Cardiologist Dr. Nicole Harkin Discusses Advances & New Tech in Preventive Cardiology

We had the pleasure of sitting down with Cardiologist Dr. Nicole Harkin to explore the latest in preventive cardiology and how cutting-edge tools and testing can dramatically reduce your risk of heart disease. From personal biomarkers to advanced imaging, Dr. Harkin shares how a proactive, personalized approach can lead to longer, healthier lives.

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My practice exists because we have so many new tools that can detect cardiovascular disease early and implement aggressive treatment if indicated. Yet, cardiovascular disease continues to be the leading cause of death, even though it is largely preventable.

For most people, the best first step is a comprehensive test that allows us to get a clearer picture of your current vascular health and determine any personal risk factors. From there, we can tailor a plan that might include lifestyle changes, medication, or both.

Small shifts can make a significant impact on your future. For example, I often advise my patients to increase their fiber intake to 30-40 grams per day. Numerous studies support its benefits for cardiovascular health, with no research indicating that exceeding the recommended levels is harmful. I invite anyone to provide challenging research.

Personal Biomarkers

Reviewing your biomarkers is the best way to inform a preventive care action plan. Some of these items may include:

• A deep dive into your Lipids:

  • Apolipoprotein B - (ApoB) is an overall metric of your "bad" cholesterol particles that are atherogenic, meaning they can get stuck in your arterial wall and cause plaque.

    • This is crucial for predicting your likelihood of cardiovascular disease.

  • Lipoprotein (a) - Lp(a) is a type of ApoB particle that is genetically determined.

    • It is similar to the more commonly known LDL particle but carries a higher risk of causing plaque buildup.

I can't emphasize enough how vital cholesterol is to your heart health, as a buildup of plaque in your vascular system is oxidized cholesterol, which is preventable. The endothelial blood vessel wall lining is both a chemical and physical barrier, so by assessing the damage to your endothelium, we can determine how much of the "bad stuff" is getting through.

Unfortunately, there are a lot of ways to get cardiovascular disease, but that does not mean that it is inevitable. Many elements influence your risk, like being born with high levels of cholesterol particles or detrimental lifestyle choices such as smoking. However, advancements in technology and a deeper understanding of the effects provide us with numerous tools to assess and manage your risk.

For example, we can review your metabolic health, chronic inflammation status, blood pressure, and cardiorespiratory fitness (VO2 max) to identify anything that is modifiable.

The Latest Tests and Tools

After we determine your risk for the disease with the above methods, we can then use our other tools to determine if you are starting to develop early signs. Preventive cardiology is now in a place where we can identify subclinical atherosclerosis, which determines whether plaque is already forming.

In my office, we use non-invasive imaging tests, including carotid ultrasounds, that look for both soft and calcified plaque in the neck arteries. The coronary artery calcium (CAC) scan, detects older, calcified plaque in the heart. However, this test is better for older adults as it shows older plaques rather than the newer, softer forms. The world of heart imaging is evolving rapidly, with newer technologies like Cleerly and HeartFlow offering more detailed insights than ever before. Based on your individual needs, we’ll determine which tools make the most sense for your health.

Medications

Our first steps will always be lifestyle and other health changes, but sometimes pharmacotherapeutics are required. The advances in medications for cardiovascular risk reduction are vast and constantly evolving. Depending on what area needs to be optimized, will affect the medication choice, but usually it involves an approach to lowering lipids with statins, ezetimibe, PSK9-Inhibitors, or bempedoic acid. All of which I reach for, depending on my patient.

In the metabolic space, there are items like metformin and GLP-1 antagonists, which are shown to reduce the risk of heart attack and stroke in the appropriate patients. There are many pharmaceuticals now that we can and should employ depending on the patient, but they are all interconnected when it comes to heart health. The medication game has really transformed in the past 10 years so it’s an exciting time to be practicing in this rapidly evolving field, where new options are continually emerging to better support my patients.

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If you want to learn more about your heart health needs, please reach out to your Client Advocate, who can help set up a consultation.