CASE STUDY

The Marathon Runner Who Had a Ticking Clock

52-Year-Old Male · Mixed Hyperlipidemia · Pre-Diabetes 

He ran marathons. His standard labs looked borderline-acceptable. His doctor called him ‘borderline’ and credited his running habit. At 52, he felt invincible. Pulse Perfect found something very different about his heart health.

What Did Traditional Medicine Say?

Traditional Cardiology 

  • LDL of 118 mg/dL → 'borderline, keep running'
  • No symptoms → no further workup
  • Marathon running = reassuring → skip advanced imaging
  • HbA1c 5.8% → labeled 'borderline,' no treatment
  • Standard lipid panel only. ApoB, LDL-P never checked

Pulse Perfect Approach

  • LDL of 118 masked an ApoB of 102 mg/dL and LDL-P pattern, active plaque drivers
  • Coronary CTA ordered proactively and it revealed CAC 158 and subclinical multi-vessel plaque
  • Fitness ≠ plaque-free: marathon running protects the heart functionally, not structurally
  • CGM-guided intervention reversed pre-diabetes in 90 days without medication
  • ApoB, LDL-P, Lp(a), hs-CRP, NMR LipoProfile. A full picture of atherogenic risk
Parameters Result Clinical Significance
Coronary Calcium Score (CAC) 158 (78th percentile for age) High lifetime cardiovascular risk
Total Plaque Volume 83.6 mm³ Mild — actively modifiable with treatment
Non-Calcified Plaque 30.1 mm³ (1.5% PAV) Mild — actively modifiable with treatment
Low-Density Plaque ✓ 0 mm³ Excellent — no vulnerable rupture-prone plaque
CAD-RADS Category ✓ 2/P2 ✓ 25–49% luminal narrowing — warrants monitoring
Right Coronary Artery 0 plaque Clean and normal
Pulse Perfect Findings

Advanced Lipid & Metabolic Panel

Marker Result Goal Status
ApoB 102 mg/dL < 60 mg/dL Needs aggressive reduction
Lp(a) 50 nmol/L < 75 nmol/L Normal — favorable
hs-CRP 0.7 mg/L < 1.0 mg/L Excellent — low inflammation
HbA1c (initial) 5.8% < 5.5% Pre-diabetic
HbA1c (3-month) 5.5% < 5.5% ✅ ACHIEVED — reversed

Diagnostic imaging and lab testing can often be coordinated through existing insurance. HSA and FSA funds may apply to membership fees — confirm with your plan administrator.

Pulse Perfect Findings

VO₂ Max & Body Composition 

Diagnostic imaging and lab testing can often be coordinated through existing insurance. HSA and FSA funds may apply to membership fees — confirm with your plan administrator.

Metric Value Comment
VO₂ Max 39 mL/kg/min 80–90th percentile for men 50–59 — excellent aerobic engine
Zone 2 Ceiling (VT1) 141 bpm Primary aerobic training zone
Body Fat % 25.8% Slightly elevated — central fat is the target
Android/Gynoid Ratio 1.16 Early cardiometabolic risk pattern
VAT (Visceral Fat) 1.32 lbs / 38.7 in³ Mildly elevated — metabolic driver
1RM Bench Press 95 lbs Well below average — upper body gap despite marathon fitness
Pulse Perfect Findings

TruAge Epigenetic Report 

His epigenetic data told a nuanced two-chapter story:
biologically resilient at the cellular level (OMICm Age 48.7 — 3.3 years younger than chronological), yet with cardiovascular organ-system aging running ahead of schedule (Symphony Age 56.5 — older than his 52 years).

His pace of aging registered at 1.02×, slightly accelerated.

Key findings included:
Low NAD+ precursors, elevated PAG (an atherogenic gut metabolite linked to CAD), low Ergothioneine (cellular antioxidant defense), and high VMA (sympathetic/stress activation chemistry).

All actionable through targeted supplementation and lifestyle change. 

Pulse Perfect Findings

Key Clinical Teaching Point

Diagnostic imaging and lab testing can often be coordinated through existing insurance. HSA and FSA funds may apply to membership fees — confirm with your plan administrator.

  • A normal standard lipid panel and marathon-running status can create a false sense of security .
    This patient had a CAC of 158 and subclinical multi-vessel atherosclerosis at age 52.
  • Cleerly plaque analysis goes beyond calcium scoring:
    it distinguishes stable calcified plaque from modifiable non-calcified plaque and quantifies total atherosclerotic burden.
  • Zero low-density plaque is a critical reassurance
    Disease is in a modifiable, non-vulnerable phase, and aggressive medical management can halt and regress it.
  • CGM-guided glucose optimization reversed pre-diabetes in 3 months without medication.
    A tangible, measurable win that would never have been captured without precision testing.
  • Upper body weakness in a marathon runner illustrates the fitness gap between cardiovascular endurance and musculoskeletal strength.
    Resistance training is as important as aerobic training for longevity.
  • Epigenetic data (biologically younger overall, but cardiovascular organs aging faster) provides a nuanced, actionable picture standard cardiology cannot offer.
Pulse Perfect Results

90 Day Outcome 

Metric Baseline Goal Status
HbA1c 5.8% < 5.5% ✅ ACHIEVED (5.5%)
ApoB 102 mg/dL < 60 mg/dL In progress — statin initiated
LDL-C 118 mg/dL < 55 mg/dL In progress
Body Fat % 25.8% < 20% In progress
Android/Gynoid Ratio 1.16 < 1.0 In progress

How often do you exercise?

Do you have high blood pressure?

Family history of heart disease?