May 28, 2025
— 8 min read
May 28, 2025
— 8 min read
May 28, 2025
— 8 min read
The Biograph Method:
A New Standard for Early Detection
The Biograph Method:
A New Standard for Early Detection
The Biograph Method:
A New Standard for Early Detection
Traditional medicine waits for symptoms to appear. At Biograph, we take a different approach, using advanced diagnostics to identify risk earlier, interpret data across systems, and deliver personalized plans that improve healthspan and reduce the burden of chronic disease before it begins.
Traditional medicine waits for symptoms to appear. At Biograph, we take a different approach, using advanced diagnostics to identify risk earlier, interpret data across systems, and deliver personalized plans that improve healthspan and reduce the burden of chronic disease before it begins.
Traditional medicine waits for symptoms to appear. At Biograph, we take a different approach, using advanced diagnostics to identify risk earlier, interpret data across systems, and deliver personalized plans that improve healthspan and reduce the burden of chronic disease before it begins.
Michael Doney
Executive Medical Director
Michael Doney
Executive Medical Director
Michael Doney
Executive Medical Director
Shifting from Reactive to Proactive Care
Most preventive care is reactive and imprecise. Annual physicals offer brief checks, basic labs, and broad advice but reveal little about real health risks. Standard tools like ASCVD risk scores or BMI miss early-stage disease, especially in women, younger adults, and those with less typical risk profiles. Meanwhile, conditions like atherosclerosis, insulin resistance, fatty liver, neurovascular injury, and many cancers can progress silently for years.
That’s why Biograph takes a different approach. Our clinical model identifies risk earlier and more precisely across the systems most critical to long-term health. We use advanced diagnostics, interpret data across domains, and track key metrics over time to guide highly personalized, evidence-based interventions. This approach centers on five pillars that account for the majority of chronic disease and age-related decline.
The Five Pillars That Shape Our Approach
Most chronic disease and age-related decline can be traced to a common set of underlying processes. At Biograph, we’ve built our diagnostic framework around five pillars that account for the vast majority of premature death, disability, and reduced quality of life.
These include the four major clinical drivers of morbidity: atherosclerotic cardiovascular disease, metabolic dysfunction, neurodegenerative disease, and cancer. These are often referred to as the “Four Horsemen” of chronic disease. To this, we add a fifth pillar: quality of life and physical resiliency, encompassing sleep, cardiorespiratory fitness, lean mass, strength, and movement. Each plays a critical role in healthy aging, independence, and extended healthspan.
Together, these five pillars form the foundation of Biograph’s model. We evaluate each through advanced diagnostics including labs, imaging, genetics, and performance testing, and interpret them in context to surface risk before disease develops and to guide long-term decision-making.
First Pillar
Atherosclerotic Disease
Atherosclerosis is the leading cause of death globally and a primary driver of heart attack, stroke, and peripheral vascular disease. It is a progressive, inflammatory process that often develops silently for years before symptoms appear. This condition is typically driven by a combination of dyslipidemia, endothelial dysfunction, and chronic inflammation.
~36%
of asymptomatic adults aged 40–65 were found to have coronary atherosclerosis in the Miami Heart Study—despite showing no symptoms
Traditional tools like ASCVD risk calculators or basic lipid panels often miss early-stage disease, especially in women and younger individuals. Coronary artery calcium (CAC) scoring has been shown to outperform traditional risk calculators for identifying individuals at risk. However, even CAC scoring, while a useful stratification tool, can overlook soft, non-calcified plaque that precedes calcification. This is where CT coronary angiography (CCTA) adds value. In the Miami Heart Study, overall prevalence of coronary atherosclerosis by CCTA was 35.9% in asymptomatic men and women ages 40-65 years, despite being classified as low risk by traditional measures. The SCOT-HEART trial demonstrated that adding CCTA to usual care of symptomatic patients reduced 5-year heart attack rates and led to a sustained 10-year reduction in coronary deaths.
Biograph’s assessment strategy is built to identify atherosclerosis earlier and more precisely. We use CAC testing to provide improved risk stratification, and CCTA to provide the most robust detection of vulnerable plaque lesions. This is paired with:
Advanced lipid profiling: including ApoB, lipoprotein(a), and oxidized LDL
Inflammatory markers: such as high-sensitivity CRP (hs-CRP)
Hereditary and Familial risk context: especially for early or silent presentations
The combination of imaging, advanced biomarker analysis, and genetic context provides a deeper view of both current plaque burden and the upstream drivers of atherosclerosis. By detecting disease before symptoms or major events, we’re able to intervene while the pathology is still modifiable.
CASE STUDY
Early Atherosclerosis Detection
A man in his 40s came to Biograph with reassuring labs and a coronary artery calcium (CAC) score of zero — results that typically suggest low cardiovascular risk. But when we performed CT coronary angiography (CCTA) as part of his Biograph assessment, we uncovered moderate non-calcified plaque and stenosis in his left anterior descending artery, a high-risk finding that would have been missed by standard screening. Thanks to early, image-confirmed detection, he was able to start an intensive prevention plan years before symptoms might have appeared.
Second Pillar
Metabolic Dysfunction
Metabolic dysfunction is a silent but widespread driver of chronic disease. It encompasses insulin resistance, metabolic-associated steatotic liver disease (MASLD), and visceral adiposity, among other conditions. All of these can exist long before glycemic markers like fasting glucose or hemoglobin A1c begin to shift. According to the CDC, over 1 in 3 U.S. adults—approximately 98 million people—have prediabetes, and nearly 80% are unaware of it. Left unaddressed, these disruptions often progress to type 2 diabetes and significantly increase the risk of cardiovascular disease, cognitive decline, and certain cancers.
