range where it’s more uncertain,” he said, including “borderline” risk of 5% to 7.5% and “intermediate” risk of 7.5% to 20%.

Why add another measurement to these assessments, which already incorporate risk factors like smoking and diabetes?

“A risk score is derived from a large population, with mathematical modeling,” Blaha explained. “We can say that this score describes the risk of heart disease among thousands of people. But there are lots of limitations in applying them to one individual.”

A calcium scan, however, produces an image of one individual’s arteries. Alexander Zheutlin, a cardiology fellow and researcher at Northwestern University, shows patients their images, so that they can see the lighter-colored calcifications.

Cardiologists tend to be fans of calcium testing, because they so regularly encounter patients who are reluctant to take statins. People who feel fine may hesitate to start drugs they’ll take for the rest of their lives, despite statins’ proven history of reducing heart attacks, strokes and cardiac deaths.

In 2019, a survey of almost 5,700 adults for whom statin therapy was recommended found that a quarter were not in treatment. Of those, 10% had declined a statin and 30% had started and then discontinued, primarily citing fear of side effects.

An American College of Cardiology expert consensus report recently put the rate of muscle pain, statin users’ most common complaint, at 5% to 20%. Researchers consider the fear of side effects overblown, citing studies showing that reports of muscle pain were comparable whether patients took statins or placebos.

“The actual risk is much, much lower than the perceived risk,” Zheutlin said.

That may be little comfort to people who are in pain, but cardiologists argue that reducing doses or switching to different statins usually solves the problem. Some patients will do better on a non-statin cholesterol drug.

Hollander, for example, suffered “muscle cramps that would wake me up at night.” Her doctor advised fewer doses, so Hollander now takes Crestor three days a week and self-injects Repatha twice monthly.

(Statins also carry a very low risk of a dangerous condition, rhabdomyolysis, that causes muscle breakdown, and they slightly increase the chance of diabetes.)

Some caveats: No one has undertaken a randomized clinical trial to show whether calcium testing eventually reduces heart attacks and cardiac deaths. That’s why, although several professional associations endorse calcium scans to help determine treatment, the independent U.S. Preventive Services Task Force has called the current evidence “insufficient” to recommend widespread use.

Such a trial would be expensive and difficult to mount, with many confounding variables. And pharmaceutical companies aren’t eager to underwrite one, since a successful result could mean that patients with zero scores avoid cholesterol drugs altogether.

But a recent Australian study of asymptomatic patients with family histories of coronary artery disease found that, after three years, those who had undergone calcium scans had sustained a reduction in cholesterol and a significantly lower risk of heart disease than those who had not been tested.

The test “leads to more statin prescriptions, better adherence to statins, less progression of atherosclerosis, and less plaque growth,” Greenland said of the study, in which he was not involved. “It tips the scale.”

Another concern: people age 75 and older. Most will have arterial plaque, making a scan’s benefit “less clear-cut,” said Zheutlin, lead author of a recent JAMA Cardiology article pointing out that CAC testing can be both overused and underused.

Because older adults face more chronic diseases and medical issues, cholesterol-lowering may become a lower priority. A study now enrolling participants over 75 should answer some questions about statins, calcium scans, and dementia in a few years.

Meanwhile, cardiologists see calcium scans as a persuasive tool.

“It’s incredibly frustrating,” Zheutlin said. With statins, “we have cheap, safe, effective drugs available at any pharmacy” that help prevent heart attacks. If CAC test results prove more influential than traditional risk assessments alone, he said, more patients might agree to take them.

A calcium scan helped Stephen Patrick, 70, a retired tech executive in San Francisco, reach that point. “For years, I was borderline on cholesterol, and I managed to beat it back with less cheese toast” and lots of exercise, he said. “I was on no meds, and I took pride in that.”

Last fall, with both his total and his LDL cholesterol higher than recommended, his doctor suggested a calcium scan. His score: 176.

