By: Steven Long DO, MS-HSA, NASM-CPT
Heart disease remains the leading cause of death in the United States, but modern tools—if used properly—give us unprecedented power to prevent it. At Beyond Health, we go far beyond basic labs and vague lifestyle advice. We use comprehensive, precision-based strategies rooted in the latest evidence to minimize cardiac risk and improve longevity.
This includes evaluating the full atherogenic process, assessing genetic and modifiable risk factors, leveraging modern diagnostics like coronary artery calcium (CAC) scoring, and, when appropriate, introducing medications such as statins, ezetimibe (Zetia), PCSK9 inhibitors, and antihypertensives. Together, these tools form a system—not a scattershot approach.
Atherosclerosis is not simply about “high cholesterol.” It is a complex process that begins with damage to the endothelium—the thin, delicate layer lining our blood vessels. This damage creates openings that allow atherogenic particles, particularly those containing apolipoprotein B (apoB), to enter the arterial wall.
There are two primary drivers of this endothelial damage:
Once injured, the endothelium becomes more permeable, allowing LDL and other apoB-containing lipoproteins to enter the subendothelial space. These particles undergo oxidation and trigger an immune response, recruiting macrophages and leading to foam cell formation, plaque buildup, and, eventually, obstruction or rupture.
This is not a one-time event—it’s a chronic, progressive process that can remain silent for decades until a sudden heart attack or stroke occurs.
Traditional markers like LDL-C do not measure particle number. That’s why we use apolipoprotein B, which represents a direct count of all atherogenic lipoproteins (including LDL, VLDL, IDL, and Lp(a)).
Another key marker: lipoprotein(a), a genetically determined lipoprotein similar to LDL but with a unique apolipoprotein(a) component. Lp(a) is:
An elevated Lp(a) level is an independent risk factor for coronary artery disease, aortic stenosis, and ischemic stroke—even in people with normal cholesterol.
Key Study: Tsimikas et al. (2016) showed that elevated Lp(a) was associated with increased risk of cardiovascular events independent of LDL-C or other traditional factors. [JAMA Cardiol. 2016;1(5):452–461. doi:10.1001/jamacardio.2016.1722]
CAC scoring is a non-invasive CT scan that quantifies calcified plaque in the coronary arteries. It is one of the most powerful predictors of future cardiovascular events.
Why we use it:
CAC scoring helps personalize treatment intensity and reassures both patient and provider when risk is unclear.
Medication plays a pivotal role in reducing cardiovascular risk—especially when used early and strategically.
Statins remain the gold standard for lipid-lowering. They:
Early use of moderate- to high-intensity statins in patients with elevated apoB or CAC score >0 can prevent years of silent atherosclerosis.
Zetia works by inhibiting intestinal absorption of cholesterol. It can:
The IMPROVE-IT trial demonstrated that the addition of ezetimibe to statin therapy reduced cardiovascular events more than statin alone in patients with recent ACS. [N Engl J Med. 2015;372:2387–2397. doi:10.1056/NEJMoa1410489]
PCSK9 inhibitors are powerful biologics that:
FOURIER trial showed a 15% reduction in cardiovascular events when PCSK9 inhibitors were added to statins in patients with ASCVD. [Sabatine et al., N Engl J Med. 2017;376(18):1713–1722]
Elevated blood pressure causes mechanical injury to the endothelium and accelerates the atherogenic process. Even modest blood pressure control yields enormous benefit.
The SPRINT trial found that intensive blood pressure control (SBP <120 mmHg) significantly reduced the risk of CV events and mortality. [SPRINT Research Group, N Engl J Med. 2015;373:2103–2116]
We combine the best of lifestyle, diagnostics, and pharmacology to tailor a prevention plan that is:
We also guide patients on:
It’s time to evolve beyond decades-old lab tests and generalized advice. Modern cardiac prevention means targeting the right risk factors, at the right time, with the right intensity.
At Beyond Health, we don’t just wait for disease—we intercept it. Through individualized risk profiling, advanced labs, early medication when warranted, and personalized lifestyle coaching, we help you build a longer, stronger life—artery by artery.
