What My PhenoAge Didn’t Tell Me About My Heart
A few days after my 61st birthday, I decided to give myself something more valuable than a present: information.
I signed up for a comprehensive health assessment measuring 81 biomarkers related to cardiovascular health, aging, metabolism, inflammation, kidney function, genetics, and recovery. Like many people who exercise regularly, play tennis several times a week, work with a trainer, and generally feel healthy, I was curious to see whether the data would confirm what I hoped was true.
In many ways, it did.
I used some of the data from the report to populate fields of an online calculator to estimate my biological age—or PhenoAge—at 54.75 years old, more than six years younger than my chronological age. My insulin levels were excellent. Kidney function was normal. Inflammatory markers were generally favorable. One of the most genetically driven markers for cardiovascular risk, Lipoprotein(a), was exceptionally low. On the surface, it looked like I was aging well.
There was another reason these results meant so much to me.
In February 2021, I underwent heart surgery to repair a severely leaking mitral valve. The operation was successful, but what happened afterward left a lasting impression on me.
Following the surgery, my surgeon reported to Heather that my mitral valve was one of the worst he had ever seen, and he had repaired at least 2,000 up until that point. Until he was actually inside my chest and able to directly observe the valve, neither of us fully appreciated the extent of the deterioration. Hearing those words was sobering. Something that had remained largely hidden beneath the surface turned out to be a serious and potentially life-altering problem.
Fortunately, the outcome could not have been better.
Since the surgery, my follow-up visits with my cardiologist have consistently delivered encouraging news. The repaired valve exhibits only minimal leakage, my heart’s ejection fraction is approximately 63%, and my cardiologist has remarked that if someone examined my heart today without knowing its history, they would never guess that I had undergone major heart surgery.
For that, I feel profoundly grateful.
The experience taught me something important: feeling healthy does not always mean you know everything that’s happening beneath the surface. Problems can quietly develop for years before they become visible. Conversely, timely intervention can restore health so completely that the past becomes nearly invisible.
Perhaps that’s why I was so intrigued by this latest round of testing.
Because investing has taught me the same lesson.
The most important information is often hidden beneath the headline numbers.
A company can report impressive earnings while underlying fundamentals weaken. A property can boast strong occupancy while deferred maintenance quietly accumulates. Surface-level metrics matter—but they don’t always tell the whole story.
The same principle applies to our health.
The Problem with Traditional Cholesterol Testing
When most people discuss heart health, the conversation usually centers around total cholesterol, LDL cholesterol, and HDL cholesterol.
My numbers appeared reasonably acceptable:
- Total Cholesterol: 162 mg/dL
- LDL Cholesterol: 102 mg/dL
- HDL Cholesterol: 38 mg/dL
- Triglycerides: 123 mg/dL
Had these been the only measurements available, I might have concluded that there was little reason for concern.
But this time I looked deeper.
The advanced cardiovascular panel measured not just how much cholesterol was present, but how it was being transported throughout my bloodstream.
And that’s where the story became far more interesting.
Why Particle Count Matters More Than Cholesterol
Imagine you’re trying to assess traffic on a freeway.
Would you rather know the total weight of all vehicles on the road?
Or the number of vehicles?
Most people would prefer to know the number of vehicles.
Five hundred motorcycles create a different traffic pattern than fifty delivery trucks, even if the total weight is similar.
Cholesterol works much the same way. Cholesterol itself isn’t the problem. Cholesterol is cargo. The particles carrying that cholesterol are the vehicles. Traditional cholesterol tests tell you how much cargo is in circulation. Advanced lipid testing tells you how many vehicles are on the road and what kinds of vehicles they are.
My advanced panel revealed:
- LDL Particle Number: 1,839 (high)
- Small LDL Particles: 351 (high)
- Medium LDL Particles: 250 (high)
- Apolipoprotein B: 93 (slightly elevated)
- LDL Peak Size: 210.3 (high risk)
- LDL Pattern B present
- Lipoprotein(a): 10 mg/dL
For those unfamiliar with these terms, Pattern B refers to a predominance of smaller, denser LDL particles. These particles are believed to be more likely to penetrate arterial walls and contribute to plaque formation than their larger counterparts.
