Your Cardiometabolic Risk Assessment Report
Part 1: Understanding the General Report Structure
Hello, and welcome to Precision Health Reports. My name is Bill Cromwell, and for the next few minutes, I want to give you an overview of your Cardiometabolic Risk report. There's a lot of detail in this report and in future videos, I'm going to take a deeper dive into each section. But for now, I just want to give you an orientation as to how the report is constructed and how you should interpret the different features.
The first is a welcome letter. The second area of the report is a series of detailed pages regarding your cardiometabolic risk information. The third is a series of tracking pages where you'll see your results over time to see your improvement. The last area is additional links to information you would like to know more about as well as your lab results.
The welcome letter basically describes that cardiometabolic risk is everything that comes together to give you risk of diabetes, heart attack, and stroke and what our approach is to putting this very large jigsaw puzzle together.
The most important information has to do with details regarding your cardiometabolic risk. Now, the first page of this is a summary page, which looks at four areas. Insulin resistance, which is the linchpin or the integrating part between diabetes, heart attack and stroke. The second section is your metabolic syndrome risk. The third is your eight-year diabetic risk and the fourth is your overall cardiovascular risk.
You will notice that each one of these areas has a slider. And that slider, for example, with the insulin resistance syndrome, goes with green on the left, which is low risk or insulin sensitive. On the far right is higher insulin resistance. The more you go to the right, the more risk you have. The same thing is true for your metabolic syndrome related risk. Low risk is green; higher risk is red. You can see that the further you go to the right, the more risk you have for your eight-year diabetic risk—low risk is in green; high risk is in red. And finally for your overall cardiovascular risk of the same thing: green is good; red is risk.
Now we can unpack each of these with other pages of information, beginning with your cardiometabolic risk, followed by your diabetic risk, and then your cardiovascular risk. On each of these pages the color coding is the same: green is good and low risk, red is higher risk.
Metabolic Risk Detail
Let's look at your Metabolic Risk Detail page. Now this page begins with insulin resistance which is the underpinning for much of the problem that you have with diabetes, heart attack and stroke. You'll see again: green is good and red is higher risk. Now, when you are insulin resistant, there are a number of different medical features that can happen and you'll see that this is called out in the red box. We look at your waist measurement, blood pressure, blood sugar, triglyceride, and HDL cholesterol. In this box, you see that there are criteria for what are considered abnormal, and then your values will appear on the right.
If your values are normal, then what you're going to see in diagram or green bubbles. If however, you meet criteria that are abnormal, your values will be yellow and those yellow features will show up as yellow bubbles. The more yellow features you have, the more elements of the metabolic syndrome you have.
Another important feature of the metabolic syndrome is that it entails inflammation and increased numbers of particles that carry cholesterol that will clog your vessels. Again, the cut points are there, and your values are to the right. If your values are normal, you'll have green bubbles. If you have very high risk, there will be red bubbles. So this is a visual way to see where you are in relative sense.
We can do better though. We can ask the question, what does this actually mean as a number? And what'd you see at the bottom is the Metabolic Syndrome Severity Score that is a number between one and a hundred. The lower the number, the lower the risk associated with diabetes, heart attack and stroke from your metabolic syndrome numbers. As you move to the right, red is higher risk. So you see how this is oriented.
Diabetes Risk Detail
There's a similar depiction of information for your Diabetic Risk. The two things that come together that are very important are your glucose level (normal is less than 100; prediabetes is 100 to 125) and that, along with your insulin resistance score, are called out in the box which indicate that your individual 8-year risk of diabetes depends on your gender, your glucose, and your insulin resistance score.
So if you look at the box underneath, you'll see that at any level of glucose, shown in the red box, there is a white bar to the side. The bar goes from insulin sensitive on the left to insulin resistant on the right. And as you notice the higher the insulin resistance at any glucose value, the more 8-year diabetic risk you have. This is even worse if you start with a higher glucose and that going to a more insulin resistant state will take you to an even higher risk.
Now, the good news is this is modifiable, and in the box below, you'll see two different representations. The first is what happens at a different glucose value if you keep the same insulin resistance score and below that is what would happen to your 8-year diabetic risk if you had a lower insulin resistance score.
So let me give you an example: let's say that you started with a glucose of 102, but you have a very high insulin resistance score of 85. Well, what you'll see is that at that glucose and that insulin resistance score, you have a 35% chance of diabetes in 8 years, which is very high. So now look in the boxes below. What you see is that at your 85-insulin resistance score, if you were to simply change your glucose numbers you can see what your 8-rear diabetic risk would do. The higher the glucose number, the higher, the 8-year risk; the lower the glucose number, the lower the risk. Now what about if you were to achieve a lower insulin resistance score. An ideal scores is less than 25?
Well, the same trend is true. Higher glucose, higher risk, lower glucose, lower risk, but the numbers are radically smaller. So this shows you that this is a very modifiable issue.
Cardiovascular Risk Detail
Now let's look at your Cardiovascular Risk. There are two different calculations that are currently advocated by guidelines: a 10-year risk and a lifetime risk. 10-year risk can be low all the way up to high. Lifetime risk can be optimal, not optimal, or high. Depending on your values, you'll see where your number is on this particular report. But that's not where the story ends. That's where the story begins. The rest of the story is there are over 30 risk enhancing factors that you may have, and they will individually appear in the center of the screen. When you take all of those details together, along with the calculations, you're able to say what your overall cardiovascular risk is from low to very high.
Now this is also modifiable and we have targets of therapy for how we can lower LDL to further reduce your risk. And at the bottom of the page, you'll see that your numbers for your current values of LDL cholesterol, non-HDL cholesterol, and particle number appear. And to the middle of that, to the right of that, there is a percent reduction number and that percent reduction keys off of your level of risk. For high risk and very high risk, the guidelines say that you need at least a 50% reduction in your baseline numbers. For moderate risk, you need a 40% reduction.
And what will happen is in the green areas to the right, all of these details come together as a range of numbers that you and your healthcare team need to discuss as to what is ideal for you.
Comprehensive Risk Tracking Charts
This gets us to the comprehensive risk tracking charts. And these charts will look at your tracking over time of metabolic risk, diabetic risk, and cardiovascular risk.
If we look first at the metabolic risk numbers, what you see at the top is a chart that will fill in with progressively more information as you get further follow-up tests done. Again, yellow is abnormal and green is going to be normal. What you're going to find is that below that is a graph and that graph has your insulin resistance in terms of the Metabolic Syndrome Severity Score, as well as your inflammation, the GylcA score, and this will fill in from left to right as you have more details over time.
Your diabetic risk similarly has a chart at the top of the graph at the bottom. What this will show is your glucose, your insulin resistance score, and your 8-year diabetic risk over time. As you get more data, this will fill in from left to right at the bottom, and you'll be able to track your progress.
The same is true for LDL cholesterol, non-HDL cholesterol, and particle number. There's a chart at the top and a graph at the bottom that will fill in as you go.
Additional Information
The last part of this are sheets that are additional information, as well as the information you provided that informed the report, and your laboratory data.
So this is your overview to the cardiometabolic risk report. Two things to remember: number one, this has a lot of detail about your current risk for heart attack, stroke and diabetes. And number two, all of these risks are highly-modifiable and we can track them over time.