~98
million
or over 1 in 3 U.S. adults have prediabetes, and nearly 80% are unaware of it according to the CDC
Standard lab panels rarely test for insulin, and even when glycemic measures are taken, they often fail to detect early-stage dysfunction. That makes proactive, high-resolution assessment essential.
At Biograph, we evaluate metabolic health with a multi-layered approach designed to surface risk earlier and with greater specificity. This includes:
Fasting markers: insulin, glucose, and insulin sensitivity (e.g. HOMA-IR or surrogate indices)
Visceral and liver fat imaging: to detect preclinical MASLD or ectopic fat accumulation
Body composition analysis: focusing on lean mass versus fat mass distribution
Substrate utilization testing: during VO₂ max testing to assess mitochondrial efficiency and metabolic flexibility
This approach reveals both current dysfunction and how the body responds to energetic demands, offering a dynamic, systems-level view of metabolic health. By identifying metabolic impairment early, we can intervene long before conventional thresholds for disease are met.
Third Pillar
Neurodegenerative Disease
Neurodegenerative diseases, including Alzheimer’s disease, vascular dementia, and related syndromes, are often assumed to be inevitable consequences of aging. In reality, many of the upstream drivers of cognitive decline are modifiable, especially when addressed in midlife. In fact, the Lancet Commission estimates that up to 40% of dementia cases could be prevented or delayed by addressing modifiable risk factors during midlife. Even among individuals with a genetic predisposition such as the APOE ε4 allele, adherence to a healthy lifestyle has been shown to significantly slow cognitive decline.
~40%
of dementia cases could be prevented or delayed by addressing modifiable risk factors during midlife according to the Lancet Commission
Risk is shaped by a complex interplay of cerebrovascular health, glucose metabolism, systemic inflammation, sleep quality, and genetic predisposition. For example, chronic sleep disturbances and short sleep duration in midlife are associated with a 30% increased risk of dementia and faster cognitive decline later in life. Importantly, many of these contributors are not neurological in origin. They emerge from cardiometabolic dysfunction, vascular damage, and poor recovery capacity.
At Biograph, we take an integrated approach to brain health assessment that reflects this complexity. We evaluate:
Structural brain MRI: to detect early signs of neurovascular injury such as white matter changes, cerebral atrophy, and microhemorrhage
Genetic risk markers: including APOE genotype
Sleep diagnostics: such as home-based apnea testing
Cross-domain correlations: with metabolic, cardiovascular, and inflammatory risk factors
This data helps us identify individuals at elevated risk long before cognitive symptoms emerge, often while the most impactful interventions are still available. Whether it's improving insulin sensitivity, treating sleep apnea, or addressing vascular health, early detection creates a critical window for prevention.
Fourth Pillar
Cancer Risk
Cancer remains one of the leading causes of premature death, and yet standard screening protocols are limited in scope and timing. Most conventional guidelines are age-based, cancer-specific, and reactive. They focus on a handful of diseases (breast, cervical, colorectal, prostate) and are rarely applied until midlife. As a result, many high-risk individuals—particularly those with atypical presentations or silent, early-stage disease—go undetected. In fact, an estimated 71% of cancer deaths in the U.S. occur from cancers that are not covered by current screening guidelines.
~71%
of cancer deaths in the U.S. occur from cancers that are not covered by current screening guidelines
Inherited risk is one of the key blind spots. For example, Lynch syndrome is a relatively common and underdiagnosed hereditary condition associated with early-onset colorectal cancer, yet it often goes unaddressed by conventional screening protocols.
At Biograph, we take a layered approach to cancer risk, combining tools that assess both hereditary predisposition and the presence of early disease across multiple organ systems. This includes:
Whole-body MRI: with diffusion-weighted sequences to screen for structural abnormalities across tissues and organs
Germline genetic testing: to identify common and rare cancer syndromes such as Lynch Syndrome, Hereditary Breast and Ovarian Cancer Syndrome, and conditions related to disease causing variants in BRCA1/2, CHEK2, and other cancer risk genes.
Multi-cancer early detection (MCED) blood tests: to detect circulating tumor DNA from a wide range of cancer types
By integrating genomic, imaging, and liquid biopsy tools, we’re able to identify risk far earlier and provide members with a clearer path forward for prevention, monitoring, and early intervention.
CASE STUDY
The Power of Early Detection
A woman in her late 30s underwent a Biograph evaluation with no symptoms or known family history of cancer. Whole-body MRI revealed a thyroid lesion, and germline testing identified a mutation associated with elevated risk for multiple malignancies, including thyroid, breast, colorectal, and renal cancers. She was referred for biopsy and enrolled in a personalized surveillance program, years before traditional guidelines would have recommended any screening.
Fifth Pillar
Quality of Life & Physical Resiliency
Healthspan isn’t defined only by the absence of disease. It’s defined by the ability to function, adapt, and recover over time. Among the strongest predictors of long-term survival is cardiorespiratory fitness. In a study of over 122,000 adults, those with elite aerobic capacity had an 80% lower risk of all-cause mortality compared to individuals in the lowest performing group—outperforming even traditional risk factors like smoking, diabetes, and coronary artery disease.