He’s taking atorvastatin (Lipitor) daily, and his cholesterol levels have dropped dramatically. “I might have tried it anyway,” he said. “But the calcium score meant I had to pay more attention.”

The New Old Age is produced through a partnership with The New York Times.

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By Ashley Miznazi, Miami Herald

MIAMI — From the front yards of West Miami-Dade to the waterfront mansions of Fort Lauderdale, artificial turf is appearing more and more.

And with the spread of artificial turf comes a mounting number of questions and criticisms — about everything from how it looks to how it impacts the environment, the climate and even human health. This stuff, made of plastic, can get absolutely skin scorching in the extreme heat of a South Florida summer.

But some homeowners still prefer it over natural, said Yoandy Perez, who has installed artificial turf at multiple homes in one East Hialeah neighborhood because they like that it looks neat year-round and saves on landscaping costs.

“The city doesn’t like concrete, but they want green,” said Perez. “Many places here are just sandy soil and construction fill. The clients prefer the turf.”

Now, a new state law has opened the multibillion-dollar artificial grass industry to what could be a big expansion, with lawmakers moving to forbid cities from banning fake grass in front yards. In Hialeah, turf is allowed with proper permits. But several South Florida cities and towns — including Coral Gables, Miami, Miami Lakes and Pembroke Pines — allow fake grass only out of sight in back or side yards.

But researchers and city governments say there are many downsides to expanding Florida’s fake grass footprint. Scientists warn that the synthetic plastic grass blades (beyond being made from petroleum) are not well suited for the warmer and wetter world the state is already experiencing from climate change. Artificial grass also can become extremely hot, doesn’t have the best drainage and isn’t easy to recycle.

Then there’s aesthetics of it. There have been years of fake vs. real disputes, including in Miami. When the real stuff along Brickell Avenue was ripped out and replaced with artificial, residents protested until the Miami officials agreed to remove the $230,160 project.

For now, despite the new law, the future of fake grass remains in a bit of a flux. This week, the Florida Department of Environmental Protection, or DEP, started accepting public comments and working on rule-making for turf on residential properties. Coral Gables and Miami Lakes officials told the Herald they are holding off changes to their permitting process until the state releases those standards.

“Once released, the Town will compare the State’s standards with the existing Town ordinance,” said Daniel Angel, Miami Lakes’ zoning director.

Fake can feel baked

In sun-drenched places like Miami, where extreme heat warnings are common, you can often feel the difference between fake and real. Natural grass tends to cool thing off. And that’s not just what you or your dog might feel under your feet. University of Florida assistant professor Marco Schiavon, who is based in Fort Lauderdale, said widespread use of synthetic grass could contribute to even higher local temperatures.

“What surprised me was that artificial turf grass on stadiums was often, if not always, warmer than the parking lot right next to it,” Schivaon said. He said he’s measured artificial turf to be as much as 100 degrees hotter than real grass.

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Earlier this week, with partly cloudy skies and the air temperature at 91 degrees, the Herald conducted its own check using an infrared thermometer. The results were not quite as extreme but still striking: In many locations, artificial turf measured nearly 40 degrees hotter than natural grass.

At the dog park at Margaret Pace Park in Miami, the turf reached 150 degrees, while the grass nearby was 112. That was not the only issue. Kevin Lopez, who came with his German shepherd mix Cosmo, said, “The smell is worse on the turf, and the poop just sticks.”

Aida Curtis, a landscape architect with 40 years of local experience, said she refuses to use artificial turf in her designs because of how it absorbs heat and is a danger to children, dogs and the environment and is a “liability waiting to happen.”

“We’re already into the problem of climate change. Severe high temperatures, more rain, and rather than going back to nature, like putting grass, we’re removing a natural system to put an artificial system,” Curtis said.

Spraying the turf with water, common before many sports events. can cool it down but also tamps down on a benefit that the industry highlights — that it doesn’t need watering.

