In this Optispan episode, the hosts speak with Joel Jamieson about the idea of the “heart attack gene” and why cardiovascular risk is more complicated than standard cholesterol numbers. Drawing from his own family history and medical testing, Joel explains how genetics, fitness, and lifestyle interact in surprising ways.

Key Points:

This episode highlights that heart health cannot be judged by fitness level alone. Even individuals with strong aerobic capacity and good lifestyle habits may carry genetic risks that silently drive plaque buildup. Direct heart imaging is crucial for anyone with a family history of early cardiovascular disease. The message is clear: proactive testing can prevent life-changing or life-threatening events.

• Family History Can Override “Good” Lifestyle Habits: Joel explains that despite not smoking or drinking and maintaining strong fitness habits, his family history placed him at significantly elevated cardiovascular risk.
• The “Heart Attack Gene” and Genetic Variants: He discusses the 9p21.3 variant (often nicknamed the heart attack gene), which can increase heart disease risk by 150–200%, especially when inherited in its homozygous form.
• Why Standard Blood Tests Aren’t Enough: Standard lipid numbers may appear normal, yet plaque can still accumulate silently. Joel’s LDL and HDL levels were considered acceptable, but imaging revealed high coronary calcium scores and arterial blockages.
• CT Angiography and Calcium Scoring as Essential Tools: The episode stresses the importance of coronary CT scans (CTAs) and calcium scoring to detect plaque before symptoms occur—especially for anyone with strong family history.
• Exercise and Measurement Are Only Part of the Picture: HRV, VO₂ max, wearables, and biological age estimates can offer useful insights, but they cannot replace direct imaging when it comes to heart disease risk.