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DR LEATHAM'S STORY
From the catheter lab to prevention
A 2 a.m. phone call. I answer on the second ring. A 63-year-old man has woken with chest pain. His ECG is already on my screen — unmistakable ST elevation, a large anterior heart attack. I am in the car within five minutes.
This is what I trained for. For thirty-five years on the NHS front line, I performed thousands of angioplasties and placed countless stents. We were astonishingly good at saving the dying.
But too often, by the time a patient reached my table, the disease had been silently developing for decades. For half of all people with coronary artery disease, the first symptom is a heart attack — or sudden death.
That is the gap this story is about.
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"I used to stent. Now I prevent."
In 2006, I founded the Surrey Cardiovascular Clinic next to Lifescan, training up on one of the first 16-slice CT scanners available for cardiac imaging. I then persuaded the NHS to invest in the very best scanner available for our district cardiology service, and when HeartFlow launched its CT-derived fractional flow reserve (FFR-CT) technology in 2016, we became one of the first district general hospitals in the country to adopt it.
The impact on my catheter lab lists — held at the Royal Brompton and Frimley Park — was striking. CT-FFR was highly sensitive but, crucially, also specific, meaning we could rule out significant disease before booking a patient for an invasive procedure. Where some of my colleagues' lab lists were dominated by diagnostic angiograms that turned out not to need a stent, mine were almost entirely intervention. My patients had already had their CT angiogram and their FFR-CT, so by the time they came to the cath lab, we knew they needed a stent. The pile of empty stent boxes at the end of each lab day was noticeably higher than in some of the others.
That experience planted the seed. If CT and AI could pre-select patients this accurately, why couldn't we operate the CT service ourselves — directly, faster, and with the same level of cardiologist oversight as the cath lab? That idea eventually became Virtual Cath Lab Ltd, trading as Heart Scan Direct.
By the late 2010s, I could see where the future of my specialty had to go. The landmark COURAGE, ORBITA and ISCHEMIA trials had confirmed what few interventional cardiologists wanted to admit — stenting stable arteries relieves symptoms but does not prolong life. Meanwhile, advanced CT was beginning to detect disease decades before symptoms appeared. The opportunity to shift from rescue to prevention was right there.
In November 2021, after almost 30 years in invasive cardiology — 25 of them as a consultant — I retired from the NHS to pursue it full-time.
What I did not know then was how much I still had to learn.
Back to school
For the first time in years, I had the space to think — and to read. I started listening to Peter Attia's The Drive podcast on long drives, then began genning up properly on metabolic health and diabetes. I worked through some genuinely provocative books — Jessie Inchauspé's Glucose Revolution, Gary Taubes's Rethinking Diabetes, Mark Hyman's Eat Fat, Get Thin, Robert Lustig's Metabolical. None of this had been part of my cardiology training.
I even had to relearn the Krebs cycle. The last time I had looked at it properly was as a Cambridge undergraduate.
It is a humbling thing, mid-career, to realise that the most important machinery in your patients' bodies — how they actually generate energy, store fuel and become inflamed — was barely touched on in everything you had been taught since. Only when you make the time to go back to first principles do you realise how much of the picture you have been missing.
A new rethink — sugars, of all things
While I was reading and re-reading, something curious was happening across cardiology. The SGLT2 inhibitor trials began producing major reductions in heart attacks and deaths — not just in diabetics, but in patients without diabetes too. Then came the GLP-1 mimetics, with even more striking results.
What on earth was going on? How were drugs originally designed to lower blood sugar cutting cardiac events in people whose blood sugar was normal? It required a complete rethink. Cardiologists who had spent their careers focused on cholesterol, blood pressure and stents were suddenly having to learn about glucose, insulin and inflammation.
The 'jacket potato moment' was part of that rethink. I put a continuous glucose monitor on myself and had what I considered a healthy lunch. My blood sugar went up to 13 mmol/L. My follow-up HbA1c was in the pre-diabetic range. So were all of my sisters'. So was a significant proportion of the patients we then offered the test to — many with normal standard blood work and "well-controlled" cholesterol, but with arteries that were quietly on fire.
The lightbulb moment
The final piece fell into place from an unexpected direction. While working on a men's health project around prostate cancer screening, I came across the Icelandic study on visceral adipose tissue — VAT, the hidden fat that wraps around the liver, pancreas and intestines. The findings showed a striking link between high VAT and aggressive, late-stage prostate cancer.
That was the lightbulb moment. Suddenly, the dots connected.
VAT was the common thread behind so much of what I had been seeing in my clinic: fatty liver, coronary inflammation, the link between weight and blood pressure, insulin resistance, small dense LDL, even heart failure. It explained why men develop coronary disease earlier than women — and why post-menopausal women catch up so quickly once their protective fat distribution shifts to the middle.
It was not just a heart problem. It was the master switch behind much of midlife disease — and nobody had been measuring it. So we built a low-dose CT protocol to do exactly that, and started screening for it routinely.
The clinic today
Walk into my clinic now and you are more likely to see a tape measure draped around a nurse's neck than a stethoscope.
That small symbol represents a quiet revolution — and the VAT Trap book series is the story of how we got here, and how you can use the same tools to escape the trap yourself.
HOW TO USE THIS SITE
Three pathways. Pick whichever fits where you are.
Whether you want to read the science, measure yourself at home, or take the framework to your own clinician — start where it makes sense to you.
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A note on commercial interests: I founded Surrey Cardiovascular Clinic (SCVC) in 2006 and remain its majority shareholder (51%). I also own and direct Virtual Cath Lab Surrey Ltd, the CT provider used by SCVC and by referring cardiologists. My company Medicalspace Ltd holds the VAT-TRAP book rights and operates this website. Full Disclosures.
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