I’m sat here writing this in Southampton airport on Saturday at 07:00 but will schedule it to go out at the usual time tomorrow. The reason? It is so foggy that our inbound airplane has diverted to Gatwick… I may be here a while! On the plus side, I’m off to the Alps skiing which I love. I met a patient this week who wanted to get advice on whether he would be ok from a heart perspective to go skiing this winter, and he is in his early 70s. Inspirational! Of course he should go. I only hope I am still up to it at his age, and firmly believe I will be.
Our ability to perform physical tasks as we age broadly depends on a few factors. Our ‘aerobic capacity’, or cardiovascular fitness, is the first thing to consider. This is measurable using a VO2 max test. I won’t discuss this in any detail now as have done so before, but the point is that this declines with age (about 10% per decade), but the rate of decline can be massively reduced by training. To leisurely resort ski (as opposed to for example off piste) men need a minimum VO2 of 35-45 ml/kg/min, and women 30-40. Reverse engineer this, and if I want to ski at 70, I need a VO2 now (aged 47) of at least 43 or so. Mine is considerably higher, so all good.
The next thing is muscle strength. Again, this declines with age (called sarcopenia) at between 3-8% per decade. For leisure skiing, high muscle strength isn’t actually that important, but you need to be able to get up after a fall, and have the muscular endurance to cope with a day on the slopes. There are some benchmark tests one can do, for example planks, wall sits and squats to see how you might cope. I’ve been specifically training for this for a couple of months now, doing a hideous number of weighted squats and lunges each week.
I accept I am an outlier in how I approach exercise training compared to the majority, but I firmly believe these fundamental principles can be applied by pretty much anyone to anything they wish to do in the future. If you want to pick up a grandchild off the floor when you are 75, you need a certain level of muscle power at 55. If you want to pick yourself up off the floor at 85, you need a certain level of muscle power at 75.
Give some thought right now to what you want to be able to do in 10 years time, Now give some serious consideration to whether you can make some positive changes now that will allow you to do those activities in the future. It’s a great thought experiment. It doesn’t need to involve gyms or outdoor runs (unless you want it to), and will look different for everyone.
I have digressed. My plan for today was to discuss my new service, Polygenic Risk Scores (PRS)
Over the last few years, heart prevention has been moving quietly but steadily towards a more personalised approach. We’ve become very good at identifying population risk — cholesterol levels, blood pressure, smoking, diabetes — but we’ve all seen people who don’t fit neatly into those boxes.
Some people do everything “right” and still develop heart disease early. Others carry several conventional risk factors yet remain unaffected for decades. The missing piece, in many cases, is genetics.
That’s why I’m now offering polygenic risk scores (PRS) for coronary artery disease through my clinic.
Putting Genetics Into Practice
Over the last two weeks I’ve written in some detail about polygenic risk scores (PRS) — what they are, how they work, and where they fit into modern cardiovascular prevention.
This week, I wanted to step back briefly and focus on the practical question many readers have asked me privately:
How can this actually help me make decisions about my heart health?
For many people, the challenge isn’t a lack of tests or information — it’s uncertainty. Cholesterol that’s only mildly raised, a strong family history but reassuring scans, or being told your calculated “10-year risk” is low despite a sense that something doesn’t quite add up.
Polygenic risk scores don’t replace traditional risk factors, imaging, or lifestyle advice. What they do is add context. They help explain why two people with similar cholesterol levels may have very different lifelong risks — and therefore why prevention strategies sometimes need to differ.
In people with a higher inherited risk, earlier or more assertive prevention can meaningfully reduce future cardiovascular events. Equally, a lower genetic risk can offer reassurance and help avoid unnecessary treatment. As always, the score is interpreted alongside blood tests, imaging (where available), family history, and overall health — never in isolation.
For those who want to explore this further, I’ve now made polygenic risk scoring available through my private cardiology practice.
Practical details
Cost: £950
What this includes:
- The genetic test (saliva sample taken via a home testing kit)
- Accredited laboratory analysis using large-scale genomic datasets
- A clinician-interpreted report
- A full consultation with me personally and integration of the result into your overall cardiovascular risk assessment
The cost reflects the complexity of the genomic analysis, the use of validated polygenic datasets, and detailed clinical interpretation, rather than this being a simple consumer genetic test returned without medical context.
As this service is being introduced, I’m offering a 10% introductory discount for the first month, bringing the cost to £855. This introductory discount is available initially to readers of my blog and will not be advertised on my public website during that period.
This test is not appropriate for everyone, and it is not intended as a screening tool. Whether it is likely to be useful for you depends on your individual circumstances, which we would discuss before proceeding.
If you’d like more detail about how the test works, who it may (and may not) be suitable for, and how results are used, you can find a full FAQ on the members’ site here
As ever, my aim is not to medicalise the healthy, but to use the best available evidence to prevent disease before it starts, in a way that’s proportionate, personalised, and sensible.
Before any testing is arranged, informed consent is required, and no samples will be processed until this has been completed. For the moment, patients who wish to proceed can email in to register their interest. I am currently on annual leave, but all enquiries and requests will be reviewed and responded to on my return.
For this week’s video, please check out the website
Lastly, I had a really thoughtful question come in this week from a member who’d watched my video on plant-based diets, diabetes, and erectile dysfunction — and although it was written by one person, it’s something I know a lot of people are quietly wondering about.
The question, in simple terms, was this:
After a heart attack or bypass surgery, how much of erectile dysfunction is down to heart disease itself, how much is due to medication, and is there a role for erectile dysfunction treatments? I answer this question in an ‘ask me anything’ video on the website.
(PS It turned out to be a 6 hour airport delay, but at least we got there, many flights were cancelled so I’m very grateful)