Facial Foundational Model Advances Early Warning of Coronary Artery Disease from Live Videos with DigitalShadow

Abstract--Global population aging presents increasing challenges to healthcare systems, with coronary artery disease (CAD) responsible for approximately 17.8 million deaths annually, making it a leading cause of global mortality . As CAD is largely preventable, early detection and proactive management are essential. In this work, we introduce DigitalShadow, an advanced early warning system for CAD, powered by a fine-tuned facial foundation model. The system is pre-trained on 21 million facial images and subsequently fine-tuned into LiveCAD, a specialized CAD risk assessment model trained on 7,004 facial images from 1,751 subjects across four hospitals in China. DigitalShadow functions passively and contactlessly, extracting facial features from live video streams without requiring active user engagement. Integrated with a personalized database, it generates natural language risk reports and individualized health recommendations. With privacy as a core design principle, DigitalShadow supports local deployment to ensure secure handling of user data. The world's population is rapidly ageing [1], with significant implications for the prevalence of chronic diseases such as Coronary Artery Disease (CAD) [2], affecting not only individuals but also families and societies at large [3]. The number of older people is increasing at an unprecedented rate, projected to grow from approximately 761 million in 2021 to 1.6 billion by 2050, which would represent nearly 16% of the global population, according to the UN's W orld Social Report 2023 [4]. The aging population presents numerous challenges, including increased pressure on healthcare systems, pension schemes, and long-term care facilities, alongside potential economic consequences, which together fuel growing demand for healthcare services [5], [6]. With advancing age, people become more vulnerable to various critical diseases [7], such as CAD [8], stroke [9], cancer [10], and Parkinson's disease (PD) [11], [12], [13], leading to considerable morbidity and mortality [14].