50. 50% of Heart Disease Is Diagnosed Too Late—Here's How to Avoid It

Heart disease is still the number one cause of death, yet most people don't realize how preventable it actually is. In this solo episode of Extend, I'm kicking off our new series on preventative medicine by breaking down the essential tests and metrics you need to know to protect your heart. I'll walk you through the four key areas I evaluate in every patient—ischemia, blood pressure, electrical function, and cardiac capacity—and explain how you can assess your own risk starting today. You'll also learn about the most underutilized tests in cardiology, including the coronary calcium score, CLEARLY CT angiogram, Holter monitors, and VO2 max. These tools can help you detect heart disease decades before symptoms appear—and long before it's too late. This episode is your roadmap to taking control of your cardiovascular health, starting now. If you're over 40 (or even younger with risk factors), this is a conversation you can't afford to miss. I Also Discuss: Preventing Heart Disease for Longevity Advanced Heart Health Screening Options Preventing Heart Disease Through Testing The 4 Hidden Heart Risks You Shouldn't Ignor Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:50Dr. Darshan Shah?

  Hello, my friends. This is Dr. Darshan Shah here on the Extend Podcast. Welcome to another solo sound. Today's episode is going to start on our series on preventative medicine. This is where I'm going to give you all of the highly impactful information that you need to know to avoid chronic disease, which, as we all know, leads to all of the major causes of death in the Western world. We're going to start this episode talking about the heart. The CDC says that over 700,000 people this year will die of heart disease. Nothing else will take more lives than heart disease, with cancer being a distant number two at 600,000 deaths per year. We know that most of these deaths occur later in life, usually after the age of 65, where it takes over from cancer as the number one cause of mortality.

• 1:35Dr. Darshan Shah?

  One in every five deaths is due to heart disease. That adds up to one person every 33 seconds will die of heart disease in the United States. Men actually tend to develop heart disease slightly earlier, with the heart attack often being the first sign that they have heart disease. Women's risks actually rise significantly after menopause due to hormonal changes, and the symptoms are more likely to present differently, such as fatigue, shortness of breath, or even indigestion. Heart disease causes 25% of all male deaths and 22% of all female deaths. Despite this awareness... Is actually lower in women. Less than half of women know is their number one killer. The reason I mention this is because I think it's extremely important for both men and women

• 2:19Dr. Darshan Shah?

  to bring this to the front of their consciousness, especially after the age of 40 years old, and double especially after the age of 65, where it can really impact their longevity. So what exactly am I talking about when we say heart disease? I think many of us refer to heart disease as simply heart attacks, and you would not be wrong if this was your answer. However, there are many forms of heart disease that also impact the statistics. I'm going to talk about some of the most common forms of heart disease here that everyone needs to be aware of. When I look at a patient to evaluate their heart, I think along four key metrics that could lead to heart issues. Number one is ischemia. Ischemia is just another way of saying dying of heart muscle tissue from lack of blood flow usually. This includes heart failure and heart attacks,

• 3:05Dr. Darshan Shah?

  usually from blockages of one of the major blood vessels that supply blood to the muscles of the heart. Number two is a problem with elevated blood pressure. High blood pressure affects every blood vessel in the body, including those that go to the heart. It also affects the heart directly, causing it to work much harder, and usually this goes years and years being untreated. Number three is the electrical system of the heart. You may have heard of atrial fibrillation as being one of the major causes of hospitalizations. Atrial fibrillation is one of the many electrical disturbances that your heart can experience as we age and we have nutrient deficiencies or other problems that might occur. There are quite a few electrical disturbances that people experience, and it's important to recognize when you might be experiencing an arrhythmia.

• 3:50Dr. Darshan Shah?

  And finally, number four is the capacity of the heart and the whole cardiovascular system. Do you have a strong enough cardiovascular system to keep up with your activities of daily living and beyond? We're going to talk about some biomarkers that you can use to assess the capacity of your heart and how strong it is compared to other people your age. It is incredibly important to understand where you currently are on all four of these key metrics, so you know how and where to focus your attention, and the attention of your doctor. So let's discuss how you would evaluate your Along all of these aspects. But before I do that, let me mention one key critical issue. Most people start way too late in looking at their heart. Did you know that 50% of heart disease gets diagnosed as someone's first heart attack?

• 4:33Dr. Darshan Shah?

  And somewhere between 25 to 50% of these are fatal. We should never be waiting until heart attack to start making assessments. True prevention means doing evaluations early. I like to start at the age of 40 with my patients to do preventative testing. And sometimes I even do it even earlier. So if you're 40 or over and have never done any of the tests I'm going to talk to you about today, please talk to your doctor about them. They could save your life. Many times a doctor will say, well, if you're not experiencing any symptoms, that might be excessive amounts of testing. And to that I say, that's actually what got me personally into trouble. I went to my doctor many times. They refused to do any tests because I did not have symptoms. Well, I can tell you from experience of thousands of patients as symptoms are the last thing that you're going to experience while you're developing chronic disease.

• 5:18Dr. Darshan Shah?