“You are replacing turf grass with artificial for water conservation, but then you find yourself watering a piece of plastic in order to have that piece of plastic functional, and at that point, you have lost all the environmental benefits,” said UF’s Schiavon.

Soccer player Andy Rodriguez practices at the Little Haiti Soccer Park, which is covered with artificial turf at noon where temperatures measured several degrees higher than in the natural turf covered areas, on July 29, 2025. (Pedro Portal/Miami Herald/TNS)

A rainstorm over a Little Haiti soccer field showed the difference water can make, but it’s still hotter than the real stuff. After the storm, the artificial turf field was 120 degrees and the grass right beside it was 96 degrees — a 24-degree difference.

“You can see the heat radiating from the turf,” said Anthony Rodriguez, a 16-year-old playing for the first time at the soccer field.

But the fake grass does have one upside in a heat wave, according to the artificial turf industry. It looks good. It won’t dry up and turn patchy — its color remains pristine green.

Drainage questions

While the newer, artificial turf is designed with drainage holes, some experts say it’s still not enough for the stronger and wetter storms Miami is prone to have because of climate change.

Jason Kruse, an associate professor of turfgrass science at the University of Florida, said fake grass takes an area that would’ve been naturally permeable and reduces its infiltration potential.

“Because of the rainfall that we get in Florida, we need a place for that water to go. And if we can infiltrate it into the profile, that’s better for everybody, because it gets down to the aquifer and we don’t have to deal with it in the stormwater system,” he said. “ I suspect that if we were to see more installation of synthetic turf that may result in more runoff, which could have some consequences that we’re not really thinking about at the moment.”

It’s important to note that there are different standards of turf in the industry that could be better suited for water, Kruse said. Bigger sports fields are usually evacuated and then storm drainage is added underneath in those cases, he said.

Real grass, on the other hand, helps with drainage and a healthy soil microbiome. Kruse said the roots open up pathways underground that loosen the soil undergrowth, and leave a channel water can seep through.

“You do see increased infiltration over time with these established root zones,” he said.

While synthetic turf lacks the ecological benefits of natural grass, Goodman, Perez and others in the industry point to how it doesn’t require any pesticides or fertilizer, which drive many of the state’s water pollution problems.

But scientists told the Herald that while it eliminates fertilizer run-off, there is concern of the grass breaking down over time and contributing to micro-plastic pollution in our waterways.

Juan Jose waters the artificial turf in the front of his house in the East Hialeah, Florida, area, where this kind of material installation is in high demand in the area, on July 29, 2025. (Pedro Portal/Miami Herald/TNS)

Landfill-bound

Artificial grass has a lifespan of about eight to 10 years, and after that, most of it goes to the landfill. Some companies specialize in artificial grass recycling, such as Artificial Grass Recyclers, but Kruse said they aren’t always regionally accessible.

“It’s not cost-effective to transport it to a location where they can recycle it. So most of these products end up in landfills at the end of life,” Kruse said.

Whatever the concerns, artificial turf does offer a quick fix to someone who wants a good looking lawn out front. One homeowner in Hialeah said he took a DIY approach to recycling old turf in his yard. Juan José explained that his son salvaged some artificial turf from a job where it was being removed, and they installed it themselves last year.

“We like how it looks much more,” he said. “We plan to get the rest of the yard done this year.”

Sean Goodman, the owner of Royal Synthetic Turf, which is based in South Florida, said lawmakers made the right call in responding to consumer demand. The restrictions by some cities hurt business because most customers want entire lawns redone, not just a piece of it.

“If the customer wants the entire house with artificial turf,” he said, “we should be able to do it.”

©2025 Miami Herald. Visit miamiherald.com. Distributed by Tribune Content Agency, LLC.

CATHERINE DANG: Presents her novel “What Hunger,” in conversation with Josh Moehling. 7 p.m. Tuesday, Magers & Quinn, 3038 Hennepin Ave. S., Mpls.

