Fasting glucose has climbed steadily for 14 years: 85 mg/dL in 2011 → 101 mg/dL in Jun 2025. The Jun 2025 visit formally diagnosed fasting hyperglycemia. A1c has not yet been ordered — this is the critical missing piece. Weight has increased 20+ lbs since 2020 low, likely the primary driver. The convergence of glucose creep + weight gain + alcohol is the core metabolic story that needs intervention.
Your genomic profile carries a 66% lifetime risk for coronary artery disease — yet your CT calcium scan (June 2024) shows a score of essentially zero. This is direct evidence that 14+ years of marathon running has protected your arteries. Your HDL is strong (63–65 mg/dL), carotid IMT is normal, ABI is normal. Keep running.
| Metric | Current | Reference | Status | Trend | Notes |
|---|---|---|---|---|---|
| LDL Cholesterol | 109 mg/dL (Sep 2025) | <100 optimal | YELLOW | ↑ creeping up | On Simvastatin 10mg; dose/switch conversation needed |
| Total Cholesterol | 190 mg/dL (Sep 2025) | <200 | GREEN | → stable | Well controlled post-statin |
| HDL Cholesterol | 65 mg/dL (Sep 2025) | >40 (men) | GREEN | ↑ excellent | Running is your superpower |
| Triglycerides | 82 mg/dL (Sep 2025) | <150 | GREEN | → stable | Well controlled |
| Fasting Glucose | 101 mg/dL (Jun 2025) | 70–99 normal | RED | ↑↑ steady climb | Formally diagnosed fasting hyperglycemia. A1c needed. |
| eGFR (Kidney) | 76 mL/min (Jun 2025) | >60 G2 CKD | YELLOW | ↑ recovering | Was 64 in Apr 2024; recovering. Avoid NSAIDs, stay hydrated. |
| PSA | 0.88 ng/mL (Jun 2025) | <4.0 ng/mL | GREEN | ↓ reassuring | Spiked to 1.91 Apr 2024 then dropped. Continue annual monitoring. |
| CT Calcium Score | 1 (Jun 2024) | <10 = minimal | GREEN ✨ | → excellent | Despite 66% genetic CAD risk. Running = cardioprotection. |
| hsCRP | 1.1 mg/L (Oct 2024) | <1.0 low risk | YELLOW | → average risk | At the low/average risk boundary. Monitor. |
| Lp(a) | 44 nmol/L (Oct 2024) | <75 normal | GREEN | → normal | Within normal range despite CAD genetic risk. |
| ApoB | 78 mg/dL (Apr 2024) | <90 optimal | GREEN | → optimal | Better CVD risk marker than LDL alone. Excellent. Add to annual panel. |
| A1c | 5.1% (Apr 2024) | <5.7% normal | GREEN | → normal | Normal as of Apr 2024 despite fasting glucose 98. Recheck due Jul 2026 — fasting glucose now 101. |
| Blood Pressure | 113/72 avg (391 home, 2022–2026) | <120/80 normal | GREEN ✅ | → normal | 391 Garmin home readings Nov 2022–Jul 2026. Avg 113.7/71.7 — normal. Clinical readings (138/70, 146/73) are white-coat effect. |
| Resting HR | 47 bpm (2026 avg) | 40–60 athletic | GREEN | ↑ slight creep | 42 bpm peak in 2020. Still excellent for age 53. |
| Brain AVM | Stable, asymptomatic | Documented | MONITOR | → stable | Known arteriovenous malformation. Every chart documents it. |
Your whole-genome sequencing identifies a 66% lifetime genetic risk for coronary artery disease — top quartile of risk. Yet your June 2024 CT heart scan shows a calcium score of essentially zero. Carotid IMT is normal. Ankle-brachial index is normal. This combination tells one story: consistent marathon running has protected your arteries despite your genetic predisposition. Keep it going.