  These tests can tell you 20 to 30 years prior to symptoms. If you are developing chronic disease and that is soon enough to reverse the course of the disease development. So please push for some of these tests, especially if you're at risk for heart disease, which many of us are. Let me tell you a quick story about one of my patients. He was a 40 year old friend of mine, super healthy, goes to the gym five days a week and never eats an ounce of ultra processed food. Mostly eats a plant based diet. He told me that he was going to hike Mount Kilimanjaro. He asked me, is there any testing he should do before he went? He was thinking about strength testing or maybe even VO2 max. And he had no symptoms at all. I told him he should really consider doing a coronary CT calcium score. I'm going to talk to you more about that test in a few minutes. He resisted at first because it did take time to get an appointment.

• 6:03Dr. Darshan Shah?

  But I managed him to hang in there and wait for the appointment because he had a slightly high cholesterol and he was of Indian origin. And one of his parents had also developed heart disease at an early age. Well, he did the test and we found a surprising finding, a lesion, as we like to call it, which is another way of saying a blockage in one of the main blood vessels to his heart. In fact, this particular type of blockage was called a widow maker. And it's called that because many men don't know they have it and they Usually die during physical exertion and their wife ends up widowed. A near total blockage of his left anterior descending blood vessel of his heart. Needless to say, he canceled his trip and instead he had to undergo an angioplasty procedure. His wife and his two young children were incredibly happy that he took this step

• 6:46Dr. Darshan Shah?

  and he lived long enough to talk about it and come back to try Mount Kilimanjaro another day. So why doesn't every single person get this scan? I've wondered this for many years. It is one of the most underutilized tests that we have in medicine and is also one of the most useful. I think there's two reasons. Number one, insurance does not pay for it and we are all under the assumption that insurance should pay for everything related to healthcare. Number two, some doctors think that we are overtesting people. I can tell you that the scan can be obtained in almost every city in the US, usually for $150 and less. And the people that I've diagnosed with severe heart disease using just this scan without symptoms would definitely tell you that they were not overtested.

• 7:28Dr. Darshan Shah?

  A coronary calcium score is a specialized, very low radiation, quick, about 10 to 15 minutes CAT scan that measures the amount of calcium building up in the walls of your coronary arteries. These are the vessels that supply blood to your heart. Calcium buildup is a late sign of plaque, which means the cholesterol depositing in the artery is causing the artery to narrow. Calcium builds up in a plaque as your body's trying to heal it, which occurs later in this disease process. The score that you get, usually from zero to 1,000, helps predict your risk of future heart disease, even if you have no symptoms. A higher score means more plaque buildup and a greater risk of heart attack. My friend scored that I talked to you about earlier was 900.

• 8:13Dr. Darshan Shah?

  Your goal is to be as close to zero as possible, but under 99 is considered low risk. Another newer version of this test is called a CT angiogram, powered by Clearly, which is an AI model on top of the CT angiogram. This goes beyond calcium scoring to visualize and quantify both calcified, which is late plaque, and soft plaque, which is earlier plaque, inside of your coronary arteries. It analyzes the plaque type, the volume, the distribution of it on the artery. It's truly a miraculous new test that I use quite frequently. We get a detailed map of your heart's vascular health with this test. It allows for earlier, more precise risk prediction and personalized prevention

• 8:57Dr. Darshan Shah?

  long before a heart attack ever happens. I've even seen people reverse soft plaque with this test after testing it two or three years after a treatment program. The downside of this test is that it takes slightly longer, so there is more radiation exposure. So I counsel my patients about the risk of radiation exposure versus the benefit of getting this test. And usually, the risk of radiation exposure for your one test is pretty low, and the benefit can be extremely high, especially if you have many risk factors of cardiac disease. As the technology improves, and we can do this with less and less radiation, I see a world not too far off that everyone uses the Clearly CT Angio as a primary method for screening for heart disease. I did a talk yesterday to a large group of business executives,

• 9:41Dr. Darshan Shah?

  and many of them were struggling about whether or not to be put on statins. I'll talk more about statins in the next episode. However, what I will say is that a Clearly Scan or a coronary calcium score can give us incredible diagnostic information of how much plaque is building up in your arteries. If you have a normal calcium score, no high blood pressure, and no metabolic disease, it's very hard to make the argument that someone needs to be on a statin in these cases. My point here is that you don't have to guess about whether you have heart disease developing or not in the coronary blood vessels. You can actually look and see now. And this can help a doctor and you in your decision-making process about taking statins or other therapeutics. Next, let's talk quickly about blood pressure,

• 10:26Dr. Darshan Shah?

  because I'm going to do another solo so just on this topic. It is that important. Everyone of you should own a blood pressure cuff after the age of 35 to 40. In your 20s and 30s, around 7% to 12% of adults already have elevated blood pressure, believe it or not. So at least once a year, check your blood pressure if you're under the age of 30. It often goes unnoticed until the age of 40 to 50. By the age of 40, the prevalence of high blood pressure rises sharply. And after 60, over 60% of people have hypertension.

