Fasting glucose has climbed steadily for 15 years: 85 mg/dL in 2011 → 108 mg/dL Jul 2026 — a new high, following the Jun 2025 formal diagnosis of fasting hyperglycemia. The good news: the A1c recheck (finally ordered) came back at 5.2%, still comfortably under the 5.7% prediabetes threshold and only 0.1 point above Apr 2024's 5.1%. That's a meaningful data point — average blood sugar over the last 2–3 months hasn't moved much even though the fasting spot-check keeps climbing, which points toward stress/dehydration/timing effects on the fasting draw rather than a true metabolic shift, but it's still worth a frank conversation with Dr. Yocks about the discrepancy. Weight has increased 20+ lbs since the 2020 low, still the likely primary driver. The convergence of glucose creep + weight gain + alcohol remains 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 | 108 mg/dL (Jul 2026) | <100 optimal | YELLOW | → holding near 109 | On Simvastatin 10mg; dose/switch conversation still needed |
| Total Cholesterol | 190 mg/dL (Sep 2025) | <200 | GREEN | → stable | Well controlled post-statin. Not re-reported Jul 2026 (only Chol/HDL ratio=3.1 given). |
| HDL Cholesterol | 58 mg/dL (Jul 2026) | >40 (men) | GREEN | ↓ down from 65 | Still well above threshold; small dip worth watching next panel |
| Triglycerides | 90 mg/dL (Jul 2026) | <150 | GREEN | → stable | Well controlled |
| Fasting Glucose | 108 mg/dL (Jul 2026) | 70–99 normal | RED | ↑↑ steady climb | Highest reading on record. A1c came back normal (5.2%) — discuss discrepancy with Dr. Yocks. |
| eGFR (Kidney) | 68 mL/min (Jul 2026) | >60 G2 CKD | YELLOW | ↓ down from 76 | Dipped from 76 (Jun 2025); still above 60. Avoid NSAIDs, stay hydrated, recheck next visit. |
| PSA | 1.59 ng/mL (Jul 2026) | <4.0 ng/mL | YELLOW | ↑ up from 0.88 | Rising again after Jan 2025 low of 0.88; below prior 1.91 spike. Flag for urology follow-up. |
| 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. Still not on Jul 2026 panel — ask to add permanently. |
| A1c | 5.2% (Jul 2026) | <5.7% normal | GREEN | → normal | Recheck complete — still normal despite fasting glucose 108. Up only 0.1pt from 5.1% (Apr 2024). Discuss glucose/A1c mismatch with Dr. Yocks. |
| 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 54. |
| 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) | 5.2% | Jul 2026 | <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 | 3.1 (Jul 2026) | Jul 2026 | <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 climbed and has now plateaued in the 108–109 range for three consecutive panels (Jun 2025, Sep 2025, Jul 2026). This is above the <100 optimal target for someone with your genetic CAD risk, but at least it has stopped climbing. 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 a peak of ~171 lbs, (2) fasting glucose up from 91 to 108 mg/dL (Jul 2026) — formally diagnosed as fasting hyperglycemia in Jun 2025 and still climbing, (3) hsCRP at the risk boundary. The A1c recheck (5.2%, Jul 2026) is reassuring — average blood sugar is not tracking the fasting-glucose climb 1:1 — but the gap between the two numbers is itself worth discussing with Dr. Yocks. 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 ~171 lbs. New signal (Jul 8–14, 2026): 7 straight daily weigh-ins show a drop from 171.1 to 168.3 lbs — the first real downward inflection in a long time. One week isn't a trend yet, but it's worth reinforcing whatever changed. Alcohol reduction, weight loss to 150–155 lbs target, and maintaining running remain the three highest-leverage interventions available.
