Catch Heart Disease, Cancer & Alzheimer’s EARLY! - Tests That Save Lives | Dr. Eric Topol

Cardiovascular Disease

Dr. Topol stresses the often overlooked fact that cardiovascular disease develops insidiously over 20 years or more before clinical symptoms manifest, just like cancer and neurodegenerative diseases. This long latency period creates a valuable window for prevention. Risk stratification, he explains, must go beyond conventional factors such as smoking, diabetes, obesity, sedentary lifestyle, and cholesterol levels.

One of the most promising tools available today is the polygenic risk score (PRS). This inexpensive and accessible saliva-based genetic test aggregates hundreds of common gene variants to quantify an individual's inherited risk for heart disease on a 0–100 scale. Unlike family history alone, which can sometimes miss inherited risks due to unique genetic combinations, a PRS can uncover hidden susceptibilities. Dr. Topol strongly encourages its wider adoption, citing how prominent institutions such as Mass General Brigham integrate this test into patient care even though it has yet to enter mainstream clinical practice broadly.

However, Topol cautions that PRS measures genetic risk but does not indicate current disease burden or "vascular aging." To address that, upcoming proteomic "organ clocks" — tests analyzing hundreds of plasma proteins associated with organ-specific aging — will soon provide insight into the pace of arterial and cardiac aging. These tests, anticipated to become commercially available within months, promise to add vital temporal context to genetic risk, helping to pinpoint whether accelerated vascular aging might precipitate earlier onset of heart attacks or strokes.

Regarding imaging, Dr. Topol expresses reservations about the widespread use of coronary artery calcium CT scans, particularly when used indiscriminately in asymptomatic individuals. He notes that elevated calcium scores often cause undue anxiety and may prompt unnecessary invasive procedures such as angiograms or bypass surgery, sometimes worsening patients' mental health without clear evidence of improved outcomes. Conversely, contrast-enhanced CT angiography offers superior plaque characterization (soft vs. hard plaque) and detailed vascular mapping, making it valuable in symptomatic or high-risk patients, albeit with higher cost and less insurance coverage.

Dr. Topol's insights embody a prudent balance: use the most informative, cost-effective tests to screen, avoid over-diagnosis and overtreatment, while empowering patients to take preventive action informed by their risk profiles.

Cancer Screening and Early Detection

Echoing the long preclinical phase of cardiovascular disease, Dr. Topol recounts how cancer often develops silently for decades before clinical diagnosis. Current population-wide screening tools like mammograms and colonoscopies detect cancers generally too late to be curative in many cases and are fraught with false positives and false negatives.

Polygenic risk scores extend not only to cardiovascular disease but also to multiple common cancers including breast, prostate, colon, and lung cancer. They can be obtained similarly through saliva genetic testing and mesh inherited cancer susceptibility with family history and rare mutations (such as BRCA1/2 or Lynch syndrome variants) identified through whole genome sequencing. This integrated genetic insight can guide personalization of cancer screening frequency and modalities.

Further advancing early detection, liquid biopsy multi-cancer early detection (MCED) blood tests—like those developed by Grail and others—can capture microscopic tumor DNA circulating in plasma years before tumors are visible by imaging. These cutting-edge assays are not yet recommended for indiscriminate population screening but offer promise when applied to individuals with known high risk, as determined by genetics and other clinical factors.

Regarding mammography specifically, Dr. Topol highlights groundbreaking studies demonstrating that adding artificial intelligence (AI) to radiologist interpretation enhances accuracy by 25%, reducing missed cancers without extra cost. Yet, in the U.S., AI-assisted reads are not standard practice and are sometimes billed as an optional add-on, underscoring systemic inertia in adopting proven technology.

Dr. Topol warns against costly, unproven screening methods such as whole-body MRI scans marketed direct-to-consumer or by celebrity endorsement. These tests often lead to incidental findings that cause anxiety and invasive follow-ups, without evidence that they improve mortality or outcomes. He clarifies that total-body MRI can be appropriate for targeted evaluation if preliminary blood tests indicate cancer presence, but should not be used indiscriminately.