LAROCHELLE/MUSKE: David LaRochelle and Colleen Muske sign copies of their new children’s picture book “How To Draw a Tree.” 10-11:30 a.m. Friday, Lake Country Booksellers, 4766 Washington Ave., White Bear Lake.

John Gaspard (Courtesy of Minnesota Mystery Night)
Jim Cunningham (Courtesy of Minnesota Mystery Night)

MINNESOTA MYSTERY NIGHT: Magic and illusion on the page and stage is the theme for this month’s MMN program featuring John Gaspard and Jim Cunningham. Gaspard is the award-winning author of 10 Eli Marks mysteries, the latest of which is “Twisting the Aces,”  and Como Lake Players mystery series as well as “Held Over,” a retrospective about the two-year run of “Harold and Maude” at the Westgate Theater in Edina. He’s also a screenwriter and filmmaker. St. Paul native Cunningham is an actor who most recently played Groucho in the world premiere of Jeffrey Hatcher’s “Groucho Marx Meets T.S. Eliot” at Illusion Theater. He has played James J. Hill for the Minnesota Historical Society and narrates audiobooks, including the Eli Marks series. 7 p.m. Monday, Lucky’s 13 Pub, 1352 Sibley Memorial Highway, Mendota. $13. Reservations required. Go to mnmysterynght.com. Dinner service begins at 5:30 p.m.

BRANDY SCHILLACE: Discusses “The Dead Come to Stay,” a cozy crime novel featuring an amateur autistic sleuth and a wry English detective. The Ohio-based autistic author is a historian and editor. In conversation with Minnesota crime writer Matt Goldman. 7 p.m. Wednesday, Magers & Quinn, 3038 Hennepin Ave. S., Mpls.

What else is going on

Friends of the St. Paul Public Library announced “Evidence of V” by Sheila O’Connor as the fall pick for One Book/One Minnesota, the statewide book club inviting Minnesotans of all ages to read a common title and come together virtually to enjoy and discuss. The reading period continues though Sept. 28, with a virtual conversation with the author at 7 p.m. Sept. 17. O’Connor’s widely praised, genre-jumping 2019 book, subtitled “A Novel In Fragments, Facts, and Fictions,” is based on how she discovered her mother was born to a 15-year-old inmate of the Minnesota Home School for Girls in Sauk Centre. All Minnesotans are invited to access a free ebook edition of “Evidence of V.” Go to thefriends.org.

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(Courtesy of Berkley / Penguin Random House)

“Matchmaking for Psychopaths”: by Tasha Coryell (Berkley, $29)

People frequently assumed that our clients were ugly or strange and that was why they struggled to find love; often it was the opposite. Strange people found one another. — from “Matchmaking for Psychopaths”

“This book is bat— crazy.”

Tasha Coryell (Emily Covington / Penguin Random House)

That’s one reader’s online opinion of Tasha Coryell’s quirky novel “Matchmaking for Psychopaths,” and the St. Paul author considers it a compliment to her story about Lexie, a matchmaker whose niche is pairing psychopaths. She’s well-suited to the job because her parents were serial killers who lured young women to their deaths. Now Lexie’s father is dead, her mother in prison, and she discovers on her 30th birthday that her best friend and her fiance are in love. As if that isn’t enough for the poor girl, she starts receiving bloody packages that seem to have something to do with her murderous parents. She’s lonely, so she’s happy when a new woman friend comes into her life who seems too good to be true.

What is this book?

“I’d say it’s a thriller with literary touches and horror elements,” Coryell says in a phone conversation from her home in Highland Park, where she lives with her husband, 3-year-old son and a greyhound.

“One of the things I tried not to do is self-censor,” she explains. “If you go into writing worried about going over the top it’s easy to shut down. You have to go for it. I don’t want to write about anything where children or animals get hurt. In some instances I had to stop reading thrillers because they were so heavy. I knew when I wrote this story that it had to be crazy but come out happy.”

