DON'T JUST ESTIMATE RISK. LOOK FOR DISEASE EARLIER.

Cardiovascular disease can develop silently for decades.

A heart attack is often treated as an acute event.

But the disease that led to it may have been developing for years—or even decades.

Atherosclerosis begins long before symptoms appear, and many people feel completely well while plaque is accumulating within their coronary arteries.

Blood pressure, cholesterol, family history and other risk factors help estimate risk.

But a longevity-focused cardiovascular strategy asks another important question:

IS ATHEROSCLEROSIS ALREADY PRESENT?

The objective is to identify cardiovascular risk—and, when appropriate, evidence of disease—early enough to do something about it.

Cardiovascular testing shouldn't begin with a scan. It should begin with you.

No single laboratory test or imaging study tells the entire story.

A comprehensive cardiovascular assessment begins by understanding the factors that influence your individual risk.

These may include:

Age & Sex

Family History

Blood Pressure

Smoking & Tobacco Exposure

Diabetes & Metabolic Health

Body Composition & Visceral Fat

Physical Activity & Fitness

Sleep & Sleep Apnea

Kidney Disease

Cholesterol & Lipoproteins

Inflammatory and other selected biomarkers

And importantly:

Whether cardiovascular disease or atherosclerosis has already been identified.

Know your risk before deciding what to measure next.

The standard lipid panel tells us part of the story.

Traditional cholesterol testing typically includes:

Total Cholesterol

LDL-C

HDL-C

Triglycerides

These measurements remain useful.

But cardiovascular risk assessment can go further.

ApoB

COUNT THE PARTICLES THAT DRIVE ATHEROSCLEROSIS.

Atherosclerosis is fundamentally related to the entry and retention of ApoB-containing lipoprotein particles within the arterial wall.

Apolipoprotein B—or ApoB—provides an estimate of the number of these atherogenic particles circulating in the blood.

That makes ApoB particularly useful when trying to understand atherosclerotic cardiovascular risk.

Two people can have similar LDL cholesterol levels while having different numbers of ApoB-containing particles.

LDL-C TELLS US HOW MUCH CHOLESTEROL IS BEING CARRIED.

ApoB HELPS TELL US HOW MANY ATHEROGENIC PARTICLES ARE CARRYING IT.

For a longevity-focused cardiovascular assessment, that distinction matters.

Lp(a)

ONE TEST MAY REVEAL A RISK YOU WERE BORN WITH.

Lipoprotein(a), or Lp(a), is a largely genetically determined lipoprotein associated with increased risk of atherosclerotic cardiovascular disease and aortic valve disease.

Lifestyle changes generally have limited effect on Lp(a) concentration.

That means someone can exercise, eat well, maintain a healthy weight and still have elevated Lp(a).

Because levels are primarily inherited and relatively stable, measuring Lp(a) at least once can identify an important risk factor that might otherwise remain hidden.

YOU CAN'T SEE GENETIC CARDIOVASCULAR RISK BY LOOKING AT SOMEONE.

Knowing it is present can change how the rest of the cardiovascular risk picture is interpreted.

RISK FACTORS ARE NOT THE SAME AS DISEASE

This distinction changes how we think about testing.

Blood pressure, ApoB, Lp(a), diabetes, smoking and family history tell us about the likelihood of developing cardiovascular disease.

They are extremely important.

But they do not directly tell us:

IS THERE PLAQUE IN MY CORONARY ARTERIES?

For selected individuals, cardiovascular imaging can help answer that question.

CAC CAN SHOW THAT CORONARY ATHEROSCLEROSIS IS ALREADY PRESENT.

A coronary artery calcium scan—or CAC—is a low-dose CT scan that detects and quantifies calcified plaque within the coronary arteries.

A higher calcium burden is generally associated with greater cardiovascular risk.

CAC can be particularly useful when cardiovascular risk is uncertain and the result may influence prevention decisions.

But CAC has an important limitation.

Atherosclerosis does not begin as calcification.

Plaque can exist before it becomes calcified.

A CAC score of zero can therefore be reassuring in the appropriate context—but it does not mean that coronary atherosclerosis is impossible.

CAC DETECTS CALCIFIED PLAQUE.

IT DOES NOT DIRECTLY CHARACTERIZE ALL CORONARY PLAQUE.

CCTA

LOOK AT THE CORONARY ARTERIES THEMSELVES.

Coronary CT angiography—or CCTA—provides a different type of information.

Using CT imaging and intravenous contrast, CCTA allows visualization of the coronary arteries and can identify coronary plaque and narrowing.

Unlike a calcium score alone, CCTA can demonstrate both calcified and non-calcified plaque.

It can help answer questions such as:

Is coronary plaque present?

Where is it located?

How extensive is it?

Is the plaque calcified or non-calcified?

Is there narrowing of the coronary artery?

This provides a more direct assessment of coronary atherosclerosis than risk factors alone.

RISK FACTORS ESTIMATE. CCTA CAN VISUALIZE.

STRESS TESTING

A NORMAL STRESS TEST DOES NOT MEAN PLAQUE-FREE ARTERIES.

This is one of the most important distinctions in cardiovascular testing.

Stress testing is primarily designed to identify whether coronary disease is producing physiologically important limitations in blood flow under stress.

That is useful information.

But it answers a different question from coronary imaging.

A person can have coronary atherosclerosis without having enough obstruction to produce an abnormal stress test.

A NORMAL STRESS TEST CAN MEAN BLOOD FLOW IS ADEQUATE.