This nuanced perspective cautions listeners to critically appraise marketing hype around novel diagnostics, rely on validated tools, and engage in shared decision-making with medical professionals informed by rigorous evidence.

Neurodegenerative Diseases

Alzheimer's disease and related neurodegenerative diseases have historically lacked early predictive tools. Dr. Topol praises new blood biomarkers, centered especially around phosphorylated tau at threonine 217, which correlate closely with PET imaging yet can be measured non-invasively from plasma. This remarkable test can detect AD pathology up to two decades before cognitive symptoms emerge.

The availability of such blood tests — offered through major clinical laboratories like LabCorp and Quest Diagnostics — heralds a paradigm shift in identifying and tracking Alzheimer's risk. Dr. Topol advises individuals with known genetic vulnerability such as APOE4 carriers and/or family history to pursue this testing and subsequently intensify lifestyle modifications shown to reduce risk, including exercise, diet, sleep hygiene, and social engagement.

Dr. Topol also underscores that neurodegenerative diseases like Parkinson's may be linked to environmental toxins, citing recent research associating pesticide exposure near golf courses with increased Parkinson's incidence. This highlights the complex interplay of genetics, environment, and lifestyle in disease risk and the urgent need for further research and environmental regulation.

Metabolic Diseases

Turning to metabolic conditions such as type 2 diabetes and metabolic syndrome, Dr. Topol notes these diseases are often easier to catch early via routine blood tests (fasting glucose, HbA1c), and crucially are driven by both genetics and lifestyle. He points out that a significant portion of people with prediabetes are not obese, illustrating genetic complexity.

Recent advances in gut hormone therapies, particularly GLP-1 receptor agonists like semaglutide (brand names Ozempic, Wegovy), signal a promising frontier in managing metabolic and broader age-related diseases. Beyond weight loss, these drugs have shown benefits in reducing inflammation, improving kidney and liver health, and even potential in neurodegenerative disease prevention. Dr. Topol anticipates future combinations of gut hormone drugs in pill form will become increasingly commonplace tools for disease prevention and healthspan promotion.

Interestingly, Dr. Topol clarifies that age-related diseases, including cardiovascular, cancer, and neurodegeneration, stem from immune system dysregulation and chronic inflammation rather than solely from overeating or excess calories. This explains why lifestyle alone might be insufficient for some, and why emerging therapeutics modulating immune function and inflammation are vital complements.

Biological Age Testing

Biological age measurement is a rapidly expanding field, but Dr. Topol urges caution against over-investment in many commercial "biological clocks," particularly methylation-based epigenetic age tests marketed directly to consumers at high cost without standardized validation. While these tests can suggest "epigenetic rusting," they do not presently provide actionable or organ-specific aging data with precision.

He advocates for a more meaningful advance: proteomic organ clocks that assess hundreds of proteins to reveal the aging status of specific organs like heart, arteries, brain, and immune system. Although not yet widely available, these tests are inexpensive, reproducible, and will soon be vital in guiding personalized interventions.

Exercise remains the only intervention consistently proven via large studies to slow epigenetic aging. Dr. Topol encourages a combined routine of five weekly aerobic exercise sessions complemented by two resistance training and balance workouts, emphasizing that moderate activity (e.g., 7,000 steps daily) yields substantial benefits. Despite ongoing questions about risks of extreme endurance exercise, consistent, moderate exercise tailored to individual capacity remains foundational to healthy aging.

Navigating Complex Medicine

Throughout the interview, Dr. Topol acknowledges systemic challenges in medicine's slow adoption of validated innovations and the confusion faced by individuals navigating health information amid competing commercial interests and uneven clinical practice. He repeatedly stresses the need for individuals to become "CEOs" of their health — becoming informed, asking the right questions, and demanding evidence-based care.

He sees a grassroots opportunity whereby educated patients can drive medicine back on track, embracing new diagnostics and therapeutics grounded in science, while avoiding overtesting and overtreatment. Dr. Topol's book, Super Agers, aims to empower such informed aging journeys by clarifying what works and what wastes money or causes harm.