During a 2012 urgent care meet-and-greet, a woman visited Randy Vawdrey, NP-C, complaining of heartburn-like symptoms. Because she didn’t have insurance at the time, she couldn’t pay for expensive testing (such as an EKG). After going through a list of standard questions, Randy agreed that it was likely heartburn and prescribed her a proton pump inhibitor.
A few days later, she was found deceased in her house. An autopsy revealed she had died from a massive coronary event—something an EKG could have caught.
The incident shook Randy to his core, and as he signed the death certificate, he vowed that he would never let something like that happen to one of his patients again.
Since that day, Randy has been on a mission to change the goal of cardiology. Rather than propagating the traditional approach of reactively managing symptoms, his primary goal is to stop coronary issues from occurring in the first place.
Redefining Cardiology
Randy refers to this as “preventive cardiology.” “Sometimes we don't address cardiovascular disease until people have an event,” he says, “and that's the wrong way to practice medicine. We should prevent events. That's the goal.”
As a result, he is much more proactive now and refuses to ignore the signs of imminent risk. This, unfortunately, is often at odds with traditional cardiology. Many doctors miss heart problems because they assume (like he once did) that symptoms like heartburn are just stomach issues.
It doesn’t help that cardiovascular disease is a complex disease of the heart muscle, the blood vessels, the heart's electrical rhythm, and chronic inflammation. It can be challenging to unravel the symptoms and clues and get to the root cause. Instead, many practitioners try to cut through the mess by taking a simpler approach based on a single factor, like cholesterol levels. But in so doing, they may be missing the clues that could lead to prevention.
Most practitioners complete their clinical training without learning how to:
- Screen for coronary artery calcium.
- Interpret white matter disease on brain MRI as hypertensive injury.
- Recognize when poor dental health is driving systemic inflammation high enough to trigger cardiac events.
As a result:
- Patients arrive with normal cholesterol yet progress toward myocardial infarction.
- Sleep apnea goes undetected despite creating severe cardiovascular stress.
- Dysautonomia from concussion drives hypertension that medications alone cannot resolve.
The consequence? Preventable cardiovascular events occur because the screening, assessment, and risk stratification protocols taught in medical school are incomplete.
“Preventive Cardiology: Comprehensive & Integrative CV Risk Reduction,” taught by Randy Vawdrey, NP-C, is designed to fill in the gaps in traditional cardiology. You'll move beyond cholesterol obsession and learn the 10 markers that actually predict cardiovascular events. This course is evidence-based, clinically practical, and designed for practitioners who want to prevent cardiac events rather than manage them after the fact.
Understanding Risk and Guidelines
Understanding hazard ratios is essential to move beyond general observations and prioritize the most dangerous risk factors for your patients. Take high cholesterol, a known risk. With a hazard ratio typically between 1.3 and 3.0, it makes sense why so many doctors focus on it. But smoking has a much higher hazard ratio—between 2.0 and 4.0—making it a much more urgent priority for intervention.
Moreover, medical guidelines, particularly in cardiology, have transitioned from focusing on single markers to a more nuanced, risk-based approach that integrates imaging and functional markers. Twenty years ago, the almost sole focus was on lowering LDL cholesterol. Now, the guidelines have broadened to include risk-based statin therapy and a new focus on "risk enhancers" like insulin resistance, kidney disease, and cardiometabolic issues. For the first time, as well, these guidelines also suggest using coronary artery calcium (CAC) scoring as a valid predictor of heart attacks.
As a practitioner, it is important to stay abreast of these changing guidelines and update your clinical protocols based on new medical research and evidence, especially as you transition toward a preventive cardiology model.
Did you know?
- 31% of Americans die from heart attacks, with 50% experiencing it as their first cardiovascular symptom.
- Periodontal disease has been identified in atherosclerotic plaques within coronary arteries.
- Coronary artery calcium scoring predicts heart attack risk six times higher than cholesterol levels alone.
“Preventive Cardiology: Comprehensive & Integrative CV Risk Reduction,” taught by Randy Vawdrey, NP-C, gives you actionable protocols for cardiovascular risk reduction.
This Kharrazian Institute Master Class, designed for nurse practitioners, physicians, and functional medicine practitioners, teaches you how to prevent cardiovascular disease through systemic risk assessment, advanced marker interpretation, and integrative lifestyle protocols.
Move past cholesterol-centric, reactionary treatment protocols and start preventing cardiac events before they happen. Click here to start implementing a preventive cardiology care model today.