• 10:58Dr. Darshan Shah?

  People get a false sense of security about their blood pressure because you really can't feel it. That's why high blood pressure is called the silent killer of medicine. High blood pressure causes disease in every organ of your body, not only your heart, and is due to multiple factors. Most of the time, the blood pressure taken in a doctor's office is incorrect and discarded for years. In reality, the best way to measure your blood pressure is at home. First thing in the morning and averaging three results. We're going to talk about exactly how to do this in my next episode. Next, let's touch base about the next evaluation I think everyone needs to think about, which is an evaluation of the electrical system of the heart. This is the system that keeps your heart beating regularly, leading to metrics like average daily heart rate, resting heart rate, and more.

• 11:39Dr. Darshan Shah?

  The test that many of us assume that works the best for our understanding of our heart rhythm is the EKG. This is the test that is done at the doctor's office with the leads that are placed on your chest and on your arms and legs and gives you a printout and the well-known heartbeat tracing. This is a very important test if you're experiencing fluttering in your chest, chest pain with exertion, or spells of low blood pressure or fainting. My concern regarding this test is that it gives people a false sense of security after it's done. Why do I say that? I often hear, "My doctor checked my heart and told me I was fine," to which I always reply to my patients, "Well, what did he or she check?" And often the answer is an EKG. Unfortunately, the EKG test shows plaque buildup and blockages of your blood vessels

• 12:24Dr. Darshan Shah?

  way too late in the disease process, when you're already experiencing ischemia or muscle loss from these blocked blood vessels. So it's not a great test for plaque buildup. Secondly, it's only measuring your heart rhythm while you're getting the test done. A typical EKG lasts only for 10 seconds. While most electrical disturbances of your heartbeat go on and off over the course of the day or a week. A much better test, in my opinion, is a longer-term EKG, which is called a Holter monitor. This is a device that you wear on your chest for a longer period of time, 24 hours or up to even two weeks, so you can detect sporadic electrical abnormalities. The one I use is called the Zeopatch. It's a little patch you wear on your chest. Your Apple Watch also has an EKG monitor on it.

• 13:08Dr. Darshan Shah?

  Looking for common arrhythmias like atrial fibrillation. My main message here is that an EKG doesn't tell you the full story, and you should be asking for more information, especially if you're having symptoms like fluttering in your chest or chest pain after exertion. Finally, let's talk about some measures of how well your heart is truly functioning for your age. The biomarker I like to use here is VO2 max. We've already covered VO2 max at a previous episode. However, I believe it's worth mentioning again here. VO2 max is the maximum amount of oxygen your body can utilize during intense exercise, and it's one of the strongest predictors of cardiovascular and overall longevity. A high VO2 max reflects superior cardiac output,

• 13:52Dr. Darshan Shah?

  great oxygen delivery to your tissues, and great mitochondrial function. As we age, VO2 max naturally declines, but consistent VO2 max and endurance training of zone two exercise can help reverse and slow down that trend. Believe it or not, clinically, improving your VO2 max is more protective than reducing LDL and blood pressure alone, making it a cornerstone metric for assessing true cardiac fitness. It can be measured in an exercise lab or more simply with a test called the Cooper's test. This is an easy test that you can do where you simply see how far you can run in 12 minutes and then look up your results on many online easily available charts. To give you the idea of the big picture here, if you can run about one and a half miles,

• 14:37Dr. Darshan Shah?

  which is about eight miles per hour on the treadmill, for 12 minutes, your VO2 max is approximately 40, which is actually pretty good. A VO2 max of 40 at age 40 is solid. You're in a cardiovascularly protective range and right where you should be, and it's associated with dramatically lower risk of cardiovascular disease and all-cause mortality. But that same number at 60 makes you an outlier in the best way. Your mortality rate is extremely low for other 60-year-olds. However, at 25, it would be considered below average. So you get the big picture here. Somewhere between 40 to 50 is a great VO2 max to aim for, especially if you're aiming to stay biologically younger.

• 15:18Dr. Darshan Shah?

  That we can do to evaluate your heart because your heart is such a complex organ. There's echocardiograms, there's stress tests, you've probably heard about all of these. However, the four that I mentioned here are usually the most underutilized tests because they're used way too late. So if you're 40, I highly encourage you to talk to your doctor and do your own research and understand whether or not you should get one of these four tests. A CT calcium score or CLEARLY test, buying your own blood pressure cuff at home to use more regularly, an EKG or a ZO patch Holter monitor, and a VO2 max test. And that's it. I hope you found this solosode incredibly helpful in understanding what testing is available and how to use them proactively

• 16:02Dr. Darshan Shah?

  to stop cardiac disease in its tracks. There's no reason that the number one cause of death should be heart disease, especially if we know early enough that we can reverse course of any plaque buildup, electrical abnormalities, or poor cardiac function. If you know someone that you are concerned about the condition of their heart, please forward this episode to them. And I can't wait to talk to you more in-depth about high blood pressure in my next solosode next week. Thanks for joining me today.

• 16:29Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.