| Test | Latest | Date | Reference | Status | Notable |
|---|---|---|---|---|---|
| Fasting Glucose | 108 mg/dL | Jul 2026 | 70–99 mg/dL | ABOVE NORMAL | New high, up from 101 (Jun 2025). A1c recheck same visit was normal (5.2%). |
| A1c (HbA1c) | 5.2% | Jul 2026 | <5.7% normal | NORMAL | Recheck complete. Up only 0.1pt from 5.1% (Apr 2024) despite fasting glucose climbing 10pts. |
| eGFR | 68 mL/min | Jul 2026 | >60 (G2 border) | G2 CKD | Down from 76 (Jun 2025). Watch creatinine; stay hydrated. |
| Creatinine | 1.12 mg/dL | Jul 2026 | 0.57–1.25 mg/dL | NORMAL | Up slightly from 1.03 (Jun 2025), still in range |
| BUN | 26 mg/dL | Jul 2026 | 7–26 mg/dL | HIGH END OF NORMAL | At the top of range; was 23 (Jun 2025). Hydration check. |
| CO₂ (Bicarb) | 31 mEq/L | Jul 2026 | 22–30 mEq/L | SLIGHTLY HIGH | Consistent mild elevation — athlete adaptation likely |
| WBC | 5.9 ×10³/µL | Jul 2026 | 4.3–11.0 | NORMAL | Stable across all years |
| Hemoglobin | 16.4 g/dL | Jul 2026 | 12.0–17.5 g/dL | NORMAL | Strong O₂ carrying capacity for running |
| Hematocrit | 48% | Jul 2026 | 38–47% | SLIGHTLY HIGH | Just above range — common in endurance athletes/altitude adaptation; monitor for hydration status |
| PSA | 1.59 ng/mL | Jul 2026 | <4.0 ng/mL | RISING | Up from 0.88 (Jan 2025); still below prior 1.91 spike. Mention at next urology visit. |
| Sodium | 138 mmol/L | Jul 2026 | 136–145 mmol/L | NORMAL | Stable electrolyte balance |
| Potassium | 3.9 mmol/L | Jul 2026 | 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.
Direct extraction from your 30x WGS raw VCF (GlennHeistand-NG14Y2P2RY, GRCh38, Sequencing.com) using bcftools/tabix against specific well-studied coordinates. This is informational, not diagnostic — these are literal genotype reads at known research/clinical SNPs, not a certified clinical genetics report. Review anything actionable with Dr. Yocks or a genetic counselor before acting on it, especially the APOE result below.
| Gene / Variant | rsID | Your Genotype | Call Quality | What It Means |
|---|---|---|---|---|
| APOE (isoform-defining pair) | rs429358 + rs7412 | ε3/ε4 (het C at rs429358; ref T/T at rs7412) | High (GQ 127, DP 24, PASS) | 2–3x increased late-onset Alzheimer's risk vs. ε3/ε3 baseline; ~22% increased CHD risk vs. ε3/ε3. Not deterministic — most ε4 carriers never develop AD. This is the single most emotionally weighty result here; worth discussing with a genetic counselor, not just a PCP, if you want to go deeper. |
| PCSK9 R46L (loss-of-function, LDL-lowering) | rs11591147 | Ref/Ref — does not carry the protective LFV allele | High (in a well-covered ref block) | You don't have the "natural PCSK9 inhibitor" variant some people carry that dramatically lowers LDL. Doesn't explain your LDL creep, but does mean PCSK9 inhibitor drugs (if ever needed) would be acting on a fully functional target — no genetic reason to expect an unusual response. |
| PCSK9 region — 50+ common SNPs scanned | rs562556, rs505151, others | Mix of het/hom, mostly common alleles | High | No rare or flagged pathogenic PCSK9 variants found in the gene region. Nothing here explains the LDL trend — points back to lifestyle/dose as the driver, consistent with the statin-note already on your Cardiovascular tab. |
| FTO (obesity susceptibility) | rs9939609 | Ref/Ref — does not carry the risk (A) allele | High (in a well-covered ref block) | You don't carry the common FTO variant linked to ~1.7x obesity odds and increased appetite/calorie intake. Your weight trend is more plausibly explained by lifestyle (alcohol, training volume, stress) than this specific genetic driver — slightly reassuring that it's a modifiable pattern, not a strong genetic headwind. |
| ACE I/D polymorphism | rs4646994 (Alu insertion/deletion) | Not directly callable — this variant is a large structural insertion that short-read SNP/indel pipelines like yours typically can't capture | N/A — technical limitation | Can't be answered from this VCF. Nearby linked SNPs (rs4341, rs4343) were found heterozygous, which are sometimes used as imperfect proxies, but a direct answer would need a PCR-based ACE I/D test or long-read sequencing. Flagging honestly rather than guessing. |
| MTHFR C677T | rs1801133 | Ref/Ref — no risk allele | High | No reduced-function C677T allele. Combined with A1298C result below, no compound-heterozygous concern. |
| MTHFR A1298C | rs1801131 | Heterozygous (one copy) | High (GQ 127) | Modest, generally low-clinical-significance finding on its own. Since you're C677T ref/ref, you're not compound heterozygous (the combination that actually raises homocysteine risk meaningfully). Not something to act on absent an elevated homocysteine lab value. |