~80%
lower risk of all-cause mortality for individuals with an elite aerobic capacity compared to individuals in the lowest performing group
As people age, declines in fitness, muscle mass, sleep quality, and movement efficiency become leading indicators of frailty, falls, hospitalization, and loss of independence. Yet these markers of physical resiliency are rarely measured in routine care. When they are, it's often only after functional decline has become obvious.
At Biograph, we assess resiliency as rigorously as we do disease risk. Our protocol includes:
VO₂ max testing: via cardiopulmonary exercise test (CPET) with gas exchange to assess aerobic capacity and cardiovascular efficiency
Grip strength: a validated predictor of mortality and frailty
Body composition analysis: focusing on lean mass and appendicular skeletal muscle index
Movement quality assessment: using high-frame-rate motion capture to evaluate balance, symmetry, flexibility, and control
Sleep diagnostics: including at-home testing for obstructive sleep apnea and sleep fragmentation metrics
Each of these metrics offers insight into how the body is aging, not just biologically, but functionally. By identifying early impairments in performance or recovery, we can intervene long before decline becomes disabling.
Interpretation, Not Just Information
Even the best diagnostic data can fall short if it’s not integrated, contextualized, and applied. At Biograph, the value of our assessments comes not just from what we measure, but how we interpret those findings across systems, and how we translate them into personalized care.
Each member receives a multi-disciplinary review that includes physicians, radiologists, registered dietitians, and exercise physiologists. Together, this team examines results not in isolation, but in combination, surfacing patterns, contradictions, and compounding risks that might otherwise go unnoticed.
It’s not uncommon for a finding in one domain, like elevated visceral fat, to alter our interpretation in another, such as brain health or cancer risk. This cross-talk between systems transforms raw data into clinically meaningful insight and drives decisions that would never emerge from a siloed report.
Conclusion
A stronger focus on early risk detection and personalized prevention has the potential to improve health outcomes before disease takes hold.
Biograph is built to surface risk before it becomes disease. We focus on the systems that drive long-term decline, helping members make better decisions, earlier, and tracking their impact over time.
This isn’t about testing everything. It’s about testing the right things and using that insight to shape a clearer, more personalized path forward.
Experience the Biograph Method
Join a new model of preventive care that detects risks early and turns data into personalized action.
Written by Michael Doney
Executive Medical Director
Dr. Doney is Biograph’s Executive Medical Director, overseeing our entire clinical team. Prior to joining Biograph, he served as Director of Medical Affairs at Human Longevity and Group42 Healthcare, and spent 4 years at the US CDC as an Associate Division Director. He received his medical degree from the University of Cincinnati and completed his residency in emergency medicine at UC San Diego.
References
Johnson PT, Horton KM, Megibow AJ, Fishman EK. Common incidental findings on MDCT: survey of radiologist recommendations for patient management. J Am Coll Radiol. 2011;8(11):762-767. doi:10.1016/j.jacr.2011.05.014
Levinson AW, Poston RS. Incidentaloma: the medical and ethical challenges of incidental findings in imaging. J Am Coll Radiol. 2024;21(3):e99-e103. doi:10.1016/j.jacr.2023.12.017
Shao S, Fogel AL, Gao Q, et al. Screening for disease in asymptomatic adults: a systematic review of guidelines. JAMA. 2024;331(11):1003-1015. doi:10.1001/jama.2024.2099
CDC. Prediabetes: Prevent Type 2 Diabetes. Centers for Disease Control and Prevention. Published 2024. https://www.cdc.gov/diabetes/prevention-type-2/prediabetes-prevent-type-2.html
Horton R. Offline: COVID-19 and the NHS—“a national scandal.” Lancet. 2020;395(10229):1022. doi:10.1016/S0140-6736(20)30367-6
Welch HG, Prorok PC, O'Malley AJ, Kramer BS. Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med. 2021;384(23):2218-2226. doi:10.1056/NEJMoa2101875
Callahan A, Shah NH. Machine learning in healthcare: review of applications and challenges. Nat Commun. 2021;12:2509. doi:10.1038/s41467-021-22354-2
Lee J, Smith K, Zhang Y, et al. Performance of AI-based triage in medical diagnostics: a large-scale validation. Nat Commun. 2024;15:2921. doi:10.1038/s41467-024-52562-5
Melnick ER, Dyrbye LN, Sinsky CA, et al. The association between perceived electronic health record usability and professional burnout among US physicians. Mayo Clin Proc. 2019;94(3):480-490. doi:10.1016/j.mayocp.2018.09.024
Shifting from Reactive to Proactive Care
Most preventive care is reactive and imprecise. Annual physicals offer brief checks, basic labs, and broad advice but reveal little about real health risks. Standard tools like ASCVD risk scores or BMI miss early-stage disease, especially in women, younger adults, and those with less typical risk profiles. Meanwhile, conditions like atherosclerosis, insulin resistance, fatty liver, neurovascular injury, and many cancers can progress silently for years.
That’s why Biograph takes a different approach. Our clinical model identifies risk earlier and more precisely across the systems most critical to long-term health. We use advanced diagnostics, interpret data across domains, and track key metrics over time to guide highly personalized, evidence-based interventions. This approach centers on five pillars that account for the majority of chronic disease and age-related decline.
The Five Pillars That Shape Our Approach
Most chronic disease and age-related decline can be traced to a common set of underlying processes. At Biograph, we’ve built our diagnostic framework around five pillars that account for the vast majority of premature death, disability, and reduced quality of life.
