The Experimental Man: David's Data

In the fall of 2007, David Ewing Duncan came to Entelos to ask whether we could help with his Experimental Man project. Experimental Man is David's quest to explore the limits of medical testing and knowledge, and to learn how much we can really know about ourselves. We began a research project to help him pull together several of the medical tests he was exploring to understand his risk of having a heart attack as he aged - his cardiovascular risk - utilizing the Entelos Cardiovascular PhysioLab® technology. This is the story of what we learned about David, what he learned about himself, and what he chose to do.

One important note: We respect people's privacy and understand that their medical information is very personal and sensitive. It is an important part of David's Experimental Man project to share this information publicly, so we are sharing his details with his permission.

Let's start with the basics. In a typical doctor visit, they gather your age, your weight, your height, your gender, your blood pressure, and if they took some of your blood, they may measure your cholesterol levels. With this information, you can estimate a person's risk of having a heart attack in 10 years, based on data from a long term medical study called the Framingham Heart Study. The Framingham calculation gave David the estimated risk of a heart attack in 10 years of 4% -- a chance of 4 in 100 that he would have a heart attack within that time period. Given these results, standard clinical guidelines suggest that to keep his risk low, he should consider making lifestyle changes. But David is already getting regular exercise, what else should he do?

In addition, David's LDL cholesterol was a little elevated at 134. At that level, some doctors would consider offering a drug to help lower cholesterol. But David did not want to take drugs unless he had to, so he wanted to better understand his risk and his options to manage it.

To go beyond this basic calculation, we had David take more tests. These included blood tests for a detailed cholesterol lipoprotein profile, inflammatory markers, and diabetes markers. He also took imaging tests that measure what the atherosclerotic plaque in his arteries looked like. David previously had genetic tests done, so we used that data as well.

Good news for David, he isn't diabetic and the test says his inflammation markers give him an average cardiovascular risk. His imaging tests suggest he has average plaque or better. Unfortunately for David, a particular genetic test he had done suggests he has a higher risk for having a heart attack.

So David had all of this data, but it provided a confusing picture. Some data suggests he is at low or moderate risk for a heart attack, and some data suggests that he has higher risk. But David had no good way to put all this information together and really understand his true risk of having a heart attack. Also, what lifestyle changes could David make to reduce his risk and what might be the impact of those changes? Could modifications to his diet and exercise make a difference? And if so, how much of a modification would he need to make to have a meaningful impact?