Dear Reader,

I never expected to uncover my own risk for heart disease in pregnancy. But that’s exactly what happened. You can hear my story HERE in a TEDx talk I gave in 2024.

During my pregnancies, I developed insulin resistance, then later preeclampsia with severe features. At the time, I was told these were pregnancy complications—but what I wasn’t told was that they were also serious warning signs for future diabetes, heart disease, dementia, kidney disease, and early death.

No one connected the dots. No one explained that these conditions were like an early smoke alarm for my metabolic and cardiovascular system. If I hadn't been a physician I may not have started looking deeper and asking questions that allowed me to realize how much we’re missing in "preventative" medicine, especially concerning the cardiovascular system.

For years, the medical field has focused on treating disease after it happens rather than preventing it from developing in the first place. We use risk calculators that don’t account for genetics, metabolic dysfunction, or pregnancy history. We tell people they are fine if their numbers “look okay” without measuring what’s happening inside their arteries. But I know we can do better. It's time to break the cycle.

I believe we can radically change people’s lives by shifting from a reactive to a proactive approach to heart health. That’s why I do the work I do today—and why I want to share these stories with you.

Because February is American Heart Month, I’ll be sharing four real stories of people who thought they were low risk—until they learned the truth. I hope these stories will help you think differently about your heart health and inspire you to take action before a crisis happens.

Dr. Loden

He Wanted a Second Opinion—What We Found Changed Everything

Mike* was 47 years old, active, and completely symptom-free.

He came to me as a new patient, looking for a second opinion about his risk for cardiovascular disease.

“I feel like I’m doing everything right,” he told me. “But my dad had a heart attack at 52, and my uncle needed bypass surgery in his 50s. Mike was also African American—which he knew put him at higher risk for heart disease.

Despite that, his previous doctor reassured him: “Your cholesterol looks good, your blood pressure is normal, and your ASCVD risk score is low. You don’t need to worry.”

But Mike didn’t just want reassurance. He wanted the facts.

His Numbers Looked Good—But They Didn’t Tell the Whole Story

We ran the numbers again.

His ASCVD risk score was 4.4%—well below the 7.5% threshold where most doctors recommend cholesterol-lowering medication.

His cholesterol and metabolic markers were considered ‘borderline but acceptable’:

📊 Total cholesterol: 215
📊 LDL: 135
📊 HDL: 42
📊 Triglycerides: 140
📊 Fasting insulin: 18
📊 A1c: 5.5%
📊 Blood pressure: 118/76

Something was missing.

🚨 ASCVD scores don’t account for family history. Mike’s father and uncle had early heart disease—this should have raised red flags.
🚨 ASCVD scores ignore Lp(a), a genetic cholesterol marker that can dramatically increase risk.
🚨 ASCVD scores don’t factor in insulin resistance. Mike’s fasting insulin was 18, a sign that his body was struggling with blood sugar regulation—a key driver of heart disease.

We decided to look deeper.

I ran an Lp(a) test—a simple blood test that measures lipoprotein(a), a genetic marker of cardiovascular risk that most doctors don’t check.

🚨 Elevated Lp(a) is a major, independent risk factor for heart disease and heart attacks.
🚨 High Lp(a) is genetic—no amount of diet or exercise can lower it.
🚨 Most standard cholesterol panels don’t test for it, meaning thousands of people like Mike are walking around with hidden risk.

Mike’s Lp(a) level came back at 106—well above the high-risk threshold.

Even though his ASCVD score said ‘low risk,’ his Lp(a) and insulin resistance told a very different story.

At this point, Mike looked concerned. “So, what do we do now?”

I recommended a Coronary Artery Calcium (CAC) scan—a simple test that is not covered by insurance that runs about $125 in St Louis.

What is the CAC Scan?

It is a noninvasive test that measures the amount of calcium in the heart’s arteries.

Unlike standard risk calculators, this test shows actual disease—not just risk factors.

What Does the Test Find?

✔️ Calcified Plaque:
The scan detects calcium deposits in the coronary arteries, which indicate the presence of plaque—a buildup of calcium, fats, and other substances that can narrow and harden arteries.

✔️ CAC Score:
The scan produces a calcium score that reflects the amount of calcified plaque in your arteries. A higher score means a greater risk of heart disease and heart attack.

How the CAC Score Works

🟢 Score: 0 → No detectable plaque. (Low risk)
🟡 Score: 1-100 → Mild plaque. (Moderate risk, lifestyle changes needed!)
🔴 Score: 100+ → Significant plaque. (High risk, aggressive prevention needed!)

When Mike’s CAC scan came back, his score was 142.

That meant despite his healthy lifestyle, plaque was already forming in his arteries.

Why the CAC Score Matters More Than the ASCVD Score for Some Patients

Mike’s previous doctor relied only on his ASCVD score.

But here’s the problem:

❌ ASCVD scores don’t include family history. Mike’s father and uncle had early heart disease—this should have raised red flags.
❌ ASCVD scores ignore Lp(a). Mike had an Lp(a) of 106—putting him at extremely high risk.
❌ ASCVD scores don’t factor in insulin resistance. Mike’s fasting insulin was 18, an early sign of metabolic dysfunction.

Mike’s CAC scan revealed the truth—he already had heart disease.

Mike was stunned. “So, if I had just gone with my ASCVD score, I wouldn’t have done anything to stop this?”

I nodded. “That’s why we go deeper. Now that we know, we can do something about it.”

How We Use CAC Scans to Personalize Prevention

For patients like Mike—who optimize their lifestyle but still have risk factors—a CAC scan changes the game.

💡 It helps determine who should start cholesterol-lowering medication.
→ Many people with ‘borderline’ cholesterol (like Mike’s LDL of 135) don’t get offered treatment because their numbers look fine on paper—but a CAC scan tells us if plaque is already forming.

💡 It stratifies risk more accurately.
→ Instead of relying on ASCVD scores alone, we use actual plaque data to determine low, moderate, or high risk.

💡 It prevents unnecessary medication for truly low-risk patients.
→ If your CAC score is zero, your actual heart disease risk is low—even if your cholesterol is slightly elevated.

Because of his CAC score of 142 and high Lp(a), we created a custom prevention plan that included:

✔️ Cholesterol-lowering medication to slow plaque progression.
✔️ Metabolic support to improve insulin resistance and lower inflammation.
✔️ Ongoing tracking to better modify risk factors.

Mike took a deep breath. “I’m so glad I came in for a second opinion.”

I smiled. “Now, instead of just hoping you’re low risk, you know exactly what’s happening in your heart—and we can take action.”

Are You Truly Low Risk—Or Just Guessing?

Many people assume they’re safe from heart disease because they:

✅ Eat well
✅ Exercise regularly
✅ Have “normal” cholesterol
✅ Get told their ASCVD score is ‘low risk’

But cholesterol alone isn’t the full picture. Risk scores only estimate probability—they don’t measure actual disease. They don’t include family history, pregnancy complications, or menopause symptoms.

✅ Wondering if a CAC scan is right for you? Click below to schedule a Metabolic & Heart Health Consultation​

Because real prevention starts with knowing—not guessing.

Warmly,
Dr. Loden

*The patient's name has been changed for privacy.
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