For years, cardiology has often focused on treating patients after a heart attack, after chest pain develops or after cardiovascular disease has already taken hold.

Dr. Nikos Pappan wants to change that approach.

This summer, St. Clair Health is launching its new Center for Cardiometabolic Prevention, a clinic designed to help identify high-risk patients earlier and provide personalized care aimed at preventing future heart disease before it starts.

“We’re seeing patients younger with cardiovascular disease,” Pappan said. “Whether it’s because technology is allowing us to identify it sooner or people are developing disease earlier, we’re seeing those risk factors much earlier in life.”

Pappan, a Pittsburgh-area native who joined St. Clair Health in July 2025 after completing his cardiology fellowship at Allegheny General Hospital, said prevention has always been his primary focus.

“Oftentimes in cardiology, we get referred patients who already have symptoms or who may have already had a heart attack,” he said. “I wanted to shift the model a little bit and start seeing younger patients where we can really intervene and prevent those events from happening in the future.”

The clinic officially was scheduled to open in mid-June and is accepting referrals and scheduling appointments.

According to Pappan, cardiovascular risk factors often begin developing long before patients realize there is a problem. Weight gain, elevated blood pressure, rising cholesterol levels and early insulin resistance can quietly develop over time, even in patients who otherwise feel healthy.

“You start to see little signals very early,” he said. “Maybe blood pressure starts creeping up. Maybe cholesterol labs start increasing. The A1C starts rising slightly. Identifying those people and being aggressive with risk factor modification can prevent events in the future.”

The clinic is geared toward adults ages 30 to 60 who have a BMI above 27 along with at least one additional cardiovascular risk factor such as hypertension, high cholesterol, chronic kidney disease or a strong family history of heart disease.

Pappan said many patients are increasingly aware of their health risks and are looking for additional guidance before major health issues develop.

“Maybe someone’s father had a heart attack at 45,” he said. “That patient may feel that family history looming in the back of their mind and want to take better control of their health.”

Unlike a traditional cardiology visit that may occur once or twice a year, the cardiometabolic clinic is designed around continuous engagement and individualized care.

Patients begin with a comprehensive cardiovascular risk evaluation that reviews blood pressure, cholesterol levels, blood sugar and additional advanced lab testing. Physicians then create personalized treatment plans tailored to each patient’s risk factors and lifestyle.

Pappan said one of the biggest differences is the clinic’s emphasis on longitudinal care with monthly touchpoints to keep patients engaged and accountable.

“There’s so much that happens between visits,” he said. “You can’t possibly fit everything into a 20- or 30-minute appointment and then not see the patient again for six months.”

Every patient also receives a nutrition consultation through a partnership with Lembas Health, which uses AI-supported tools to help create personalized nutrition plans. Rather than promoting unrealistic fad diets, Pappan said the clinic focuses on practical, sustainable lifestyle changes.

“We try to make small goals that create a big difference over time,” he said. “If someone eats bread three times a day, maybe we start by eliminating it at lunch for two weeks. Small changes become long-term lifestyle changes.”

In addition to lifestyle counseling, the clinic incorporates advanced imaging and diagnostic tools now available through St. Clair Health. Pappan highlighted the hospital’s CT coronary imaging capabilities, which allow physicians to directly visualize plaque buildup in heart arteries before major blockages occur. St. Clair also uses HeartFlow technology, which helps analyze plaque characteristics and identify patients who may be at higher risk.

“We can now identify whether someone has 10 percent plaque or 90 percent plaque,” Pappan said. “Those tools really allow us to focus on prevention in a much more meaningful way.”

Treatment plans may also include medications when appropriate, including cholesterol-lowering therapies and weight management medications. The clinic’s broader goal, however, is helping patients understand their individual risk and empowering them to make long-term changes.

“I think a lot of patients want to make changes,” Pappan said. “They just feel lost and don’t have the resources to get there. That’s what we’re trying to provide.”

Residents interested in learning more about the Center for Cardiometabolic Prevention are encouraged to speak with their primary care physician about whether the program may be a good fit for them and to visit stclair.org to learn more.