IT DOES NOT NECESSARILY MEAN THERE IS NO CORONARY PLAQUE.

NORMAL STRESS TEST ≠ PLAQUE-FREE ARTERIES

That distinction matters because many heart attacks are caused by plaque disruption and thrombosis—not simply by the gradual progression of a severely narrowed artery.

The objective of preventive cardiovascular assessment is therefore not only to identify arteries that have already become severely obstructed.

It is also to identify atherosclerotic disease earlier.

CLEERLY

FROM SEEING PLAQUE TO CHARACTERIZING IT.

Advanced coronary CT analysis can provide additional information beyond the conventional interpretation of a CCTA.

Cleerly uses artificial intelligence to analyze CCTA images and quantify coronary plaque.

Depending on the study and analysis, this can provide information about:

Total Plaque Burden

Calcified Plaque

Non-Calcified Plaque

Plaque Distribution

Coronary Stenosis

and other plaque characteristics.

The important point is not the technology itself.

It is the ability to move from:

“DO I HAVE A BLOCKAGE?”

toward a broader question:

“HOW MUCH ATHEROSCLEROSIS DO I HAVE?”

Cleerly does not perform the CT scan itself.

The CCTA is performed at an appropriate imaging facility, and the imaging data can then be analyzed using Cleerly's technology when available and appropriate.

ATHEROSCLEROSIS DOESN'T BEGIN WITH A BLOCKAGE.

Cardiovascular disease is better understood as a process.

ApoB-containing particles enter and become retained within the arterial wall.

Plaque develops.

Plaque burden increases.

Some plaque becomes calcified.

Some lesions may eventually produce significant narrowing.

And some plaques may become disrupted, triggering thrombosis and an acute cardiovascular event.

ATHEROSCLEROSIS → PLAQUE → PLAQUE BURDEN → STENOSIS / PLAQUE DISRUPTION → EVENT

Waiting until symptoms or severe obstruction appear means entering this process relatively late.

A longevity strategy tries to identify the process earlier.

YOUR HEART AND ARTERIES ARE ONLY PART OF CARDIOVASCULAR HEALTH.

Cardiorespiratory fitness provides another important dimension.

One of the best objective measurements is:

VO₂ MAX

VO₂ max measures the body's ability to take in, transport and utilize oxygen during maximal exercise.

It reflects the integrated function of the:

Heart

Lungs

Circulation

Blood

Skeletal Muscle

It therefore provides information that cannot be obtained from a cholesterol panel or CT scan.

Cardiovascular longevity isn't simply about avoiding plaque.

It is also about maintaining the physiological capacity to live an active life.

DISEASE BURDEN AND PHYSICAL CAPACITY BOTH MATTER.

NO SINGLE TEST IS A CARDIOVASCULAR STRATEGY

THE VALUE COMES FROM PUTTING THE INFORMATION TOGETHER.

A comprehensive cardiovascular picture may incorporate:

Blood Pressure

ApoB

Lp(a)

Traditional Lipids

Glucose & HbA1c

Body Composition & Visceral Fat

Smoking History

Family History

Physical Activity

VO₂ Max

CAC when appropriate

CCTA when appropriate

Advanced plaque analysis when appropriate

The objective isn't to perform every cardiovascular test on every person.

It is to determine:

WHAT DO WE ALREADY KNOW?

WHAT DON'T WE KNOW?

WHAT INFORMATION WOULD ACTUALLY CHANGE WHAT WE DO NEXT?

CARDIOVASCULAR TESTING & LYVYNG

KNOW YOUR RISK. KNOW YOUR PLAQUE. KNOW YOUR CAPACITY.

Cardiovascular Disease is one of the Four Horsemen evaluated within LYVYNG.

Your cardiovascular profile can bring together multiple layers of information:

RISK

Family history · Smoking · Blood pressure · Diabetes · Metabolic health

↓

BIOMARKERS

ApoB · Lp(a) · Lipids · HbA1c

↓

BODY COMPOSITION

Visceral fat · Lean mass · Waist circumference

↓

IMAGING

CAC · CCTA · Advanced plaque analysis when appropriate

↓

FITNESS

VO₂ max · Exercise capacity

↓

TACTICS

Exercise · Nutrition · Sleep · Medical therapy when appropriate

↓

The objective isn't simply to generate more cardiovascular data.

It is to use the right information to identify risk earlier, determine what deserves attention and measure whether your strategy is changing your trajectory.

[ START MY FREE HEART HEALTH ASSESSMENT ]

A SINGLE RESULT IS A SNAPSHOT.

CARDIOVASCULAR HEALTH IS A TRAJECTORY.

Blood pressure can change.

ApoB can change.

Metabolic health can change.

VO₂ max can change.

And with appropriate imaging and clinical guidance, changes in coronary plaque burden may sometimes be evaluated over time.

The important question isn't simply:

“IS MY TEST NORMAL?”

It is:

“AM I CHANGING MY CARDIOVASCULAR TRAJECTORY?”

RISK → MEASURE → INTERVENE → TRACK → REASSESS

START BEFORE SYMPTOMS.

DON'T WAIT FOR CARDIOVASCULAR DISEASE TO ANNOUNCE ITSELF.

Know your risk.

Measure the factors that matter.

Look for disease when appropriate.

Build cardiovascular fitness.

And take action early enough to change what happens next.

NORMAL STRESS TEST ≠ PLAQUE-FREE ARTERIES

DON'T JUST ESTIMATE RISK. LOOK FOR DISEASE EARLIER.

[ START MY FREE HEART HEALTH ASSESSMENT ]

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