| Marker | Value | Date | Reference | Risk |
|---|---|---|---|---|
| CT Calcium Score | 1 | Jun 2024 | <10 minimal, <100 low | MINIMAL ✅ |
| hsCRP | 1.1 mg/L | Oct 2024 | <1.0 low, 1–3 average | AVERAGE RISK |
| Lp(a) | 44 nmol/L | Oct 2024 | <75 nmol/L normal | NORMAL |
| ApoB | 78 mg/dL | Apr 2024 | <90 optimal | OPTIMAL |
| A1c (HbA1c) | 5.1% | Apr 2024 | <5.7% normal | NORMAL |
| Carotid IMT | Normal | Life Line 2025 | No significant thickening | NORMAL ✅ |
| AAA Screen | Normal | Life Line 2025 | No abdominal aortic aneurysm | NORMAL ✅ |
| Ankle-Brachial Index | Normal | Life Line 2025 | >0.9 = no PAD | NORMAL ✅ |
| Cholesterol/HDL Ratio | ~2.9 (Sep 2025) | Sep 2025 | <3.5 optimal | OPTIMAL |
| Genetic CAD Risk (WGS) | 66% lifetime | Mar 2024 | Population avg ~30% | HIGH GENETIC |
| Genetic AFib Risk | Elevated | Mar 2024 | — | WATCH |
You've been on Simvastatin 10mg since ~2020. After the initial LDL drop from 149 → 72 mg/dL (Feb 2022 best), LDL has been climbing: 80 → 95 → 100 → 104 → 109. The Sep 2025 value of 109 mg/dL is above the <100 optimal target for someone with your genetic CAD risk. At your next visit with Dr. Yocks, discuss: (1) dose increase to 20–40mg, (2) switch to a higher-potency statin (rosuvastatin), or (3) adding ezetimibe. Your pharmacogenetics (23andMe) show statin metabolism variants — review these when making the change.
Three trends have converged since 2020: (1) weight up from 141 lbs to 171 lbs (+30 lbs), (2) fasting glucose up from 91 to 101 mg/dL — now formally diagnosed, (3) hsCRP at the risk boundary. The Garmin data shows the weight acceleration clearly: 2022 avg 147 lbs → 2023 avg 150 lbs → 2024 avg 154 lbs → 2025 avg 162 lbs → 2026 YTD 170 lbs. The inflection point aligns with reduced training load. Alcohol reduction, weight loss to 150–155 lbs target, and maintaining running are the three highest-leverage interventions available.
| Test | Latest | Date | Reference | Status | Notable |
|---|---|---|---|---|---|
| Fasting Glucose | 101 mg/dL | Jun 2025 | 70–99 mg/dL | ABOVE NORMAL | Formally diagnosed. A1c urgent. |
| eGFR | 76 mL/min | Jun 2025 | >60 (G2 border) | G2 CKD | Recovering from 64 low. Watch creatinine. |
| Creatinine | 1.03 mg/dL | Jun 2025 | 0.57–1.25 mg/dL | NORMAL | Improved from 1.16 at Oct 2024 |
| BUN | 23 mg/dL | Jun 2025 | 7–26 mg/dL | NORMAL | Was 29 (H) in Oct 2024 |
| CO₂ (Bicarb) | 30 mEq/L | Jun 2025 | 22–29 mEq/L | SLIGHTLY HIGH | Consistent mild elevation — athlete adaptation likely |
| WBC | 6.4 ×10³/µL | Oct 2024 | 4.3–11.0 | NORMAL | Stable across all years |
| Hemoglobin | 16.0 g/dL | Oct 2024 | 12.0–17.5 g/dL | NORMAL | Strong O₂ carrying capacity for running |
| Hematocrit | 45% | Oct 2024 | 38–47% | NORMAL | Consistent |
| PSA | 0.88 ng/mL | Jun 2025 | <4.0 ng/mL | NORMAL ✅ | Reassuring drop from 1.91 spike |
| Sodium | 137 mmol/L | Jun 2025 | 136–145 mmol/L | NORMAL | Stable electrolyte balance |
| Potassium | 4.4 mmol/L | Jun 2025 | 3.5–5.1 mmol/L | NORMAL | Good for cardiac function |
You have 30x whole genome sequencing (WGS) from Sequencing.com — not the limited SNP array that consumer tests like 23andMe use. This provides coverage of millions more variants including structural variants, rare pathogenic alleles, and pharmacogenomic markers. The results below come from your Sequencing.com reports (Athletic Performance, Healthy Heart, Arthritis Prevention, Age with Strength, Melanoma Prevention) plus your 23andMe pharmacogenetics summary. Your raw VCF file also enables deeper analysis of specific variants like PCSK9, APOE, ACE, and FTO.