These include the four major clinical drivers of morbidity: atherosclerotic cardiovascular disease, metabolic dysfunction, neurodegenerative disease, and cancer. These are often referred to as the “Four Horsemen” of chronic disease. To this, we add a fifth pillar: quality of life and physical resiliency, encompassing sleep, cardiorespiratory fitness, lean mass, strength, and movement. Each plays a critical role in healthy aging, independence, and extended healthspan.
Together, these five pillars form the foundation of Biograph’s model. We evaluate each through advanced diagnostics including labs, imaging, genetics, and performance testing, and interpret them in context to surface risk before disease develops and to guide long-term decision-making.
First Pillar
Atherosclerotic Disease
Atherosclerosis is the leading cause of death globally and a primary driver of heart attack, stroke, and peripheral vascular disease. It is a progressive, inflammatory process that often develops silently for years before symptoms appear. This condition is typically driven by a combination of dyslipidemia, endothelial dysfunction, and chronic inflammation.
~36%
of asymptomatic adults aged 40–65 were found to have coronary atherosclerosis in the Miami Heart Study—despite showing no symptoms
Traditional tools like ASCVD risk calculators or basic lipid panels often miss early-stage disease, especially in women and younger individuals. Coronary artery calcium (CAC) scoring has been shown to outperform traditional risk calculators for identifying individuals at risk. However, even CAC scoring, while a useful stratification tool, can overlook soft, non-calcified plaque that precedes calcification. This is where CT coronary angiography (CCTA) adds value. In the Miami Heart Study, overall prevalence of coronary atherosclerosis by CCTA was 35.9% in asymptomatic men and women ages 40-65 years, despite being classified as low risk by traditional measures. The SCOT-HEART trial demonstrated that adding CCTA to usual care of symptomatic patients reduced 5-year heart attack rates and led to a sustained 10-year reduction in coronary deaths.
Biograph’s assessment strategy is built to identify atherosclerosis earlier and more precisely. We use CAC testing to provide improved risk stratification, and CCTA to provide the most robust detection of vulnerable plaque lesions. This is paired with:
Advanced lipid profiling: including ApoB, lipoprotein(a), and oxidized LDL
Inflammatory markers: such as high-sensitivity CRP (hs-CRP)
Hereditary and Familial risk context: especially for early or silent presentations
The combination of imaging, advanced biomarker analysis, and genetic context provides a deeper view of both current plaque burden and the upstream drivers of atherosclerosis. By detecting disease before symptoms or major events, we’re able to intervene while the pathology is still modifiable.
CASE STUDY
Early Atherosclerosis Detection
A man in his 40s came to Biograph with reassuring labs and a coronary artery calcium (CAC) score of zero — results that typically suggest low cardiovascular risk. But when we performed CT coronary angiography (CCTA) as part of his Biograph assessment, we uncovered moderate non-calcified plaque and stenosis in his left anterior descending artery, a high-risk finding that would have been missed by standard screening. Thanks to early, image-confirmed detection, he was able to start an intensive prevention plan years before symptoms might have appeared.
Second Pillar
Metabolic Dysfunction
Metabolic dysfunction is a silent but widespread driver of chronic disease. It encompasses insulin resistance, metabolic-associated steatotic liver disease (MASLD), and visceral adiposity, among other conditions. All of these can exist long before glycemic markers like fasting glucose or hemoglobin A1c begin to shift. According to the CDC, over 1 in 3 U.S. adults—approximately 98 million people—have prediabetes, and nearly 80% are unaware of it. Left unaddressed, these disruptions often progress to type 2 diabetes and significantly increase the risk of cardiovascular disease, cognitive decline, and certain cancers.
~98
million
or over 1 in 3 U.S. adults have prediabetes, and nearly 80% are unaware of it according to the CDC
Standard lab panels rarely test for insulin, and even when glycemic measures are taken, they often fail to detect early-stage dysfunction. That makes proactive, high-resolution assessment essential.
At Biograph, we evaluate metabolic health with a multi-layered approach designed to surface risk earlier and with greater specificity. This includes:
Fasting markers: insulin, glucose, and insulin sensitivity (e.g. HOMA-IR or surrogate indices)
Visceral and liver fat imaging: to detect preclinical MASLD or ectopic fat accumulation
Body composition analysis: focusing on lean mass versus fat mass distribution
Substrate utilization testing: during VO₂ max testing to assess mitochondrial efficiency and metabolic flexibility
This approach reveals both current dysfunction and how the body responds to energetic demands, offering a dynamic, systems-level view of metabolic health. By identifying metabolic impairment early, we can intervene long before conventional thresholds for disease are met.
Third Pillar
Neurodegenerative Disease
Neurodegenerative diseases, including Alzheimer’s disease, vascular dementia, and related syndromes, are often assumed to be inevitable consequences of aging. In reality, many of the upstream drivers of cognitive decline are modifiable, especially when addressed in midlife. In fact, the Lancet Commission estimates that up to 40% of dementia cases could be prevented or delayed by addressing modifiable risk factors during midlife. Even among individuals with a genetic predisposition such as the APOE ε4 allele, adherence to a healthy lifestyle has been shown to significantly slow cognitive decline.
~40%
of dementia cases could be prevented or delayed by addressing modifiable risk factors during midlife according to the Lancet Commission
Risk is shaped by a complex interplay of cerebrovascular health, glucose metabolism, systemic inflammation, sleep quality, and genetic predisposition. For example, chronic sleep disturbances and short sleep duration in midlife are associated with a 30% increased risk of dementia and faster cognitive decline later in life. Importantly, many of these contributors are not neurological in origin. They emerge from cardiometabolic dysfunction, vascular damage, and poor recovery capacity.
