Thanks, Bob, for your thoughts and in-depth comment.

The best “prophylactic medicine” is lifestyle medicine. That’s my conviction.

Monitoring biomarkers that predict future disease or events also makes a lot of sense. For the simple reason that life isn’t a dress rehearsal. We have no reset button, that we could hit at age 60 or 70. So trying to “peep” into the future and adjust one’s lifestyle habits to ideally match one’s genetic predisposition is what I am working on with all my conviction and passion.

With the ability to have biomarkers, such as pulse wave velocity (PWV) or coronary artery calcium (CAC), tell us today where our health will end up in the future comes the desire to optimize those biomarkers through drugs. For the simple reason that many people can’t or won’t apply the required lifestyle changes. And this is the point where I have to defend the medical practice and profession a bit.

Many medical doctors make the unenviable experience that their patients do not follow through with their advice about preventive lifestyle changes.

Just imagine, the simplest of lifestyle changes is to take a drug that helps prevent a repeat heart attack in a heart attack patient. One of the latest studies on patient compliance found that roughly one in two patients drops off the prescription within a matter of two years (and the difference between those who receive the meds f.o.c. and those who co-pay is minimal). If people can’t follow through with this simple habit of popping a pill, how much compliance can we expect to lifestyle change?

The discrepancy between your relatively high risk score on one hand, and the absence of CAC on the other, highlights your justified criticism of the risk scores in general “medical treatment appears to be focused on treatment based on correlation rather than causation”. I’d like to add to your observation a purely statistical notion that is so often overlooked: a biomarker that is significant in a statistical sense (and those associations are significant, otherwise, they wouldn’t make it into the scores) is not necessarily predictive. That’s a statistics fact that sounds counterintuitive, which is why I have planned a post on that subject.

And I fully agree, the three-decimal “accuracy” is not to be taken for real at all.