Your 30x WGS raw VCF file contains millions of variants not yet analyzed. Of particular interest given your clinical picture: PCSK9 variants (LDL regulation — highly relevant given your statin response and LDL creep), APOE genotype (Alzheimer's + cardiovascular risk), FTO variants (obesity predisposition — relevant to weight gain trajectory), and ACE I/D polymorphism (blood pressure + endurance performance). A clinical geneticist or genetic counselor could extract these from your existing data.
⚠️ ALLERGIES — REVIEW BEFORE ANY TREATMENT
| Allergen | Reaction | Severity | Action Required |
|---|---|---|---|
| Bee Venom | Anaphylaxis | LIFE-THREATENING | Epinephrine auto-injector required. Always carry Epi-Pen during outdoor activities. ER-level emergency if stung. |
| Tree Pollen | Allergic rhinitis | MODERATE | Seasonal antihistamines as needed. Not life-threatening. |
You train outdoors year-round. Bee sting anaphylaxis is a documented life-threatening allergy. An Epi-Pen should be accessible on every outdoor run. Consider a lightweight waistbelt carry. Make sure your emergency contact and running partners know about this allergy. Confirm your current Epi-Pen prescription is filled and not expired.
| Medication | Dose | Frequency | Since | Purpose | Notes |
|---|---|---|---|---|---|
| Simvastatin | 10 mg | Daily | ~Dec 2019 | LDL reduction | LDL now 109 (creeping up from 72 best). Dose/switch conversation warranted. Review pharmacogenetics first. |
| Saw Palmetto | OTC dose | Daily | Ongoing | BPH symptom management | PSA spike in Apr 2024 noted — saw palmetto can lower PSA levels, masking changes. Mention to urologist. |
| PreserVision AREDS 2 | Recommended dose | Daily | Ongoing | AMD prevention / eye health | Ophthalmologist-recommended. Continue. Annual eye exams documented (last Feb 2026). |
| Vitamin D | OTC dose | Daily | Ongoing | Bone health / immune function | Reasonable for northern-latitude outdoor athlete. Level not recently tested — consider adding to annual labs. |
| Omega-3 Fish Oil | OTC dose | Daily | Ongoing | Cardiovascular / anti-inflammatory | Modest TG reduction benefit. Anti-inflammatory effect relevant for runner. Safe to continue. |
| Vaccine | Status | Notes |
|---|---|---|
| COVID-19 Primary Series | COMPLETE | J&J + Moderna series documented |
| COVID-19 Bivalent Booster | COMPLETE | Sep 22, 2022 |
| COVID-19 2023 Updated Booster | COMPLETE | 2023 updated formulation documented |
| Tetanus (Td/Tdap) | CHECK DUE | Booster every 10 years. Verify last date with Dr. Yocks. |
| Flu (Annual) | ANNUAL DUE | Get annually in fall. As a runner, flu impacts training significantly. |
| Shingles (Shingrix) | DUE AT 50+ | Recommended at age 50. 2-dose series. Discuss with Dr. Yocks if not yet done. |
| RSV (Abrysvo) | DISCUSS | Now recommended for 60+. Check at next visit. |
| Condition / Procedure | Date | Status | Notes |
|---|---|---|---|
| Brain AVM (Arteriovenous Malformation) | Known/documented | STABLE | Asymptomatic. Documented in every chart note. Monitor per neurologist guidance. |
| Colonoscopy | Dec 2023 | NORMAL ✅ | No polyps. Next due ~Dec 2028 (5-year interval). |