At Biograph, we take an integrated approach to brain health assessment that reflects this complexity. We evaluate:
Structural brain MRI: to detect early signs of neurovascular injury such as white matter changes, cerebral atrophy, and microhemorrhage
Genetic risk markers: including APOE genotype
Sleep diagnostics: such as home-based apnea testing
Cross-domain correlations: with metabolic, cardiovascular, and inflammatory risk factors
This data helps us identify individuals at elevated risk long before cognitive symptoms emerge, often while the most impactful interventions are still available. Whether it's improving insulin sensitivity, treating sleep apnea, or addressing vascular health, early detection creates a critical window for prevention.
Fourth Pillar
Cancer Risk
Cancer remains one of the leading causes of premature death, and yet standard screening protocols are limited in scope and timing. Most conventional guidelines are age-based, cancer-specific, and reactive. They focus on a handful of diseases (breast, cervical, colorectal, prostate) and are rarely applied until midlife. As a result, many high-risk individuals—particularly those with atypical presentations or silent, early-stage disease—go undetected. In fact, an estimated 71% of cancer deaths in the U.S. occur from cancers that are not covered by current screening guidelines.
~71%
of cancer deaths in the U.S. occur from cancers that are not covered by current screening guidelines
Inherited risk is one of the key blind spots. For example, Lynch syndrome is a relatively common and underdiagnosed hereditary condition associated with early-onset colorectal cancer, yet it often goes unaddressed by conventional screening protocols.
At Biograph, we take a layered approach to cancer risk, combining tools that assess both hereditary predisposition and the presence of early disease across multiple organ systems. This includes:
Whole-body MRI: with diffusion-weighted sequences to screen for structural abnormalities across tissues and organs
Germline genetic testing: to identify common and rare cancer syndromes such as Lynch Syndrome, Hereditary Breast and Ovarian Cancer Syndrome, and conditions related to disease causing variants in BRCA1/2, CHEK2, and other cancer risk genes.
Multi-cancer early detection (MCED) blood tests: to detect circulating tumor DNA from a wide range of cancer types
By integrating genomic, imaging, and liquid biopsy tools, we’re able to identify risk far earlier and provide members with a clearer path forward for prevention, monitoring, and early intervention.
CASE STUDY
The Power of Early Detection
A woman in her late 30s underwent a Biograph evaluation with no symptoms or known family history of cancer. Whole-body MRI revealed a thyroid lesion, and germline testing identified a mutation associated with elevated risk for multiple malignancies, including thyroid, breast, colorectal, and renal cancers. She was referred for biopsy and enrolled in a personalized surveillance program, years before traditional guidelines would have recommended any screening.
Fifth Pillar
Quality of Life & Physical Resiliency
Healthspan isn’t defined only by the absence of disease. It’s defined by the ability to function, adapt, and recover over time. Among the strongest predictors of long-term survival is cardiorespiratory fitness. In a study of over 122,000 adults, those with elite aerobic capacity had an 80% lower risk of all-cause mortality compared to individuals in the lowest performing group—outperforming even traditional risk factors like smoking, diabetes, and coronary artery disease.
~80%
lower risk of all-cause mortality for individuals with an elite aerobic capacity compared to individuals in the lowest performing group
As people age, declines in fitness, muscle mass, sleep quality, and movement efficiency become leading indicators of frailty, falls, hospitalization, and loss of independence. Yet these markers of physical resiliency are rarely measured in routine care. When they are, it's often only after functional decline has become obvious.
At Biograph, we assess resiliency as rigorously as we do disease risk. Our protocol includes:
VO₂ max testing: via cardiopulmonary exercise test (CPET) with gas exchange to assess aerobic capacity and cardiovascular efficiency
Grip strength: a validated predictor of mortality and frailty
Body composition analysis: focusing on lean mass and appendicular skeletal muscle index
Movement quality assessment: using high-frame-rate motion capture to evaluate balance, symmetry, flexibility, and control
Sleep diagnostics: including at-home testing for obstructive sleep apnea and sleep fragmentation metrics
Each of these metrics offers insight into how the body is aging, not just biologically, but functionally. By identifying early impairments in performance or recovery, we can intervene long before decline becomes disabling.
Interpretation, Not Just Information
Even the best diagnostic data can fall short if it’s not integrated, contextualized, and applied. At Biograph, the value of our assessments comes not just from what we measure, but how we interpret those findings across systems, and how we translate them into personalized care.
Each member receives a multi-disciplinary review that includes physicians, radiologists, registered dietitians, and exercise physiologists. Together, this team examines results not in isolation, but in combination, surfacing patterns, contradictions, and compounding risks that might otherwise go unnoticed.
It’s not uncommon for a finding in one domain, like elevated visceral fat, to alter our interpretation in another, such as brain health or cancer risk. This cross-talk between systems transforms raw data into clinically meaningful insight and drives decisions that would never emerge from a siloed report.
Conclusion
A stronger focus on early risk detection and personalized prevention has the potential to improve health outcomes before disease takes hold.
Biograph is built to surface risk before it becomes disease. We focus on the systems that drive long-term decline, helping members make better decisions, earlier, and tracking their impact over time.
This isn’t about testing everything. It’s about testing the right things and using that insight to shape a clearer, more personalized path forward.
Experience the Biograph Method
Join a new model of preventive care that detects risks early and turns data into personalized action.
