The 6 Functional Heart Tests Your Cardiologist Probably Isn't Running
Blending advanced diagnostics and Mediterranean-inspired lifestyle strategies, CorAeon is a physician-led functional medicine practice founded by a functional cardiologist and psychiatrist team who treat cardiovascular and mental health as one connected system. Learn more at coraeon.com.
I recently sat down with a husband-and-wife duo who are changing the way we think about heart health for an episode of the mindbodygreen podcast.
Giovanni Campanile, M.D., a functional cardiologist, and Sandra Cammarata, Ph.D., a functional psychiatrist, are the founders of CorAeon. Their approach combines advanced cardiovascular testing with questions many cardiologists gloss over, such as your relationships, stress levels, and sleep.
And these lifestyle factors are critical. I was surprised when they told me that a Harvard longevity study found the number one predictor of living long is the quality of your relationship with your spouse or partner by age 50, not your cholesterol.
But they also shared some seriously advanced testing that most conventional cardiologists aren't running. These tests can predict your future risk much better than the standard lipid panel. Let's break it down.
ApoB & the ApoB/A1 ratio
This is the marker Campanile considers most important. ApoB is the "bad" marker that causes disease. ApoA1 is the "good" marker that helps clear cholesterol out of your arteries.
The ratio of these two has a direct correlation on heart attacks and major adverse cardiac events, Campanile explained.
If you are not at increased risk of heart disease, you want your ApoB/ApoA1 ratio to be below 0.6. If you have existing heart disease or increased risk, Campanile recommends aiming to get this ratio as close to 0.2 as possible.
Lowering ApoB and this ratio can be achieved with shifts in lifestyle factors, but it's harder for some people than others. Getting to 0.2 usually requires a PCSK9 inhibitor, Campanile noted, a newer class of drugs that can reduce cholesterol by 50 to 60 percent with minimal side effects.
Lp(a) — the genetic wildcard
Lipoprotein(a), or Lp(a), is a genetic predisposition for heart disease that's completely independent from lifestyle. This means you can eat perfectly, exercise daily, and still have elevated Lp(a).
When treating patients with elevated Lp(a), Campanile tends to be more aggressive with treatment, often using PCSK9 inhibitors to lower overall cardiovascular risk.
Fasting insulin, HOMA-IR & metabolic markers
Insulin resistance and metabolic syndrome are epidemics in the Western world, Campanile says. And these conditions can directly affect your heart.
When you have insulin resistance, it makes your cholesterol particles smaller and more numerous. This makes it easier for the particles to slip through artery walls and cause damage.
When it comes to metabolic markers, most doctor's simply test A1C, a 3-month blood sugar average. While Campanile says this is useful, he also tests his patients' fasting insulin, fasting glucoe, C-peptide, and HOMA-IR, which are markers directly tied to insulin resistance, the real metabolic driver of heart disease.
Here's what Campanile says you should aim for when it comes to metabolic markers:
- Hemoglobin A1C: Around 5
- Fasting insulin: Ideally below 10, optimally at 5
- Fasting glucose: Around 75 to 80 mg/IL
- C-peptide: Another marker of insulin production
- HOMA-IR: A calculation based on insulin and glucose that's directly related to development of diabetes and heart disease
Excess amounts of insulin in your body can also cause cancer and diabetes, so managing insulin resistance extends beyond heart health. It also helps prevent your overall disease risk.
Advanced lipid testing
If you've ever had bloodwork done, you probably got the classic "good cholesterol, bad cholesterol" breakdown. Campanile told me that's accurate, but not the most useful in terms of future risk. The problem is that standard panels don't tell you about particle size or particle number. If you have big, fluffy cholesterol particles, they can't penetrate the artery wall as easily. But if you have a lot of small, dense LDL particles, they can slip through and cause damage.
Campanile uses two advanced panels to assess this.
The Boston Heart test has long been a go-to for advanced lipid markers. It can tell you whether you're a hyper-absorber of cholesterol (like me – I discovered I'm an ultra-absorber of saturated fat) or a hyper-producer. This helps personalize treatment.
The Cardio Zoomer is a cutting-edge panel Campanile helped design with Vibrant America, and he considers it the best available. It goes beyond Boston Heart by including:
- Ceramides: Waxy molecules that, when found in blood, indicate plaque stability or instability.
- Myeloperoxidase: An inflammatory marker that creates bleach inside your cells. This is your body's attempt to clean arteries, but it can backfire when cholesterol builds up.
- Deep insulin resistance markers: A comprehensive look at metabolic health.
Cammarata added that these inflammatory markers also correlate with depression risk. The higher the inflammation, the higher your chance of depression.
Cleerly scan
For the best imaging in the business, Campanile recommends a Cleerly Scan, which combines a CT scan with contrast and AI analysis. This helps dive deeper into the calcium score, which many people misinterpret.
A lot of people think a zero calcium score means they're in the clear, but anywhere from 15 to 25 percent of people with a zero calcium score have soft plaque, Campanile told me.
Cleerly scans differentiate between calcified plaque (more stable), soft plaque (less stable), and inflamed soft plaque (prone to rupture). Giovanni described inflamed soft plaque like a pimple inside your artery, and unlike a pimple on your face, this one forms a blood clot and causes a heart attack when it pops.
InBody scan for body composition
One of the things Campanile and Cammarata check on everyone patient who comes in to their clinic body composition, because visceral fat has a major impact on health.
They use the InBody 970 because it accurately measures visceral fat and phase angle (a measure of cell health). Recent studies have shown that visceral fat is associated with potential risk for dementia, heart disease, possible cancer, and faster aging.
The InBody can reveal hidden visceral fat that's driving disease risk, even in people who look healthy. That's why the doctors follow body composition closely over time.
The mind-body-heart connection
Giovanni shared a fascinating story about one of his patients: a dentist with significant soft plaque in a dangerous location. They optimized his biomarkers, and the plaque came down a little. But the real transformation happened when the dentist retired from his stressful practice, got divorced, found a girlfriend, and became the happiest version of himself.
Giovanni now uses that patient's imaging as an example of incredible reversal of heart disease. The stress reduction and the relationship improvement made the difference, not the biohacking.
This is the part where Cammarata's expertise comes in. She explained that stress can be healthy. It motivates you, releases dopamine and norepinephrine, and then comes back down.
But chronic stress causes to leads to consistently elevated cortisol, depletion of your neurotransmitters, inability to focus, and general feelings of exhaustion and depression. You might not realize it, but this chronic stress directly impacts your heart1. That's why relationship quality at age 50 proves to be the strongest predictor of health at age 80.
The takeaway
Their approach is both high-tech and deeply human. Yes, they want you to get the advanced testing, but they also want you to ask yourself the basic lifestyle questions people often miss. Think: how are my relationships? How's my stress? Am I sleeping well?
Because sometimes the most powerful intervention isn't a drug or a scan. It's a hug before your procedure. It's retiring from a job that's killing you. It's prioritizing the people you love.