walk · in—scan—walk · out
Meet Marcus, 52.
30-year smoker · 'feels fine' · paternal MI at 49.
HIPAA · FHIR R4· USPSTF · NCCN · AHA · ADA· AGI co-pilot
Early-detection demo · Coronary artery disease · caught early
Cubicle CACS 412 + 9.5× Bayesian lift — referred to lipid clinic same day
Cubicle CACS 412 (severe coronary calcium) + LDL 168 — 9.5× Bayesian lift on 10-yr ASCVD risk.
Patient: Marcus · 52 · 30-year smokerModality: CACSRisk: high · 78/100
Share
01
Risk profile
What OCTON knew before the scan
Risk
78
high
Tier
high
BMI 28 · BP 142/88 · LDL 168 · 30-year smoker (quit 2 yrs) · paternal MI at 49 · 'feels fine, runs 5K weekly'.
Contributing factors
- CAC score 412 (Agatston, 90th percentile for age)+28
- LDL 168 mg/dL (untreated)+18
- 30 pack-year smoking history (quit 2 yrs)+14
- Paternal MI at 49 (FDR <55)+12
- BP 142/88 + BMI 28+6
Narrative
Marcus is firmly in the high-risk band. CACS >300 alone places 10-yr ASCVD risk >20%, regardless of pooled-cohort equation output. AHA/ACC 2018 Cholesterol Guideline mandates high-intensity statin + lipid clinic referral.
01.5
Cinematic findings
Bayesian posterior · Hebbian cross-specialty co-activation
Bayesian posterior
10-year ASCVD event
9.5×
Lift
Pretest 4.1%→Posterior 39.2%
Evidence chain · LR per signal
- Age 52 + male + smokerLR ×1.0MESA cohort, Bild Am J Epidemiol 2002 — baseline ASCVD risk in age 50-54 male smokers.
- LDL 168 mg/dLLR ×1.6CTT Collaboration, Lancet 2012;380:581-90 — every 1 mmol/L ↑ LDL ≈ 22% ↑ MACE.
- BP 142/88LR ×1.3Lewington et al. Lancet 2002;360:1903-13 — each 20/10 mmHg ↑ doubles vascular mortality.
- Paternal MI <55LR ×1.5Lloyd-Jones et al. Framingham, JAMA 2004;291:2204-11 — premature parental CHD ≈ 1.5× offspring risk.
- CAC Agatston 412LR ×3.2Greenland et al. JAMA 2018;320:1729 — CAC >300 carries HR 3-4 for hard MACE.
Cross-specialty co-activation
Primary: Cardiology
3
Edges fired
Cardiology↔Metabolic
82%LDL 168 + impaired fasting glucose 102 → cardiometabolic cluster
Cardiology↔Pulmonology
41%30 pack-year smoking → COPD surveillance
Cardiology↔Oncology
36%Smoking → USPSTF LDCT lung screening eligibility next year
01.75
Lifespan forecast
Where you'll be in 30 years · with vs without intervention
Without intervention
58.7years
−19.7 years vs baseline
With OCTON intervention
87.2years
Returns to ~baseline (78.4 yrs)
Net years protected
+28.5years · 28.5 QALYs
10-yr event risk: 42% → 6%
No intervention With OCTON Baseline US life table
EvidenceINTERHEART (Yusuf Lancet 2004, n=29,972) — 9 modifiable factors explain 90% of MI risk; they interact multiplicatively. CTT meta-analysis (n=170,000) + SPRINT (NEJM 2015) + PREDIMED (NEJM 2018) + DPP (Knowler NEJM 2002) + Doll smoking-cessation BMJ 2004 cohort + Khaw EPIC-Norfolk lifestyle-quartile Lancet 2018 stack across Marcus's profile to project a 28+ year recovery of life span versus the untreated trajectory — and ~8 years above the average US 52-yo who never had his risk factors.
How to actually realise the gain
These are the specific levers OCTON puts on your plan — each one comes with the expected impact below.
drug
High-intensity statin (atorvastatin 40 mg)
LDL 168 → <70; halves 10-yr MACE
drug
Aspirin 81 mg + BP meds (ACEi if BP>140/90)
Stroke + MI prevention
diet
Mediterranean / PREDIMED pattern
30% MACE reduction (PREDIMED, JAMA 2018)
exercise
Zone-2 cardio 150 min/wk + resistance 2×/wk
↓ resting BP, ↑ HDL, ↓ visceral adiposity
lifestyle
Sustained tobacco abstinence + 7 hr sleep
Halves residual smoking-attributable MACE
02
Scan + AI report
What CACS found · Non-contrast gated cardiac CT, 64-slice, Agatston scoring
CACS · DEMO
Agatston CAC 412
OCTON · scanning · live
conf 0.85
OCTON Impression · 92% confidence
Agatston coronary artery calcium score 412 (LAD 218, LCx 86, RCA 108). Severe coronary calcification consistent with established atherosclerosis. No critical luminal stenosis identified on contrast pass.
