Want to ensure your heart is ready for the long game? You are not alone. In this month’s THE PULSE, Dr. Sarah MacGregor focuses on our newest LONGEVITY PLUS offerings related to Heart Health: Coronary CT Angiography (CCTA) with Cleerly Plaque Analysis (CPA) and Precision Coronary Heart Disease (CHD) testing. CHD has been the leading cause of death in the United States for over a century. The good news is that most risk factors for heart disease are modifiable; that’s where the long game begins. The more we know, the better we can guide lifestyle changes, personalize care, and identify signs early. When it comes to your heart, playing the long game starts with addressing risks sooner rather than later. Our core membership is built around this strategy. As early adopters of cutting-edge screening technology, we are excited to include newer tools in our LONGEVITY PLUS offerings that assess CHD in a different way. But first, it is helpful to start with a refresher on coronary heart disease and our fundamental risk assessment.
What is Coronary Heart Disease?
Coronary heart disease, also known as coronary artery disease (CAD), is a condition in which the arteries that supply blood and oxygen to the heart muscle develop a buildup of fatty, cholesterol-containing material called plaque.
You can think of coronary arteries like fuel lines to the heart. Over years, plaque can build up slowly, leading to narrowing of these vessels (stenosis), so less blood reaches the heart. This can cause chest pressure or discomfort (angina), shortness of breath, or fatigue. Sometimes there are no symptoms. A heart attack can occur when plaque suddenly ruptures, and a blood clot forms, abruptly blocking blood flow to part of the heart muscle.
CHD is strongly linked with high cholesterol, high blood pressure, diabetes, smoking, inactivity, excess weight, and family history. This often develops silently, without symptoms, over many years – which is why preventing and treating these risk factors is crucial.
How do we assess CHD and CHD risk?
Your personal assessment will start with the basics. Based on your initial risk assessment, history, and interest in additional information, you will work with your physician to determine what type of testing might make the most sense for you and when.
Think of assessing your heart disease risk by gathering pieces of a puzzle. Some pieces are simple blood tests you may already know. Other pieces may involve imaging or newer technologies that look directly at your arteries or your genetic makeup.
Blood tests and reviewing traditional risk factors are the foundation and always a routine part of our assessment.
- Lipid panel – looks at total cholesterol, LDL (“bad”) cholesterol, HDL (“good”) cholesterol, and triglycerides
- Apolipoprotein B (apoB) – measures the number of “bad” cholesterol particles in your blood
- Lipoprotein (a) [Lp(a)] – genetically inherited marker. High levels roughly double your lifetime risk of heart attack or stroke
- Other risk enhancers: elevated inflammation markers, lipid particle number and size, and medical/family histories such as diabetes and smoking status
There are also imaging tests that can look at your arteries. This goes beyond the typical blood work to directly see whether plaque is present. As part of our overall risk assessment/annual exam, we frequently check coronary artery calcium (CAC) scans (sometimes referred to as a “heart scan”) once patients reach a certain age. This is a quick, non-contrast CT scan that looks for calcium in your heart’s arteries.
While all these items are extremely helpful in assessing CHD risks, the Longevity Plus tools can offer even more.
LONGEVITY PLUS CARDIOVASCULAR OFFERINGS
Let’s take a deeper dive into our more advanced LONGEVITY PLUS tests/technology.
A coronary CT angiography (CCTA) is a more detailed scan using contrast dye. This allows us to see not only calcium, but also soft plaque and narrowing in the arteries. It can find the presence of heart disease even when the calcium score is zero, which helps us decide how aggressively to treat a patient. Many of our members have taken advantage of this newer technology, with Cleerly Plaque Analysis, in the last few years.
More specialized, integrated genetic-epigenetic tests are also a useful piece of this puzzle. This is a specialized type of blood test that combines genetic data with epigenetic changes to DNA that occur because of lifestyle and environment. An example of this technology is Cardio Diagnostics Precision CHD testing. One goal of this type of testing is to help identify people who may appear at lower risk by more traditional measures but harbor significant plaque.
Coronary CT Angiography (CCTA) with Cleerly Plaque Analysis (CPA)
What is a CCTA?
As mentioned above, this is a specialized CT scan that uses intravenous (IV) contrast dye to create detailed images of the coronary arteries. This type of imaging allows us to directly see whether plaque is present, how much narrowing it causes, and what type of plaque it is.
