Heart disease is the number one killer on the planet. It kills more people under 70 than any other cause. And according to cardiologist Dr. Danny Noonan, 80% of it is preventable. Not managed. Not slowed down. Prevented.
That figure should probably be front-page news everywhere. Instead, most people are waiting until they have symptoms before anyone looks closely at their cardiovascular system, which is precisely when it becomes exponentially harder and more expensive to address. On the latest Ever Onward Podcast, host Tommy Ahlquist sat down with Noonan, a cardiac electrophysiologist and sports cardiologist who co-founded High Desert Heart and Vascular in the Treasure Valley, for a conversation that ranged from the basics of nutrition and exercise to cutting-edge AI-assisted cardiac imaging. The practical takeaways are worth your time regardless of your age or current health status.
The $150 Test Nobody Gets
If you go to the dentist twice a year to look for cavities, you know the logic of preventive screening. You know that colon cancer screening starts at 45 and breast cancer screening follows a defined schedule. But there is a very cheap, very fast, very widely available test that screens for the thing most likely to kill you, and most people have never had one.
The coronary calcium score is an imaging test that looks for calcified plaque in the coronary arteries, essentially a snapshot of old, healed coronary disease that indicates how much plaque has accumulated over your lifetime. It takes a few minutes, involves no dye or contrast, and costs somewhere around $150 out of pocket. Anything in the double digits is considered a meaningful score. A score in the thousands means significant coronary disease has been building for years.
Noonan described a patient he saw recently, a prominent Idaho figure in excellent apparent health, thin, fit, no obvious risk factors, who finally got a calcium score at age 65 after years of seeing top-tier physicians at major institutions. His score was 2,000. He was understandably furious. “How do I go until I’m 65 years old and see all these people for 30 years and no one catches this for $150?”
Ahlquist had a version of the same experience. Despite a family history of heart disease, years of night shifts and poor sleep as an ER physician, and symptoms that eventually led to a stent in his left anterior descending artery and open heart surgery, he had gone years without the kind of proactive, thorough cardiovascular workup that would have caught things earlier. The point isn’t to assign blame. It’s to understand that the default in traditional primary care medicine is to wait for symptoms, and by the time symptoms appear, the disease has usually been developing for decades.
What AI and CT Angiography Can Now See
Beyond the calcium score, a more comprehensive test called a CT angiogram can now give physicians an extraordinarily detailed picture of the coronary arteries. With a small amount of dye and essentially one heartbeat’s worth of imaging time, the scan reveals not just how much calcium is present, but where it is, what type of plaque it is, and whether active inflammation is present around the vessels.
That last piece, perivascular inflammation measured through what’s called the fat attenuation index, is genuinely new territory. Noonan mentioned research just published in the Journal of the American College of Cardiology showing that elevated inflammation around the coronary arteries can signal that a heart attack is imminent, even in vessels that don’t show severe narrowing on conventional imaging.
This matters because the conventional model of heart disease risk has a counterintuitive flaw. The plaques most likely to rupture and cause heart attacks are often not the ones causing the most narrowing. A 40% blockage that is soft, lipid-rich, and inflamed is more dangerous than a stable, calcified 70% blockage. The old approach of waiting until arteries were severely narrowed before intervening was based on the technology that existed. The technology has changed.
“We can now predict heart attacks,” Noonan said. “It’s no longer a 10-year guess. We can tell you exactly what you have.”
For anyone who wants to know where they stand, the conversation to have with your doctor is about a coronary calcium score first, and a CT angiogram if more detail is warranted. These are not exotic procedures available only at major medical centers. They are available now, locally, at practices like High Desert Heart and Vascular.
Three Nutrition Rules Worth Remembering
When Ahlquist asked about diet, which gets more confusing by the year as competing claims pile up about fat, protein, carbohydrates, meat, seed oils, and everything else, Noonan offered the simplest possible framework.
Rule one: eat less food. Rule two: eat real food, meaning minimally processed whole foods rather than packaged products. Rule three: mostly plants.
“Directionally, you are correct,” Noonan said. “If you start there, you are going to make progress.”
He added one practical refinement: if you focus on hitting an adequate daily protein target, at least 1.6 grams per kilogram of body weight and ideally up to 2.2 grams, the other variables tend to take care of themselves. Adequate protein keeps you satiated, which naturally reduces overeating. It supports muscle mass, which matters enormously as we age. And if the protein is coming from clean, whole food sources, you’re already eating better than most people do without having to think carefully about every other macronutrient.
For a 200-pound person, that means somewhere in the range of 150 to 200 grams of protein per day, which is more than most people get without making a deliberate effort. Ahlquist described using a high-quality protein shake with organic peanut butter powder as a practical way to get a large chunk of that total in one go, making the rest of the day much easier to hit.
VO2 Max Is the Number That Predicts How Long You Live
If there is one metric worth understanding and improving, according to Noonan, it is VO2 max: the body’s maximum capacity to consume and use oxygen during exercise. The research on this is unusually robust. VO2 max is more highly correlated with longevity than virtually any other measurable variable, with no apparent ceiling effect. The higher it is, the better your odds, and this holds true across age groups and fitness levels.
Ahlquist shared the humbling experience of getting his VO2 max tested after more than a year of consistent daily walking, fully expecting to score well, and discovering he was below the bottom of the red zone even on the age-adjusted scale. The fix, according to Noonan, is structured aerobic training that actually challenges the cardiovascular system rather than keeping it comfortable.
The recommended framework is six days of aerobic activity per week, with roughly four of those at zone two intensity, which is moderate enough to sustain a conversation but just at the edge of the aerobic threshold. A rough calculation for zone two heart rate is 180 minus your age. Two days per week should involve high-intensity interval work.
The most well-researched interval protocol, sometimes called Norwegian intervals, involves 30-second all-out efforts followed by 15 seconds of rest, repeated 13 times, for three rounds. It takes about 40 minutes and is genuinely demanding, but the data on its effect on VO2 max is strong.
“Exercise is the greatest pill if we could put it in a pill,” Noonan said. “There is nothing that would heal our ills more.”
Why the Healthcare System Keeps Missing This
The conversation took a frank turn when Ahlquist and Noonan discussed why medicine keeps failing to do the preventive cardiovascular work that is so clearly available and cost-effective.
Part of the answer is structural. The people making decisions about what to screen for and what to reimburse, insurance executives, health system CEOs, and elected officials, tend to operate on short time horizons. Preventing a heart attack 15 years from now doesn’t improve this quarter’s margin. Treating the heart attack when it arrives does generate revenue. The incentives are not aligned with prevention.
Noonan described a transparency tool he tried to build years ago that would have allowed patients to easily compare the cost of procedures like echocardiograms across different providers in a given area. The developers couldn’t get the data. The pricing is deliberately opaque. What he and Ahlquist know from years in the system is that the exact same test, performed by the exact same physician, can cost anywhere from $300 to $3,000 depending on whether the facility billing for it is hospital-affiliated.
None of this is intended to discourage people from engaging with the healthcare system. It’s an argument for engaging with it more intentionally, seeking out physicians who practice preventive and personalized medicine, asking for the tests that are available and affordable, and not waiting for symptoms that, in cardiovascular disease, often arrive too late.
High Desert Heart and Vascular in Boise, where Noonan practices alongside cardiologists David Costello, Fred Hinchman, and Rich Moses, was built specifically around this more proactive model of care. For anyone in the Treasure Valley who hasn’t had a thorough cardiovascular workup, it is a place worth calling.
Learn more about High Desert Heart and Vascular at highdesertheart.com.