Suddenly, my relatively ordinary cholesterol numbers weren’t the whole story.
The deeper data suggested there may be a cardiovascular risk that standard cholesterol testing alone could easily miss.
The Importance of Looking Beyond the Headlines
One of the greatest lessons I’ve learned from investing is that averages can hide important details.
When evaluating an apartment community, we don’t simply ask, “What is occupancy?”
We ask:
- What is occupancy by unit type?
- What are renewal rates?
- What are concessions doing?
- Are expenses growing?
- Is deferred maintenance accumulating?
The same principle applies to health.
Two people can have virtually identical cholesterol levels yet possess very different cardiovascular risk profiles. One person may have relatively few large LDL particles. Another may have thousands of smaller particles circulating throughout the bloodstream.
Traditional cholesterol numbers might make them appear similar. Their actual risk profile may not be. What gets measured gets managed. And what isn’t measured may remain hidden.
The Clue I Couldn’t Ignore
There was another piece of information that made the Pattern B finding difficult to dismiss.
In December 2019, I underwent a Coronary Artery Calcium (CAC) scan. The result showed a calcium score of 56.99, placing me between the 50th and 75th percentile for men my age and indicating a mild plaque burden.
At the time, the report recommended repeating the scan in five years to monitor progression.
Five years have now passed (actually 6.5 years).
The significance of the recent bloodwork isn’t simply that it revealed Pattern B. It’s that Pattern B now exists in the context of documented plaque that was already present nearly seven years ago.
That makes the question much more important:
Has the plaque progressed?
The Promise and Limits of PhenoAge
One of the most fascinating aspects of modern medicine is the emergence of biological age measurements such as PhenoAge.
Unlike chronological age—which simply measures the number of birthdays you’ve celebrated—PhenoAge attempts to estimate how your body is actually aging based upon a variety of biomarkers.
My result of 54.75 years was encouraging. It suggests that many things are going right.
But it also taught me an important lesson. You can have a favorable biological age and still possess specific health risks. You can be physically active. You can feel great. You can have excellent metabolic markers. You can have a repaired heart functioning beautifully. And you can still discover aspects of your cardiovascular profile that warrant further investigation.
Life is often “both-and” rather than “either-or.” The data wasn’t telling me that I was unhealthy. It was telling me that I had more to learn.
My Decision Tree
The purpose of testing is not collecting data. The purpose of testing is making better decisions.
The next step for me is straightforward.
First, obtain a new coronary artery calcium scan.
Second, compare the results to my 2019 baseline score of 56.99.
Third, let the evidence guide the next decision.
If plaque has increased significantly, I will have an important discussion with my cardiologist regarding statin therapy and other interventions.
If plaque has remained stable despite the Pattern B profile, that may support continuing my current fitness regimen, nutrition program, supplementation strategy, and periodic monitoring.
The CAC scan becomes the tie-breaker. Not because bloodwork is unimportant. But because the question that really matters is not whether I have Pattern B. The question is whether Pattern B is translating into additional plaque accumulation.
Gratitude and Stewardship
If there’s a larger lesson in all of this, it’s that health is less about perfection and more about stewardship.
I remain deeply grateful for the success of my mitral valve repair. Five years ago, I was recovering from major heart surgery. Today, I play competitive tennis, travel extensively, work out regularly, and wake up most mornings without giving my heart a second thought.
That is a gift.
Yet stewardship requires vigilance.
The surgeon’s discovery of my severely damaged valve taught me that serious problems can sometimes remain hidden until someone looks deeper.
This latest round of bloodwork taught me the same lesson.
My biological age was younger than expected. Many biomarkers were excellent.
Yet beneath those encouraging headlines lay information that deserved further investigation.
The challenge, in investing and in health, is not to be comforted by good news or alarmed by bad news. The challenge is to remain curious enough to keep looking. Because sometimes the most important truths live below the surface.
And sometimes passing the test isn’t the same thing as learning the lesson.
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