Why might I consider a CCTA with CPA?
This kind of testing may be useful if you have:
- Multiple cardiovascular risk factors
- A strong family history of heart disease
- Abnormal or unclear results from other cardiac testing
- Chest pain/pressure, or unexplained shortness of breath
- Desire for a more detailed assessment of your coronary artery health
- Interest in a proactive approach to cardiovascular prevention
What can results from a CCTA with CPA show?
The CCTA with CPA will tell if any plaque is present throughout the arteries of your heart. It will also tell us if that plaque is calcified (low risk), non-calcified (soft), or low-density high lipid (higher risk of rupture). Most importantly, we can see where the plaque is in the heart arteries and how much narrowing (stenosis) the plaque is causing.
What can a CCTA with CPA tell me that is different from a regular calcium score?
Coronary artery calcium (CAC) score measures only calcified plaque. It does not show soft plaque or assess the degree of artery narrowing. Some studies show that 10-25% of patients with a calcium score of zero still have significant soft plaque, offering them a false sense of security.
CCTA visualizes the entire coronary artery. It can detect both calcified and non-calcified (soft) plaque. This test shows the location and severity of any arterial narrowing (stenosis) and can identify high-risk plaque features. Significantly more detailed information is provided.
Bottom Line
Coronary CT angiography is one of the most effective non-invasive tests available to directly evaluate plaque and narrowing in the arteries of the heart. This test helps us know how aggressively we need to manage your risks so we can prevent heart attacks from happening. The cost of CCTA testing with CPA is $1250.
Cardio Diagnostics: Precision CHD Testing
What is this test?
The Precision CHD test is a simple blood test that integrates genetics, epigenetics, and artificial intelligence (AI) to help predict the likelihood that CHD is present, without any radiation exposure or fasting. It also tells us if we are currently managing the environmental risk factors for CHD in the best way possible.
What are epigenetics? How is that different from our genetics?
Genetics refer to your inherited DNA sequence. This is largely fixed from conception and determines your basic biological potential – think eye color, blood type, and inherited risk for certain conditions. Epigenetics is how your environment talks to your genes. These are chemical modifications that sit on top of your DNA and can influence which genes are turned on or off without altering the underlying DNA sequence. DNA methylation is a type of epigenetic change that adds a small chemical group to DNA and either silences or turns on gene expression.
Unlike your DNA sequence, epigenetic marks are dynamic – they can change in response to your environment, behaviors, and even aging. Smoking, diet, stress, exercise, and pollution can all leave epigenetic signatures.
A significant amount of heart disease (up to 80%) comes from environmental stressors and lifestyle factors that have their own DNA methylation signatures.
Why does AI need to be involved in the Precision CHD?
Artificial intelligence allows the multi-dimensional epigenetic and genetic data to be interpreted without losing prediction power. AI models can allow for detection of hidden and overt patterns in data, such as genetic variation that affects DNA methylation.
How Does This Test Work and What Does It Tell Me?
This blood draw analyzes ten genetic and six epigenetic biomarkers. The patient results report either “Signal Detected” or “Signal Not Detected,” while the physician report will outline the specific molecular markers that are driving CHD risk. If a signal is detected, your physician will be able to target the specific area(s) needed to help further reduce your risk. If no signal is detected, then you can be reassured that you are doing the right things to keep your CHD risk low.
Since environmental and lifestyle factors are changeable, we can repeat this test after making changes. We can see these biomarkers improve as early as 12 weeks after adjusting our treatment! This test is a simple blood test that can help you and your physician optimize your specific risk factors to prevent a heart attack. We can also use it to monitor your response to the changes you and your physician have made with your lifestyle and medications. The cost of this test is $850.
How could the results change my care?
This is one of the most important questions I ask when ordering a test – how might these results change my management? Depending on the findings, we might recommend
- Continued monitoring and prevention
- More aggressive cholesterol management
- Dietary and lifestyle modifications
- Additional cardiac testing
- Referral to a cardiologist
- Medications to reduce future cardiovascular risk
With the help of your team at Priority Physicians, the more we know, the better we can play the long game. Be sure to talk to your physician about what makes the most sense for you during your annual exam or an upcoming appointment.
