Cardiovascular prevention, actively managed
Most prevention patients already have the data: lab values from several vendors, imaging read by several readers, a sequencing report, years of wearable readings. What they do not have is anyone who has analyzed it. A membership is a cardiologist who does, on a schedule, and who changes the plan when the data says to. The trials behind those decisions ran five years. You are deciding about forty.
Levels of membership
Trajectory is the practice's app and every patient has it. It renews prescriptions before they lapse, follows tests until the result is back, and records side effects when they happen. Your cardiologist reads your record at every level during visits.
Membership adds what happens between visits. Your cardiologist puts every result that arrives against the treatment it was meant to move, and changes the plan: a dose raised, a drug swapped, a test ordered, a target reset. There is one membership at one price. Anything urgent is scheduled by urgency at every level, including Free.
Free
Nothing in your care waits on a phone call.
The practice keeps your tasks, tests and refills moving
- The schedule is live, so booking a visit takes no phone call
- Tests go to a lab or imaging centre near you, and the practice follows each one until the result is back
- The practice flags a refill before you run out, so no medication lapses in a queue
- Side effects go into the record the day they happen
- Visits begin with your record already assembled, so the time goes on decisions
Your cardiologist builds your trajectory from the start and walks you through it during visits. Seeing it yourself between visits begins with membership.
Membership
Your cardiologist answers within 12 hours and sees you within one business day.
Your cardiologist turns new data into a revised plan at least monthly
- Unlimited messaging: your cardiologist answers within 12 hours
- Follow-up visits within one business day: hours are held for members
- Wearables: VO2 max, heart rate variability, sleep, blood pressure and weight
- Genetics: exome, individual variants, pharmacogenetics
- The Longitudinal Record: the impact of treatments on laboratory, imaging and symptom data to derive cause and effect
- A dynamically-updating prevention plan reflecting the latest data
- Access to cutting-edge therapies and diagnostic testing
- Everything in Free
Month to month. Cancel any time. There is no minimum term and no cancellation fee. Cancelling stops the next charge. The level you have paid for runs to the end of that month and then steps down to Free, and the account stays open. Your record is retained either way.
Visits are billed as visits at every level, including Free: $199 for a new patient and $149 for a follow-up, or billed to insurance. They are never bundled into a membership fee. A membership changes when a routine visit can be scheduled. It does not change what a visit costs, and it does not change who is seen first when something is urgent. Book a visit →
Everything the record holds
Your record, the asks waiting on you, your symptoms, your medications, your tests, your care team and your messages each hold their own tab. Each one shows where a thing stands. "Has that been done yet" becomes a question you answer by looking.
Everything being tracked
384 measurements · 27 constructsProposed view. Synthetic patient and synthetic values, not a real person, and not medical advice.
Your genetics change the target and the timing
Most patients who have had genetic testing have a PDF and nothing done with it. Your cardiologist reads the variants out of it and treats to them: an inherited cholesterol variant lowers your LDL-C target and starts treatment earlier, a coronary risk allele raises how hard the whole profile is treated, a statin-response genotype is there when a muscle symptom needs explaining.
Genetics
Sequencing report · 20 panels evaluatedOne heterozygous Pathogenic variant identified in APOB. APOB is associated with autosomal dominant hypercholesterolaemia, type B.
| Gene | Variant | Zygosity | Classification |
|---|---|---|---|
| APOB | c.10579C>T (p.Arg3527Trp) NM_000384.3 | heterozygous | Pathogenic 13 submissions |
APOB c.10579C>T (p.Arg3527Trp) classified Pathogenic in ClinVar RCV000231844, last evaluated February 2026.
No other reportable variants were identified in the remaining panels evaluated.
Risk and response
common variants, not classified pathogenic · not yet curated in the practice's panel set| Gene or locus | Genotype | Affects |
|---|---|---|
| SLCO1B1 rs4149056 | CT | raised risk of statin myalgia on rosuvastatin; evidence is conflicting |
| APOE | e3/e4 | lipid handling and dementia risk |
| 9p21 rs1333049 | CC | coronary artery disease risk, independent of lipids |
| 4q25 rs2200733, near PITX2 | TT | atrial fibrillation risk |
Panel names and the reported allele are the practice's curated set. The patient and the result are synthetic. Design view of a surface not yet built, and not medical advice.