Key Cardiological Checkpoints
As mentioned above, traditional cardiology has largely been cholesterol-centric. But Randy Vawdrey argues that preventing cardiovascular disease requires a broader protocol that includes looking for a wide range of symptoms. These include:
- Blood pressure (hypertension) - High blood pressure can be extremely damaging to sensitive organs, including the heart.
- Homocysteine levels - Levels should be less than 8; levels above 17 (the standard lab flag) are enough to damage blood vessels, increasing the risk of stroke and vascular dementia.
- Inflammation - High-sensitivity C-reactive protein (hsCRP) is a non-specific marker of chronic inflammation. The target level is less than 1.
- CAC score - A CAC score is 10 times more predictive of a heart attack than all other risk factors combined, with a staggering hazard ratio of up to 9.6, compared to cholesterol’s 1.5–3.
Preventive Cardiology: Comprehensive & Integrative CV Risk Reduction with Randy Vawdrey, NP-C
Traditional cardiology necessarily focused on reactive medicine; it was what we knew at the time. After decades of research and study, however, we have the data and tools to shift to a preventive cardiology model. By changing your mindset to look for issues before they become a problem, understanding medical risk and continually updated medical guidelines, and dialing your diagnoses by searching for specific cardiovascular-related symptoms, you can save more patients from potentially fatal cardiac events.
So what are the practical steps you need to take to institute a preventive cardiology model in your clinic? “Preventive Cardiology: Comprehensive & Integrative CV Risk Reduction,” taught by Randy Vawdrey, NP-C, gives you the tools you need to stop treating cholesterol and start preventing heart attacks.
This course distills 15 clinical modules into a comprehensive prevention strategy that addresses the actual drivers of cardiovascular disease. You'll learn how to screen for silent neurological damage from hypertension, identify clotting risks before they become events, optimize hormone status for cardioprotection, and use advanced markers like coronary artery calcium scoring to predict risk 10 times better than traditional lipid panels.
Key insights include:
- Why blood pressure management prevents brain microinfarcts in a way that statins can’t.
- Why homocysteine, uric acid, and inflammation matter independently of cholesterol.
- Why dental health, sleep apnea, and dysautonomia are cardiovascular risk factors you don’t want to ignore.
- Why lifestyle interventions reduce biomarkers more effectively than many drugs.
The modules integrate conventional and functional medicine approaches, combining blood pressure targets, pharmaceutical options, and nutraceutical protocols into decision trees you can implement in your practice today.
Click here to learn more and register today.
Randy Vawdrey is the former Program Director for Portneuf Valley Hospital’s Gerontological Psychiatric Hospital. He has completed an advanced pharmaceutical certification at McLean Hospital and served as the Director of the Psychotropic Drug Review at the Idaho State Veterans’ Home. He is currently CEO/NP-C at Physicians Immediate Care and Physicians Optimal Health and Medical Director of A Mind For All Seasons. Randy graduated in 1998 from BYU with a degree in nursing.
Frequently Asked Questions
Why is a cholesterol-centric approach insufficient for preventing cardiovascular events?
While LDL cholesterol is a known risk factor, focusing on it exclusively misses the broader, complex picture of cardiovascular disease. A truly preventive model must also assess independent risk factors like chronic inflammation (via hsCRP), blood vessel damage from high homocysteine, and subclinical plaque buildup.
How do modern cardiological guidelines differ from traditional protocols?
Traditional protocols primarily focus on managing isolated lipid panels and reacting after a patient has experienced a cardiac event. Modern, evidence-based guidelines have shifted toward a comprehensive, risk-based approach that integrates imaging and metabolic markers.
What are the most critical, non-traditional checkpoints to evaluate in an integrative cardiovascular screening?
Practitioners should expand their standard screening protocols to include a mix of functional, inflammatory, and anatomical markers. Key checkpoints include tracking high-sensitivity C-reactive protein, monitoring homocysteine levels, and utilizing CAC scoring, which is up to ten times more predictive of a heart attack than traditional risk factors. Additionally, hidden drivers like poor dental health and sleep apnea must be assessed for their role in driving systemic cardiovascular stress.
How can I transition my practice from reactive management to a true preventive cardiology model?
Shifting your clinical model requires moving beyond standard medical school training to master advanced risk stratification and systemic assessment tools. The Kharrazian Institute Master Class, “Preventive Cardiology: Comprehensive & Integrative CV Risk Reduction,” taught by Randy Vawdrey, NP-C, is specifically built to bridge this gap for functional medicine clinicians.
