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Case Study · Cardiometabolic Health
Coronary Artery Disease: Detecting Heart Disease Before Symptoms
He came in feeling well and focused on his knee. A deeper cardiovascular evaluation revealed critical multivessel coronary artery disease that could have led to a major cardiac event and may have gone undetected in a symptom-driven model of care.
Patient
Male, late 50s
Presenting Concern
Post-surgical knee pain
Physician
Dr. Chris Di Giorgio
Time in Care
About one year
Regenerative Medicine
Metabolic Health
Hormone Optimization
Preventive Cardiology
He Came In For
A knee that would not heal
What We Found
Critical multi-vessel coronary disease
Where He Is Now
A Different Cardiovascular Trajectory
What appeared to be an asymptomatic patient was actually someone with significant cardiovascular disease. Identifying it before a major cardiac event gave us the opportunity to intervene early, reduce his risk, and change his long-term health trajectory.
The Journey
Four Chapters in One Year of Care
I
Months 0–2 · Regenerative Medicine
The Knee, and the Wedding
He came to Nova for alternatives to further surgery. A knee operation a year earlier had healed poorly and become infected, leading to a second operation a few months before his first visit. He was months out and still limited: significant pain, little ability to exercise, and difficulty walking comfortably. His real concern was not clinical. His daughter was getting married in two months, and he was afraid he would not be well enough to dance with her.
We began a multimodality approach to restore function and reduce pain. By the wedding, he had full functionality with no pain, and he had that dance.
Multimodality knee program
Outcome: full function, no pain
II
Months 2–8 · Metabolic and Hormonal Health
Rebuilding the Foundation
With the knee resolved, we turned to metabolic health. Over the following months we reversed his insulin resistance, optimized his body composition with a meaningful reduction in visceral fat, and, after evaluation, began testosterone replacement therapy. His energy, sleep, and quality of life improved, and his long-term risk of chronic disease fell with them.
By the end of this phase he was, in his own words, feeling and looking better than he had in twenty years.
Multimodality knee program
Outcome: full function, no pain
III
Months 8–11 · Cardiovascular Risk
Looking Beneath a Healthy Surface
With the foundational work done, we began a deliberate look at cardiovascular risk. He carried a family history of heart disease alongside a combination of traditional and non-traditional risk factors: elevated ApoB, elevated hsCRP, elevated homocysteine, insulin resistance, suboptimal vitamin D, hormone imbalance, and elevated visceral fat. Each was treated through nutrition, exercise, lifestyle, targeted supplements, peptides, and TRT.
Then we proceeded to additional testing, beginning with a coronary artery calcium score.
IV
Months 8–11 · Cardiovascular Risk
A Markedly Elevated Score, and Six Days
The calcium score came back markedly elevated, confirming that this was not simply a patient with future cardiovascular risk. He already had a significant burden of coronary disease—and without symptoms, it could easily have remained undetected until a heart attack or other major cardiac event brought it to our attention.
The disease had been developing quietly for years. By finding it before the first major event, we had an opportunity to change not only his immediate cardiac risk, but the trajectory of his health and longevity.
CAC
Cath
2 days
4 days
Risk Factors Addressed
The Markers Standard Care Rarely Measures
Nutrition
Exercise
Lifestyle
Supplements
Peptides
TRT
Advanced Lipids
Atherogenic particle burden beyond LDL
(ApoB, Lipoprotein Little A, etc…)
Elevated hsCRP
Elevated Homocysteine
Insulin Resistance
Suboptimal Vitamin D
Hormone Imbalance
Elevated Visceral Fat
Family History of CVD
Physician's Note
“Feeling better than you have in twenty years is not the same as being free of disease. His coronary disease had been building for decades before we met. What we could change was the terrain around it, and that is what allowed him to walk out of the hospital four days after open-heart surgery with a future that looks very different from the one he was headed toward. The goal now is not simply to prevent a heart attack. It’s to help him stay healthy enough to be there for the life ahead of him: his family, future milestones, and maybe one day dancing at his grandchildren’s weddings.”
Dr. Chris Di Giorgio, MD, FACC, FASE, CNBC, RPVI
What This Case Teaches
Three Lessons From One Year
Start where the patient is
Foundation before investigation
Test beyond the standard panel
What Are Your Blind Spots?
No symptoms does not always mean no disease. Advanced diagnostics can uncover cardiovascular risk before the first major event and create an opportunity to change the trajectory early.