Written by Michael Doney
Executive Medical Director
Dr. Doney is Biograph’s Executive Medical Director, overseeing our entire clinical team. Prior to joining Biograph, he served as Director of Medical Affairs at Human Longevity and Group42 Healthcare, and spent 4 years at the US CDC as an Associate Division Director. He received his medical degree from the University of Cincinnati and completed his residency in emergency medicine at UC San Diego.
References
Johnson PT, Horton KM, Megibow AJ, Fishman EK. Common incidental findings on MDCT: survey of radiologist recommendations for patient management. J Am Coll Radiol. 2011;8(11):762-767. doi:10.1016/j.jacr.2011.05.014
Levinson AW, Poston RS. Incidentaloma: the medical and ethical challenges of incidental findings in imaging. J Am Coll Radiol. 2024;21(3):e99-e103. doi:10.1016/j.jacr.2023.12.017
Shao S, Fogel AL, Gao Q, et al. Screening for disease in asymptomatic adults: a systematic review of guidelines. JAMA. 2024;331(11):1003-1015. doi:10.1001/jama.2024.2099
CDC. Prediabetes: Prevent Type 2 Diabetes. Centers for Disease Control and Prevention. Published 2024. https://www.cdc.gov/diabetes/prevention-type-2/prediabetes-prevent-type-2.html
Horton R. Offline: COVID-19 and the NHS—“a national scandal.” Lancet. 2020;395(10229):1022. doi:10.1016/S0140-6736(20)30367-6
Welch HG, Prorok PC, O'Malley AJ, Kramer BS. Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med. 2021;384(23):2218-2226. doi:10.1056/NEJMoa2101875
Callahan A, Shah NH. Machine learning in healthcare: review of applications and challenges. Nat Commun. 2021;12:2509. doi:10.1038/s41467-021-22354-2
Lee J, Smith K, Zhang Y, et al. Performance of AI-based triage in medical diagnostics: a large-scale validation. Nat Commun. 2024;15:2921. doi:10.1038/s41467-024-52562-5
Melnick ER, Dyrbye LN, Sinsky CA, et al. The association between perceived electronic health record usability and professional burnout among US physicians. Mayo Clin Proc. 2019;94(3):480-490. doi:10.1016/j.mayocp.2018.09.024
Shifting from Reactive to Proactive Care
Most preventive care is reactive and imprecise. Annual physicals offer brief checks, basic labs, and broad advice but reveal little about real health risks. Standard tools like ASCVD risk scores or BMI miss early-stage disease, especially in women, younger adults, and those with less typical risk profiles. Meanwhile, conditions like atherosclerosis, insulin resistance, fatty liver, neurovascular injury, and many cancers can progress silently for years.
That’s why Biograph takes a different approach. Our clinical model identifies risk earlier and more precisely across the systems most critical to long-term health. We use advanced diagnostics, interpret data across domains, and track key metrics over time to guide highly personalized, evidence-based interventions. This approach centers on five pillars that account for the majority of chronic disease and age-related decline.
The Five Pillars That Shape Our Approach
Most chronic disease and age-related decline can be traced to a common set of underlying processes. At Biograph, we’ve built our diagnostic framework around five pillars that account for the vast majority of premature death, disability, and reduced quality of life.
These include the four major clinical drivers of morbidity: atherosclerotic cardiovascular disease, metabolic dysfunction, neurodegenerative disease, and cancer. These are often referred to as the “Four Horsemen” of chronic disease. To this, we add a fifth pillar: quality of life and physical resiliency, encompassing sleep, cardiorespiratory fitness, lean mass, strength, and movement. Each plays a critical role in healthy aging, independence, and extended healthspan.
Together, these five pillars form the foundation of Biograph’s model. We evaluate each through advanced diagnostics including labs, imaging, genetics, and performance testing, and interpret them in context to surface risk before disease develops and to guide long-term decision-making.
First Pillar
Atherosclerotic Disease
Atherosclerosis is the leading cause of death globally and a primary driver of heart attack, stroke, and peripheral vascular disease. It is a progressive, inflammatory process that often develops silently for years before symptoms appear. This condition is typically driven by a combination of dyslipidemia, endothelial dysfunction, and chronic inflammation.
~36%
of asymptomatic adults aged 40–65 were found to have coronary atherosclerosis in the Miami Heart Study—despite showing no symptoms
Traditional tools like ASCVD risk calculators or basic lipid panels often miss early-stage disease, especially in women and younger individuals. Coronary artery calcium (CAC) scoring has been shown to outperform traditional risk calculators for identifying individuals at risk. However, even CAC scoring, while a useful stratification tool, can overlook soft, non-calcified plaque that precedes calcification. This is where CT coronary angiography (CCTA) adds value. In the Miami Heart Study, overall prevalence of coronary atherosclerosis by CCTA was 35.9% in asymptomatic men and women ages 40-65 years, despite being classified as low risk by traditional measures. The SCOT-HEART trial demonstrated that adding CCTA to usual care of symptomatic patients reduced 5-year heart attack rates and led to a sustained 10-year reduction in coronary deaths.
Biograph’s assessment strategy is built to identify atherosclerosis earlier and more precisely. We use CAC testing to provide improved risk stratification, and CCTA to provide the most robust detection of vulnerable plaque lesions. This is paired with:
Advanced lipid profiling: including ApoB, lipoprotein(a), and oxidized LDL
Inflammatory markers: such as high-sensitivity CRP (hs-CRP)
Hereditary and Familial risk context: especially for early or silent presentations
The combination of imaging, advanced biomarker analysis, and genetic context provides a deeper view of both current plaque burden and the upstream drivers of atherosclerosis. By detecting disease before symptoms or major events, we’re able to intervene while the pathology is still modifiable.