Cardiologists that incorporate wearable data into treatment plans
A clinic blood pressure is one reading on one day. Your home readings are what you actually live at, and your cardiologist treats to those. VO2 max, heart rate variability and a sleep score sit beside them, each tagged with the device that produced it, because a score from one device is not the same quantity as a score from another.
Readings you take at home
Last 7 entries · on the same timeline as your labsYour cardiologist reviews each reading before it joins your record.
Design view of a surface not yet built. Synthetic patient and synthetic values, not a real person, and not medical advice.
Where every test stands
Each test the practice orders is grouped by the place that will run it and tracked through ordered, scheduled, completed and results back. A coronary CT angiogram is read with Cleerly plaque analysis. The plaque volumes land on the record.
Waiting on you: a scheduled date.
Waiting on you: a completed date.
Example view. Synthetic patient, not a real person.
Treatments read against their results
A lab dashboard shows you values. A medical record stores them. Neither tells you whether the treatment you are taking is the reason a value changed, or whether it is the reason you feel worse. Answering that takes every marker a treatment could affect, on one timeline, against the dose you actually took, with what was expected of each recorded before the result came back.
Longitudinal record
Statin uptitration · 8 wk ago384 measurements · 27 constructs
Statin uptitration
expected vs observedRosuvastatin was increased from 20 mg to 40 mg, with lipids rechecked at 8 weeks to measure the response.
- ApoB is predominantly Lp(a)-carried, so the 40 mg step buys less than the LDL-C drop suggests , read from Lp(a)
- Cholesterol is absorption-dominant, so a statin alone will plateau , read from campesterol, absolute, beta-sitosterol, absolute
Example view. Synthetic patient and synthetic values, not a real person, and not medical advice.
Ask the record whether a change is meaningful
A repeat calcium score that comes back higher reads like bad news, and most patients are told exactly that. Ask the record instead and the answer arrives in seconds, assessed criterion by criterion against the Bradford Hill tests for causation: timing, dose-response, size, reversibility, known mechanism, and what else could explain it. Every figure is read from your own data, and where the data cannot settle a question the answer says so rather than filling the gap.
“Could the worsening of my calcium score be explained by my statin?”
Your score most likely rose because of the statin. That is the drug working. Statins convert soft plaque into calcified plaque, which is more stable and also more visible to the scan. A rising Agatston score on treatment is the expected consequence, which is why it is read here as an intended effect rather than a warning.
| Criterion | Finding | From your record |
|---|---|---|
| Timing computed | Met | moved from 34 to 52 after the change |
| Dose–response computed | Met | the marker tracks the dose ladder (10 MG: 22, 20 MG: 34, 40 MG: 52). |
| Size of the change computed | Large | a 53% change from baseline |
| Stopping and restarting curated | Not applicable | stopping is not expected to reverse this, so a gap off the drug would not settle it. |
| Known mechanism curated | Met | curated intended effect: rosuvastatin is expected to increase coronary calcium score over ~180–730 days. |
| Other explanations computed | None found | no other treatment on this marker overlaps the window. |
Example answer, computed from a synthetic patient, not a real person, and not medical advice.
Common questions about the membership
Does membership mean better care?
No. Whatever management is clinically necessary is delivered in full at every level, and anything urgent is scheduled by urgency rather than by level. Medically warranted encounters are billed as visits at every level and are never bundled into the fee.
What happens if I stop the membership?
You keep the level you have paid for until the end of that month, and then move to Free.
How do I join if I have already been seen by the practice?
Sign up with the email address already on file and the membership connects to your existing record. If it does not match, the practice sends an invitation to the address on file, so access to an existing record is never granted on an unverified claim.
Does the membership replace my primary care physician?
No. This is specialty cardiovascular prevention for patients managing risk deliberately. It does not provide primary care, urgent care, or emergency care, and members are expected to keep a primary care physician.
Is the membership billed to insurance?
No. The membership fee is self-pay and is never billed to insurance. Insurance is used only for traditional medically necessary encounters: a visit is billed the way any specialist visit is billed, at every level including Free. The two are separate: the fee buys the harmonizing and the analysis, and it buys no visit time.
Ask about the membership
Signup is not open yet. Membership will be month to month, cancel any time, and available in the states where the practice is licensed.
Membership terms and the consents collected at signup will be published before signup opens. This membership does not provide emergency care. If you are having a medical emergency, call 911.