Coryell’s widely praised debut novel, “Love Letters to a Serial Killer,” is about a woman who writes to an accused serial killer and moves in with him after his acquittal, grappling with her feelings for him while secretly investigating his background. Like “Matchmaking for Psychopaths,” it’s a multi-genre thriller/horror/humorous story.

After the success of “Love Letters,” Coryell and her editors were kicking around ideas for a second book, including the author’s love of reality TV shows like “Love Island,” and somehow the conversation turned to psychopaths and matchmaking.

“I was open to the idea. It was a good airing for serial killers.” she recalled.

Coryell didn’t do a lot of research into psychopaths, a term that is not used by mental health professionals. To depict how Lexie figured out which of her clients fit the description, she got help from Canadian psychologist Robert Hare’s textbook that gives a checklist of psychopathic traits.

“Psychopaths in general are good at convincing people to like them,” she says. “They know what people want. They’re gregarious, fun to be around.”

Coryell, who is expecting a baby in September, is deep into writing her next novel set in a milieu similar to her previous books.

She will sign copies of “Matchmaking for Psychopaths” with Sam Tschida, who also writes mystery mashups, at 3 p.m. Aug. 23 at Barnes & Noble, 11500 Wayzata Blvd., Minnetonka, and will join fellow thriller writers Andrew DeYoung, Kathleen West, Katrina Monroe and Tschida for a panel discussion at 3 p.m. Sept. 6 at Avant Garden Bookstore, 215 E. Main Street, Anoka.

(Courtesy of Harpers Ferry Park Association)

“Between These Rivers”: by Kathleen Ernst (Harpers Ferry Park Association, $9.95)

The two rivers surrounding this story by an experienced Wisconsin author are the Potomac and the Shenandoah that flow through the legendary scenery around Harpers Ferry, W. Va. It’s 1895, and two very different young women form an unlikely friendship that withstands the hatred of many white people for their Black neighbors decades after the end of the Civil War. Ida Mae Parker’s family belongs to what we would call today the Black middle class. Her stern parents, who insist on education and upholding their conduct to the highest standard, want her to be a teacher. She wants to sing onstage. Hazel Whitaker, who is white, is shoved out of her family home by her stepfather when she’s only 15 because there are too many mouths to feed. The young women meet at a resort hotel where Ida Mae works and Hazel collects rags she sells to make money.

Ida Mae has never directly faced discrimination, but when her brother’s newly constructed hotel is burned, she follows a male friend to civil disobedience in a railroad car and pays the price. Hazel is fascinated by a photographer working at an island carnival and is soon learning from him how to take lifelike photos instead of staid, posed ones. Her dream is to take over his business.

Ernst is a social historian, educator and bestselling author of more than 40 novels, including the Hanneke Bauer historical mystery series and the Chloe Ellefson mysteries. Her children’s books include 20 titles for American Girl. “Between These Rivers” could easily fit into the young adult category.

“The Duke of Buccleuch”: by A.S. Lorde (Sea Goat Press, $30)

Subtitled “Nick Carraway writes The Great Gatsby,” this second novel by a Texas-based writer tells of what happened to Carraway (narrator of Scott Fitzgerald’s “The Great Gatsby”) during the two years after Jay Gatsby was found shot to death in his swimming pool in New York.

Returning to St. Paul after national publicity attaching Carraway’s name to involvement with the murder of a bootlegger, the young man is not well received by his wealthy family’s social group. He lives at the University Club and is engaged to his former girlfriend. But he’s really in love with professional golfer Jordan, Daisy’s best friend in “Gatsby.” The story is a mash-up of parts of Fitzgerald’s real life and characters and settings in the original novel. And there are revelations about Daisy and Gatsby that will surprise readers. Although this story can be read without any knowledge of “The Great Gatsby,” Fitzgerald fans can spend hours debating whether he would approve of this take on what happened after the Gatsby magic was gone.

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