CASE STUDY
Early Atherosclerosis Detection
A man in his 40s came to Biograph with reassuring labs and a coronary artery calcium (CAC) score of zero — results that typically suggest low cardiovascular risk. But when we performed CT coronary angiography (CCTA) as part of his Biograph assessment, we uncovered moderate non-calcified plaque and stenosis in his left anterior descending artery, a high-risk finding that would have been missed by standard screening. Thanks to early, image-confirmed detection, he was able to start an intensive prevention plan years before symptoms might have appeared.
Second Pillar
Metabolic Dysfunction
Metabolic dysfunction is a silent but widespread driver of chronic disease. It encompasses insulin resistance, metabolic-associated steatotic liver disease (MASLD), and visceral adiposity, among other conditions. All of these can exist long before glycemic markers like fasting glucose or hemoglobin A1c begin to shift. According to the CDC, over 1 in 3 U.S. adults—approximately 98 million people—have prediabetes, and nearly 80% are unaware of it. Left unaddressed, these disruptions often progress to type 2 diabetes and significantly increase the risk of cardiovascular disease, cognitive decline, and certain cancers.
~98
million
or over 1 in 3 U.S. adults have prediabetes, and nearly 80% are unaware of it according to the CDC
Standard lab panels rarely test for insulin, and even when glycemic measures are taken, they often fail to detect early-stage dysfunction. That makes proactive, high-resolution assessment essential.
At Biograph, we evaluate metabolic health with a multi-layered approach designed to surface risk earlier and with greater specificity. This includes:
Fasting markers: insulin, glucose, and insulin sensitivity (e.g. HOMA-IR or surrogate indices)
Visceral and liver fat imaging: to detect preclinical MASLD or ectopic fat accumulation
Body composition analysis: focusing on lean mass versus fat mass distribution
Substrate utilization testing: during VO₂ max testing to assess mitochondrial efficiency and metabolic flexibility
This approach reveals both current dysfunction and how the body responds to energetic demands, offering a dynamic, systems-level view of metabolic health. By identifying metabolic impairment early, we can intervene long before conventional thresholds for disease are met.
Third Pillar
Neurodegenerative Disease
Neurodegenerative diseases, including Alzheimer’s disease, vascular dementia, and related syndromes, are often assumed to be inevitable consequences of aging. In reality, many of the upstream drivers of cognitive decline are modifiable, especially when addressed in midlife. In fact, the Lancet Commission estimates that up to 40% of dementia cases could be prevented or delayed by addressing modifiable risk factors during midlife. Even among individuals with a genetic predisposition such as the APOE ε4 allele, adherence to a healthy lifestyle has been shown to significantly slow cognitive decline.
~40%
of dementia cases could be prevented or delayed by addressing modifiable risk factors during midlife according to the Lancet Commission
Risk is shaped by a complex interplay of cerebrovascular health, glucose metabolism, systemic inflammation, sleep quality, and genetic predisposition. For example, chronic sleep disturbances and short sleep duration in midlife are associated with a 30% increased risk of dementia and faster cognitive decline later in life. Importantly, many of these contributors are not neurological in origin. They emerge from cardiometabolic dysfunction, vascular damage, and poor recovery capacity.
At Biograph, we take an integrated approach to brain health assessment that reflects this complexity. We evaluate:
Structural brain MRI: to detect early signs of neurovascular injury such as white matter changes, cerebral atrophy, and microhemorrhage
Genetic risk markers: including APOE genotype
Sleep diagnostics: such as home-based apnea testing
Cross-domain correlations: with metabolic, cardiovascular, and inflammatory risk factors
This data helps us identify individuals at elevated risk long before cognitive symptoms emerge, often while the most impactful interventions are still available. Whether it's improving insulin sensitivity, treating sleep apnea, or addressing vascular health, early detection creates a critical window for prevention.
Fourth Pillar
Cancer Risk
Cancer remains one of the leading causes of premature death, and yet standard screening protocols are limited in scope and timing. Most conventional guidelines are age-based, cancer-specific, and reactive. They focus on a handful of diseases (breast, cervical, colorectal, prostate) and are rarely applied until midlife. As a result, many high-risk individuals—particularly those with atypical presentations or silent, early-stage disease—go undetected. In fact, an estimated 71% of cancer deaths in the U.S. occur from cancers that are not covered by current screening guidelines.
~71%
of cancer deaths in the U.S. occur from cancers that are not covered by current screening guidelines
Inherited risk is one of the key blind spots. For example, Lynch syndrome is a relatively common and underdiagnosed hereditary condition associated with early-onset colorectal cancer, yet it often goes unaddressed by conventional screening protocols.
At Biograph, we take a layered approach to cancer risk, combining tools that assess both hereditary predisposition and the presence of early disease across multiple organ systems. This includes:
Whole-body MRI: with diffusion-weighted sequences to screen for structural abnormalities across tissues and organs
Germline genetic testing: to identify common and rare cancer syndromes such as Lynch Syndrome, Hereditary Breast and Ovarian Cancer Syndrome, and conditions related to disease causing variants in BRCA1/2, CHEK2, and other cancer risk genes.
Multi-cancer early detection (MCED) blood tests: to detect circulating tumor DNA from a wide range of cancer types
By integrating genomic, imaging, and liquid biopsy tools, we’re able to identify risk far earlier and provide members with a clearer path forward for prevention, monitoring, and early intervention.