| CT Heart Calcium Score | Jun 2024 | SCORE = 1 ✅ | Essentially zero. Excellent result. |
| Life Line Screening | 2025 | ALL NORMAL | Carotid IMT, AAA, ABI all normal. BP 138/70 noted. |
| Fasting Hyperglycemia | Jun 2025 | ACTIVE DX | Formal diagnosis. A1c needed. Dr. Yocks. |
| Malignant Hyperthermia Susceptibility | Mar 2024 (WGS) | DOCUMENTED | Already charted. Must be disclosed before any anesthesia procedure. |
| BPH (Benign Prostatic Hyperplasia) | Ongoing | MANAGED | Using saw palmetto. PSA monitoring ongoing. |
| Foot X-ray | Jun 2019 | HISTORICAL | Runner-related foot evaluation. |
Your last A1c was 5.1% (Apr 2024) — completely normal. Your ApoB was also excellent at 78 mg/dL — a better cardiovascular predictor than LDL, especially on a statin. However, 15 months have passed and your fasting glucose has since climbed to 101 mg/dL (formally diagnosed fasting hyperglycemia). The recheck at your upcoming Dr. Yocks visit will confirm whether the average has crept at all. Ask him to add ApoB to your annual panel going forward.
🚨 Immediate (This Month)
⚡ Near-Term (3–6 Months)
✅ Ongoing Monitoring Schedule
🔬 Genomic Watchlist
| Lever | Target Metrics Affected | Impact | Notes |
|---|---|---|---|
| Alcohol Reduction | Glucose, weight, sleep, BP, liver enzymes | HIGHEST | Most interconnected lever. Affects every metabolic marker simultaneously. Even 50% reduction has measurable glucose impact. |
| Weight → 150–155 lbs | LDL, glucose, BP, joint load, running performance, eGFR | HIGHEST | Currently 171 lbs — 16–21 lbs above target. Each 10 lbs lost is clinically meaningful across all markers. |
| Maintain Running Volume | CT Calcium (keep at 1), HDL, resting HR, glucose, weight, mood | HIGH | This is what's protecting your heart despite CAD genetics. Non-negotiable. The CT calcium = 1 proves it works. |
| Add Resistance Training 2x/wk | Insulin sensitivity, muscle mass, bone density, joint protection | HIGH | At 53, muscle mass preservation is increasingly important. Favorable genetics for strength aging (Age with Strength report). |
| Dietary Sodium Reduction | Blood pressure (especially given salt-sensitive hypertension genetics) | MODERATE-HIGH | More impactful for you than average due to salt-sensitive hypertension genetic variants. |
| Sleep Optimization | Glucose, weight, BP, cortisol, recovery, HRV | MODERATE-HIGH | Garmin sleep data available. Poor sleep drives glucose elevation and cortisol — directly feeds the metabolic picture. |
| Hydration (especially around runs) | eGFR, BUN, creatinine, electrolytes | MODERATE | eGFR was 64 at worst. Dehydration during training is a direct kidney stressor. Consistent hydration is protective. |
The data tells a clear story. Your HDL went from 38 to 65 mg/dL. Your CT calcium score is 1 despite genetic CAD risk in the 66th percentile. Your resting heart rate is 47 bpm at age 53. Your colonoscopy was normal. Your PSA spike resolved. The running is not incidental to these outcomes — it is the mechanism. Every single year you maintain this habit, you are banking protection against the genetic risks you carry. The weight, glucose, and alcohol picture can be fixed. The running must be protected at all costs.