Preventative Cardiology in Practice

Traditional approaches to cardiovascular prevention have and still do rely heavily on population-based risk tools and standard laboratory markers.

While these methods have value at a public health level, they often fall short when applied to individuals. Many people who go on to develop cardiovascular disease are never identified as high risk, while others are treated aggressively despite having relatively low likelihood of events.

At Functional Medicine Associates, we see preventative cardiology as a process of understanding the full risk picture for each individual. This means moving beyond averages and thresholds, and instead integrating genetics, metabolism, lifestyle, environment, and early imaging to guide truly personalized prevention.

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In this blog post, we will discuss:

• The limitations of traditional cardiovascular risk scores
  
• How genetics, metabolism, and lifestyle interact to shape individual risk
  
• The role of imaging and advanced testing in early detection
  
• A real-world example of family-based prevention in practice
  
• How Functional Medicine Associates approaches personalised cardiovascular prevention

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The limits of traditional risk prediction

Tools such as QRISK and ASCVD scores have long been used to estimate cardiovascular risk. These calculators are designed to predict the likelihood of events across large populations, using factors such as age, sex, cholesterol, blood pressure, smoking status, and diabetes.

However, recent research has highlighted important gaps. Many individuals who experience heart attacks were previously categorised as low or intermediate risk. Others with elevated scores never develop disease. These tools whilst helpful do not fully capture the complexity of an individual’s life, biology, or environment.

The newer QR4 model, developed using data from nearly 10 million adults in the UK, incorporates a wider range of variables, including comorbidities, lifestyle patterns, and environmental exposures. While this represents an important advance, even the most sophisticated algorithms cannot fully account for the unique interactions that shape risk in a specific person.

This is why many cardiologists now recognise that risk scores should inform, but not dictate, prevention strategies.

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Seeing the full picture of cardiovascular risk

True prevention requires understanding how multiple layers of risk interact. At Functional Medicine Associates, we consider cardiovascular risk as the sum of several interdependent domains.

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Genetic and familial risk

Family history of early cardiovascular disease, inherited lipid disorders, and elevated lipoprotein(a) can significantly increase risk, even in individuals who maintain healthy lifestyles.

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Advanced lipid profiles

Standard cholesterol panels provide limited insight. Markers such as ApoB, LDL particle number and size, triglycerides, and lipoprotein(a) offer a more accurate picture of atherogenic burden.

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Metabolic health

Insulin resistance, impaired glucose tolerance, elevated HbA1c, visceral adiposity, and metabolic inflexibility all accelerate vascular ageing and plaque development.

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Lifestyle and behavioural factors

‍Diet quality, physical activity, sleep patterns, stress exposure, and smoking history influence cardiovascular risk continuously over time.

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Environmental and societal exposures

Air pollution, noise, neighbourhood design, access to green space, and social determinants of health all play measurable roles in cardiovascular outcomes.

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Inflammatory and emerging biomarkers

Markers such as high-sensitivity CRP, fibrinogen, and other indicators of residual inflammatory risk can reveal ongoing arterial stress that is not reflected in cholesterol alone.

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Assessing these layers together allows prevention to be proactive, precise, and personalised, rather than generic or reactive.

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Imaging and early detection of disease

In addition to laboratory testing, modern preventative cardiology increasingly uses imaging to detect disease before symptoms arise.

Different imaging modalities provide different insights:

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‍Carotid ultrasound‍

CIMT measures arterial wall thickness and can indicate early atherosclerosis, but it does not visualise coronary plaque directly.

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Coronary artery calcium scoring

CAC scoring detects calcified plaque and provides a measure of calcified  plaque burden. It is useful for risk stratification but does not detect soft plaque, which is more dangerous and more likely to cause plaque rupture.

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CT coronary angiography

CTCA can identify both calcified and non-calcified plaque. Soft plaque is particularly concerning because it is more prone to rupture and trigger acute events. Advances in AI-enhanced CTCA can also identify inflamed or high-risk plaque and assess fat attenuation index, offering insight into arterial inflammation and plaque instability.

Used appropriately, these tools allow clinicians to identify disease earlier, monitor progression over time, and guide intervention before catastrophic events occur.

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Real-world prevention in practice

A practical example illustrates how personalised prevention works beyond theory.

A 56-year-old woman under our care has a coronary artery calcium score of 90, moderate stenosis (narrowing) in the left anterior descending artery, moderately elevated LDL cholesterol and elevated lipoprotein(a). Lp(a) is a genetically determined lipid - you are either high or low and this is determined at around 5 years of age and then stays elevated or not throughout your life. She has consistently followed recommended lifestyle strategies for many years, including dietary optimisation, regular exercise, stress management, and metabolic support. Despite these sustained efforts, her cardiovascular risk remains highly elevated.

In her case, lifestyle intervention alone was not sufficient. As part of a long-term prevention strategy, she is supported with targeted lipid-lowering medication alongside continued lifestyle optimisation.

Recognising the strong familial component, we also discussed early prevention with her 24-year-old daughter. Testing revealed elevated lipoprotein(a) and mildly raised LDL cholesterol /ApoB. Although she is young and asymptomatic, early identification allowed us to begin a personalised, lifestyle-focused prevention pathway. This includes dietary refinement, structured physical activity, stress reduction strategies, and careful metabolic monitoring. Non-invasive arterial imaging was also performed to provide a baseline for future comparison.

This case highlights how modern prevention is anticipatory rather than reactive, family-oriented rather than isolated, and grounded in long-term risk reduction rather than short-term targets. This is called primordial prevention.

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How Functional Medicine Associates approaches personalised prevention

At Functional Medicine Associates, preventative cardiology is built on integration rather than protocols. We combine conventional cardiology expertise with systems-based assessment to understand how risk develops and how it can be modified over time.

Lifestyle optimization remains foundational, but it is not viewed as a universal solution. Where genetic or biological risk remains high, targeted medication may be appropriate and protective. The aim is not to medicalise unnecessarily, but to intervene proportionately and intelligently, based on individual data.

By integrating genetics, advanced lipids, imaging, metabolic assessment, lifestyle analysis, and environmental context, we are able to support prevention strategies that evolve as a person’s life and risk profile change.

Further details about this approach can be found on our Preventative Cardiology page.

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Key takeaways

Population-level risk tools are useful, but they are not sufficient for individual prevention. Cardiovascular risk emerges from the interaction of genetics, metabolism, lifestyle, environment, and inflammation over time.

Modern preventative cardiology is about seeing risk earlier, understanding it more deeply, and responding with personalised strategies that prioritise long-term resilience. When applied thoughtfully, this approach offers the opportunity to prevent disease rather than simply manage it once it appears.

If you would like to understand how this personalized approach applies to your own cardiovascular health, you can explore our Preventative Cardiology services or speak with our team to discuss next steps.