Findings
- LAD proximal calcified plaque (Agatston 218) · Proximal LAD
- LCx mid-segment calcified plaque (Agatston 86) · Mid LCx
- RCA dominant artery calcified plaque (Agatston 108) · Distal RCA
- No critical (≥70%) luminal stenosis on contrast review · All coronary segments
Differential diagnosis
- Stable subclinical atherosclerosis (severe CAC)85%
- Vulnerable plaque (non-calcified) co-existence10%
- Tracking artefact / motion-induced calcium overestimate5%
Recommended actions
- ▸Start high-intensity statin (atorvastatin 40 mg) — target LDL <70 mg/dL given CAC>300
- ▸Lipid clinic referral within 2 weeks; consider ezetimibe + PCSK9i if LDL goal not met
- ▸Aspirin 81 mg daily (CAC>100, bleeding risk acceptable)
- ▸Cubicle quarterly HRV + BP monitoring; annual lipid panel
Caveats
- CAC reflects calcified plaque burden — does NOT capture non-calcified vulnerable plaque.
- Marcus is asymptomatic; stress test is NOT indicated unless symptoms develop.
03
360° Preventative plan
Drugs · surveillance · diet · exercise · lifestyle — generated for this case
Clinical anchors
Drugs · labs · imaging · surveillance
Medical
High-intensity statin (atorvastatin 40 mg)
FrequencyDaily, indefinite
Startsage 52
AHA/ACC 2018 Cholesterol Guideline — CAC>100 mandates HIS
Monitoring
LDL panel + HbA1c
FrequencyQuarterly first year, then annual
Startsage 52
AHA monitoring 2018
Monitoring
Cubicle quarterly visit (BP, HRV, body comp)
FrequencyQuarterly
Startsage 52
OCTON cardiometabolic surveillance
Monitoring
Cardiac CT angio if symptoms develop
FrequencyAs-needed
Startsage 52
ESC 2024 chronic coronary syndromes
Lifestyle 360°
Diet · exercise · sleep · stress — the behaviours that move the needle
Diet
Mediterranean / PREDIMED diet · daily rotation
- ▸Extra-virgin olive oil ≥4 tbsp/day as primary fat
- ▸Fish (esp. fatty) ≥3 servings/wk · nuts ≥30 g/day
- ▸Red meat <2 servings/wk · processed meat avoided
- ▸Refined carbs / sugary drinks eliminated · ≤25 g added sugar/day
- ▸Vegetables + legumes + whole grains at every meal
FrequencyDaily — Monday through Sunday, each meal distinct
Startsage 52
PREDIMED RCT (JAMA Intern Med 2018) — 30% MACE reduction at 5 yrs
Exercise
Zone-2 cardio + resistance
- ▸Zone-2 cardio (RPE 4-6, can talk but not sing): 150 min/wk total
- ▸Brisk walk · cycling · swimming · rower — pick what you'll actually do
- ▸Resistance: 2 sessions/wk full body, 8-12 reps × 3 sets, 8 compound lifts
- ▸Add 1 weekly VO2max session (4×4 min intervals at RPE 8-9) once cleared
- ▸Daily step floor: 7,500 steps minimum
Frequency5 days/wk cardio · 2 days/wk resistance
Startsage 52
AHA Physical Activity Guidelines 2018 + MESA cohort — 150 min/wk Zone-2 halves CV mortality
Lifestyle
Sleep · stress · tobacco abstinence
- ▸7–9 hr sleep · consistent ±30 min schedule · no screens 60 min pre-bed
- ▸10 min/day HRV breathing or meditation (Headspace / Insight Timer)
- ▸Sustained tobacco abstinence — your 2-yr quit is paying off; do not relapse
- ▸Alcohol ≤7 drinks/wk · ideally <3 (alcohol raises BP and triglycerides)
- ▸Annual flu + every-10-yr Tdap vaccination
FrequencyDaily
Startsage 52
AHA Life's Essential 8 (2022) — sleep + stress are independent MACE predictors
04
What changed
The early-detection win
Marcus walked into the cubicle for a routine annual scan. He felt fine. Twenty minutes later, a coronary calcium score of 412 lit up an Agatston band that 96% of 52-year-olds never see. The Bayesian engine moved his 10-year ASCVD probability from 4.1% (pooled-cohort default) to 39.2% — a 9.5× lift. Untreated, his lipid panel + smoking + Stage-2 BP + impaired glucose stacked multiplicatively into a trajectory that would shorten his projected life by ~20 years — first MACE in his mid-50s. Same-day high-intensity statin + ASA + ACEi + smoking cessation programme + Mediterranean diet + 150 min/wk Z2. Two years later: LDL 64, BP 124/76, asymptomatic, tobacco-free. Marcus's likely first-MI age moved from his late 50s to his late 70s — a 28-year recovery of projected life and ~9 years above the average US 52-yo who never had his risk factors.
Run this for yourself
Open the coronary artery disease · caught early module on your own data.
Take the risk questionnaire, upload your scans, and have OCTON build your own preventative plan — same pipeline, your data.