Most heart attacks happen to people who were never told they were at high risk. Often that is not because the risk was invisible. It is because the only things measured were a total cholesterol, an LDL and a blood pressure reading taken on the day.
A preventive heart risk assessment looks further. This page explains what one involves, what each part adds, and how the Cardio Res-Q assessment at YoungerMeMD is put together.
Key takeaways
- A preventive heart assessment looks beyond a basic cholesterol and blood pressure check.
- A risk calculator estimate describes the average person with your numbers and is only a starting point.
- Your history and added labs such as ApoB, Lp(a), hs-CRP and insulin help explain why risk may be higher than it looks.
- Imaging such as a calcium score can show whether risk factors have already left a mark on the arteries.
- EndoPAT is not a general screening test, and Cardio Res-Q does not replace cardiology when that is needed.
Step one: the risk estimate
Every assessment starts with the basics: age, sex, blood pressure, cholesterol, blood sugar, smoking, kidney function and weight. Many clinicians combine these in a risk calculator. In US guidelines that is now the AHA's PREVENT equations, which estimate your chance of a heart attack or stroke over the next 10 years.1 Dr. Varano does not use the PREVENT calculator in Cardio Res-Q.
That estimate is a starting point, not an answer. It describes the average person with your numbers, and it can be wrong in either direction for you in particular. The rest of the assessment is about narrowing that uncertainty.
Step two: your history
Some of the strongest information comes from a conversation, not a lab:
- Family history: a father or brother with heart disease before 55, or a mother or sister before 65.
- Pregnancy history: preeclampsia, gestational diabetes or early menopause, all of which raise later heart risk in women.
- Inflammatory and autoimmune conditions, such as rheumatoid arthritis, lupus and psoriasis.
- Metabolic signals: waist size, insulin resistance, fatty liver and sleep apnea.
- Erectile dysfunction, which in men can be an early sign of vascular disease.
Step three: labs that go beyond a standard panel
A standard lipid panel measures cholesterol. A preventive panel adds the markers that explain why risk might be higher than it looks:
- ApoB, which counts the cholesterol-carrying particles that cause plaque;
- Lp(a), an inherited risk factor, usually measured once;
- hs-CRP, a marker of inflammation;
- fasting insulin, glucose and A1c, to find insulin resistance before it becomes diabetes;
- kidney function, homocysteine and other markers, as indicated.
In Cardio Res-Q, this includes the Cleveland Heart cardiac panel, which reports Lp(a), ApoB, hs-CRP, oxidized LDL and small dense LDL, plus other proprietary markers. Your provider walks you through each result.
Step four: looking at the arteries
Labs describe risk factors. Imaging shows whether those factors have already left a mark. The Enhanced Assessment adds two studies:
- A coronary artery calcium (CAC) score, a low-dose CT that detects calcified plaque in the heart's arteries. It is the strongest single test for refining risk in people without symptoms.
- A CIMT ultrasound of the neck arteries, performed in our office, which looks at wall thickness and early plaque.
EndoPAT: how well your arteries respond
Plaque is a structural change. Before it forms, and alongside it, the inner lining of the arteries (the endothelium) can lose some of its ability to widen when blood flow increases. This is called endothelial dysfunction, and it is one of the earliest measurable changes in vascular health.2
EndoPAT measures it. Sensors on your fingertips record the pulse before and after a blood pressure cuff on your arm is inflated for five minutes. How strongly the blood vessels respond when the cuff is released gives a score called the reactive hyperemia index. The test is non-invasive and done in our office by our cardiac technician. It is an add-on that is not included in the $775 or $999 assessment price.
What it does and does not do:
- It measures how the arteries function, not how much plaque is present. That makes it a complement to CAC and CIMT, not a substitute.
- In research studies, lower scores have been linked to a higher rate of future heart events.
- It is not a general screening test and is not recommended for routine risk assessment in everyone. We use it selectively, when your provider thinks vascular function would change the plan, and to follow response to treatment over time.
Step five: the plan
An assessment is only worth doing if it changes what happens next. Your results are brought together into one picture and one plan. That covers lipids and ApoB, blood pressure, insulin resistance, inflammation, sleep, activity and nutrition, and, where appropriate, medication. It also sets a schedule for what gets rechecked and when.
Cardio Res-Q is preventive care. It is not a substitute for cardiology when that is what is needed. If anything in your results points to a heart problem that needs specialist care, we will tell you and help coordinate it.
Which assessment fits
Both Cardio Res-Q assessments include Dr. Varano's clinical evaluation, the full advanced lab panel (including the Cleveland Heart panel) and a personalized plan.
- Comprehensive Initial Assessment, $775: labs, history and a personalized strategy.
- Enhanced Assessment, $999: everything above, plus CIMT ultrasound and a coronary calcium score.
See the full details on the Cardio Res-Q program page.
Are You a Candidate for Cardio Res-Q?
Three quick questions about the risk factors we screen for. Your answers stay between you and the clinic.
Frequently asked questions
I already see a cardiologist. Is this for me?
Cardio Res-Q is built for prevention in people without established heart disease, or people who want a deeper look at their risk factors. If you are under a cardiologist's care, we can share results with them. Your cardiologist remains in charge of treating any diagnosed heart condition.
Is this covered by insurance?
No. The assessment is direct-pay, which lets us provide comprehensive, time-intensive care without insurance constraints.
I have chest pain. Should I book an assessment?
No. Chest pain, pressure, shortness of breath or pain spreading to the arm or jaw need urgent medical evaluation. If symptoms are happening now, call 911. See when to seek care.
Related reading
This article is for general education and is not medical advice. If you have chest pain or other symptoms of a heart attack, call 911.
