Can a clean wearable record mean I don't need to see a cardiologist?

No. This is the most important misconception in consumer wearable health monitoring. Excellent wearable data, strong HRV trend, low resting heart rate, consistent sleep duration, measures autonomic function, cardiac rate, and sleep architecture. It does not measure ApoB, coronary artery calcium, left ventricular hypertrophy, valve disease, hypertrophic cardiomyopathy, or the atherogenic particle burden that will determine whether you have a heart attack at 57. The man with the highest HRV in the room can have a CAC score of 380 and an ApoB of 175 mg/dL. The watch did not detect either.

The clinical pathway for a man over 40 with no known cardiac disease who has never been evaluated is not: "my Oura recovery is consistently green, so I'm fine." The pathway is: complete a cardiovascular risk assessment that includes ApoB, Lp(a), hs-CRP, fasting insulin, a home blood pressure series, and at 40+ years of age, a serious consideration of CAC scoring. A CAC score of zero in a man with excellent wearable data and normal biomarkers is genuine, evidence-based reassurance. A CAC score of 280 in the same man is a clinical finding that changes his life, and that no wearable could have predicted. (Blaha et al., JACC, 2016)

Cardiologist's calibrated position, Solid (1) that clean wearable data is not a substitute for cardiovascular risk assessment.

What to do: Use your clean wearable record as a foundation, not a conclusion. Book a cardiovascular panel if you have not had one. The two things together, strong wearable trends and clean biomarkers, are genuine reassurance. One without the other is incomplete.

For the full picture, read What Your Apple Watch Is Trying to Tell You.