| APOA5/APOC3 region (triglyceride-raising) | rs3135506 | Ref/Ref — no TG-raising allele | High | Consistent with your consistently well-controlled triglycerides (82–107 mg/dL range across 14+ years). |
| CYP2C19 (clopidogrel/some statin-adjacent metabolism) | rs4244285 (*2 allele) | Ref/Ref — normal metabolizer | High | Confirms the "CYP2C19 normal metabolizer" note already in your 23andMe pharmacogenetics summary. No red flag for clopidogrel or related drug metabolism if ever prescribed. |
This is the one result here worth sitting with rather than shrugging off. APOE ε3/ε4 roughly doubles-to-triples your lifetime Alzheimer's risk compared to the most common ε3/ε3 genotype, and modestly increases cardiovascular risk on top of your already-elevated genetic CAD risk (66th percentile). It is not a diagnosis and not deterministic — plenty of ε3/ε4 carriers never develop AD, and the actual mechanism (impaired amyloid-beta clearance, promoted plaque aggregation) is influenced by modifiable factors: cardiovascular health, metabolic health, sleep quality, exercise, and cognitive engagement. Your running habit and excellent CT calcium score are directly protective here too — vascular health and brain health are tightly linked. This is worth a conversation with Dr. Yocks and, if you want a deeper read, a genetic counselor — they can talk through whether further workup (cognitive baseline testing, etc.) makes sense at 54, or whether it's simply useful context to file away and revisit in a decade.
Analysis performed by querying your raw VCF (GlennHeistand-NG14Y2P2RY-30x-WGS-Sequencing_com-03-28-24.snp-indel.genome.vcf.gz, GRCh38/hg38, tabix-indexed) at specific, well-published genomic coordinates using bcftools/tabix — a direct, transparent lookup, not a black-box report. Every genotype above is traceable to a specific chromosome position and can be re-verified. This covers only the loci checked; the VCF contains millions of additional variants not reviewed here. If you want more genes checked in the future, just ask — the file is already indexed and ready for fast targeted queries.
⚠️ 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). |
| Omega-3 Fish Oil | OTC dose | Daily | Ongoing | Cardiovascular / anti-inflammatory | Modest TG reduction benefit. Anti-inflammatory effect relevant for runner. Safe to continue. |
| GNC Mega Men Sport Multivitamin | 1 serving | Daily | Years | General multivitamin / athletic performance formula | High-dose B-complex, Vitamin C 300mg, D 50mcg, Zinc 25mg (>2x RDA, offset by 2mg copper in same formula), amino acids, turmeric 26.3mg, antioxidant carotenoids. Long-term high-dose zinc worth a mention to Dr. Yocks given years of use. |
| Arazo Glucosamine Chondroitin Turmeric MSM Boswellia | 1 serving | Daily | Years | Joint support | Glucosamine 1500mg, chondroitin 1200mg, MSM 1000mg, turmeric 100mg, Boswellia 100mg. Combined turmeric intake with multivitamin (~126mg/day total) has mild antiplatelet properties — relevant if clopidogrel or other antiplatelet/anticoagulant therapy is ever considered. No known interaction with Simvastatin. |
| 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, A1c NORMAL | Formal diagnosis Jun 2025. A1c rechecked Jul 2026 (5.2%, normal) despite glucose hitting new high of 108. |
| 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. |
A1c came back at 5.2% (Jul 2026) — up only 0.1 point from 5.1% (Apr 2024) and still comfortably under the 5.7% prediabetes threshold, despite fasting glucose hitting a new high of 108 mg/dL the same visit. This is genuinely reassuring — average blood sugar over the last 2–3 months hasn't tracked the fasting-glucose climb. Worth a direct conversation with Dr. Yocks about why the two numbers diverge (timing of the draw, hydration, stress, or just spot-check noise). ApoB (78 mg/dL, Apr 2024) was not re-run this visit — ask to add it permanently to the annual panel, along with A1c now that it's established as a recurring test.
PSA rose from 0.88 ng/mL (Jan 2025) to 1.59 ng/mL (Jul 2026) — still well below the prior 1.91 spike (Apr 2024) and under the 4.0 clinical threshold, but the upward direction after a period of reassurance is worth flagging at the next urology or annual visit. Saw palmetto use can suppress PSA readings, so a "true" trend may be even more pronounced than the numbers suggest — mention this to whoever reviews the result.
🚨 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 58–65 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 54. Your colonoscopy was normal. Your PSA spike resolved, though it's ticking up again — worth a mention at your next visit. 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.