While working in the yard today, I was listening to an excellent podcast in Michael Mantell’s “15 Minutes to Wellness, ACE Fitcast” series. The subject was boutique gyms and wellness coaching via small group training and presented an exciting vision for helping people change lifestyle for better health. So how does this relate to my current discussion about advanced cardiovascular testing? The tie-in is that it served as a reminder for me to emphasize keeping first things first. A common tendency in the world of cardiovascular prevention is to get caught up in technology and cutting edge lab testing which leads to multiple medications and more testing. (Even when you are seeking to prevent stents and heart bypass operations) Dr. Daniel Edmundowicz, a preventive heart specialist speaking at the recent Cleveland Heartlab Annual Symposium, opened his talk about heart imaging with a warning. He urged us not to get so caught up in technology that we lose the big picture forgetting what got us into our current bad state of health in the first place. The culprit is first and foremost an unhealthy lifestyle consisting of poor diet, lack of exercise, excess stress, inadequate sleep and smoking. Addressing these issues should always come first in prevention and even in treatment. Might we have to add medications on occasion? Absolutely, but that’s what excites me about this new testing. It allows very selective use of drugs but more than that provides a way to intelligently prescribe and follow the results of lifestyle change. We are able to modify programs, give warnings when due or encouragement when progress is made. This, in my opinion, is the cutting edge of “medically based wellness.” Treat and prevent illness by identifying the cause and pulling it out by the roots! Thanks for the reminder Dr. Mantell. I will resume discussing biomarkers of disease on Wednesday.