CASE STUDY 1
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.
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
Pulse Perfect Findings
Coronary CTA with Cleerly AI Plaque Analysis
| 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 |