CASE STUDY
The Power of Early Detection
A woman in her late 30s underwent a Biograph evaluation with no symptoms or known family history of cancer. Whole-body MRI revealed a thyroid lesion, and germline testing identified a mutation associated with elevated risk for multiple malignancies, including thyroid, breast, colorectal, and renal cancers. She was referred for biopsy and enrolled in a personalized surveillance program, years before traditional guidelines would have recommended any screening.
Fifth Pillar
Quality of Life & Physical Resiliency
Healthspan isn’t defined only by the absence of disease. It’s defined by the ability to function, adapt, and recover over time. Among the strongest predictors of long-term survival is cardiorespiratory fitness. In a study of over 122,000 adults, those with elite aerobic capacity had an 80% lower risk of all-cause mortality compared to individuals in the lowest performing group—outperforming even traditional risk factors like smoking, diabetes, and coronary artery disease.
~80%
lower risk of all-cause mortality for individuals with an elite aerobic capacity compared to individuals in the lowest performing group
As people age, declines in fitness, muscle mass, sleep quality, and movement efficiency become leading indicators of frailty, falls, hospitalization, and loss of independence. Yet these markers of physical resiliency are rarely measured in routine care. When they are, it's often only after functional decline has become obvious.
At Biograph, we assess resiliency as rigorously as we do disease risk. Our protocol includes:
VO₂ max testing: via cardiopulmonary exercise test (CPET) with gas exchange to assess aerobic capacity and cardiovascular efficiency
Grip strength: a validated predictor of mortality and frailty
Body composition analysis: focusing on lean mass and appendicular skeletal muscle index
Movement quality assessment: using high-frame-rate motion capture to evaluate balance, symmetry, flexibility, and control
Sleep diagnostics: including at-home testing for obstructive sleep apnea and sleep fragmentation metrics
Each of these metrics offers insight into how the body is aging, not just biologically, but functionally. By identifying early impairments in performance or recovery, we can intervene long before decline becomes disabling.
Interpretation, Not Just Information
Even the best diagnostic data can fall short if it’s not integrated, contextualized, and applied. At Biograph, the value of our assessments comes not just from what we measure, but how we interpret those findings across systems, and how we translate them into personalized care.
Each member receives a multi-disciplinary review that includes physicians, radiologists, registered dietitians, and exercise physiologists. Together, this team examines results not in isolation, but in combination, surfacing patterns, contradictions, and compounding risks that might otherwise go unnoticed.
It’s not uncommon for a finding in one domain, like elevated visceral fat, to alter our interpretation in another, such as brain health or cancer risk. This cross-talk between systems transforms raw data into clinically meaningful insight and drives decisions that would never emerge from a siloed report.
Conclusion
A stronger focus on early risk detection and personalized prevention has the potential to improve health outcomes before disease takes hold.
Biograph is built to surface risk before it becomes disease. We focus on the systems that drive long-term decline, helping members make better decisions, earlier, and tracking their impact over time.
This isn’t about testing everything. It’s about testing the right things and using that insight to shape a clearer, more personalized path forward.
Experience the Biograph Method
Join a new model of preventive care that detects risks early and turns data into personalized action.
Written by Michael Doney
Executive Medical Director
Dr. Doney is Biograph’s Executive Medical Director, overseeing our entire clinical team. Prior to joining Biograph, he served as Director of Medical Affairs at Human Longevity and Group42 Healthcare, and spent 4 years at the US CDC as an Associate Division Director. He received his medical degree from the University of Cincinnati and completed his residency in emergency medicine at UC San Diego.
References
Johnson PT, Horton KM, Megibow AJ, Fishman EK. Common incidental findings on MDCT: survey of radiologist recommendations for patient management. J Am Coll Radiol. 2011;8(11):762-767. doi:10.1016/j.jacr.2011.05.014
Levinson AW, Poston RS. Incidentaloma: the medical and ethical challenges of incidental findings in imaging. J Am Coll Radiol. 2024;21(3):e99-e103. doi:10.1016/j.jacr.2023.12.017
Shao S, Fogel AL, Gao Q, et al. Screening for disease in asymptomatic adults: a systematic review of guidelines. JAMA. 2024;331(11):1003-1015. doi:10.1001/jama.2024.2099
CDC. Prediabetes: Prevent Type 2 Diabetes. Centers for Disease Control and Prevention. Published 2024. https://www.cdc.gov/diabetes/prevention-type-2/prediabetes-prevent-type-2.html
Horton R. Offline: COVID-19 and the NHS—“a national scandal.” Lancet. 2020;395(10229):1022. doi:10.1016/S0140-6736(20)30367-6
Welch HG, Prorok PC, O'Malley AJ, Kramer BS. Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med. 2021;384(23):2218-2226. doi:10.1056/NEJMoa2101875
Callahan A, Shah NH. Machine learning in healthcare: review of applications and challenges. Nat Commun. 2021;12:2509. doi:10.1038/s41467-021-22354-2
Lee J, Smith K, Zhang Y, et al. Performance of AI-based triage in medical diagnostics: a large-scale validation. Nat Commun. 2024;15:2921. doi:10.1038/s41467-024-52562-5
Melnick ER, Dyrbye LN, Sinsky CA, et al. The association between perceived electronic health record usability and professional burnout among US physicians. Mayo Clin Proc. 2019;94(3):480-490. doi:10.1016/j.mayocp.2018.09.024
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