Diseases & Longevity · File 04

Ischemic heart disease. 90% of risk is modifiable.

It remains the #1 cause of global death and the main contributor to prolonged disability in high-income countries. And simultaneously, it is the chronic disease with the strongest modifiable-risk attribution in all cardiovascular medicine: the INTERHEART study (Yusuf, Lancet 2004) demonstrated that 9 factors explain 90% of acute myocardial infarction risk globally.

The CV risk paradigm — and why LDL-C is not enough

Todern lipidology no longer settles for LDL-C. The measure that best predicts coronary events is the number of atherogenic particles, measured as ApoB (apolipoprotein B) or as LDL-P (LDL particle number by ion mobility). A patient can have normal LDL-C and elevated ApoB — that discordance, called 'discordant ApoB,' is a high-risk situation traditional lipid panels miss.

The INTERHEART study (Yusuf et al., Lancet 2004, n=15,152 cases + 14,820 controls, 52 countries) identified nine factors explaining 90% of MI risk: dyslipidemia (ApoB/ApoA1 ratio), smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, low fruit and vegetable intake, physical inactivity, and regular alcohol consumption. Elevated Lp(a) — a genetic factor — adds independent risk and is measured once in a lifetime.

90% of heart attack risk is explained by 9 factors that can be measured and worked on. What's missing is not the evidence — it's putting it into practice before the event.
Yusuf et al. · Lancet · 2004 · INTERHEART

Factors that explain 90% of global MI risk

INTERHEART is the largest case-control study on MI risk factors. 30,000 participants, 52 countries, 6 continents. Its conclusion defined the modern CV prevention framework.

  • Dyslipidemia (ApoB/ApoA1)

    OR 3.25 · top driver

    The ApoB/ApoA1 ratio was the factor with highest odds ratio in INTERHEART. ApoB quantifies atherogenic particles; ApoA1 the protective ones. The modern measure of lipid risk.
    — Yusuf et al., Lancet 2004

  • Smoking

    OR 2.87

    Second strongest factor. Danish cohort: active smoking = −3.20 years (M) / −3.74 years (W) of disease-free life.
    — Yusuf 2004; Eriksen 2025

  • Elevated Lp(a)

    Factor genético independiente

    Lp(a) >50 mg/dL (~20% of population) doubles CV risk independently of LDL-C. Measured once in a lifetime — genetically determined. Identifies risk invisible to classic profile.
    — Tsimikas Circulation 2017; ESC guidelines 2019

  • Habits · full score

    +7 años LE

    5 healthy habits (no smoking, healthy BMI, physical activity, diet, moderate alcohol) = 12–14 more years of LE in US (Li 2018 Circulation, NHS cohorts).
    — Li et al., Circulation 2018

Chap. 03 · Global mortality and disability

The cost when the event arrives

After an MI, trajectory changes. Cardiovascular longevity medicine focuses on avoiding the first event — because the second is statistically worse.

  • Pre-hospital mortality

    ~30% IAM

    Approximately 30% of heart attacks die before reaching hospital. Primary prevention remains, by far, the highest-yield intervention in cardiology.
    — GBD 2019

  • 5-year survival

    50–60% · >65 años

    5-year survival post-MI in over-65: 50–60%. Each subsequent event worsens prognosis non-linearly.
    — GBD 2019

  • Post-MI depression

    15–30% incidencia

    15–30% of survivors develop clinical depression post-event. Untreated depression worsens CV prognosis and multiplies second-event risk.
    — GBD 2019

  • Global burden

    Top 1 muerte y discapacidad

    #1 global cause of death (2019, GBD) and top 1 contributor to prolonged disability in Scandinavia, UK, and US alongside dementia.
    — GBD 2019; Eriksen 2025

What we don't do — and what we do

Wellness Care does not substitute the cardiologist. Diagnosed ischemic heart disease, complex pharmacological management, revascularization decisions, post-MI management — that belongs to the cardiologist, and that is how it should be. Cardiovascular longevity medicine operates in the space before established coronary disease diagnosis.

What we do: evaluate the advanced lipid profile modern cardiology asks for but rarely applies in general consultation — ApoB, Lp(a), LDL-P, small dense particles; inflammaging (hsCRP, IL-6); insulin sensitivity; intracellular metabolic profile; microbiota. On that map we identify the 9 INTERHEART factors applicable to each patient and design an individualized primary prevention protocol under medical judgment.

If your cardiologist only orders a standard lipid panel, they are using cardiology from 20 years ago. Modern lipidology asks for ApoB and Lp(a).
How we measure it

The layers of advanced cardiovascular
risk assessment

Before talking about statins, ezetimibe, or PCSK9: we measure the markers that actually predict events.

Advanced biomarkers

21 specialized panels across 8 clinical categories — biological age, inflammaging, metabolic profile, functional hormonal, microbiota. The quantitative layer.

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Functional medicine

Shared root causes — mitochondrial dysfunction, inflammaging, neuroendocrine dysregulation — before organ pathology.

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Bioregulatory medicine

Autonomic regulation, HRV, stress response. The functional trajectory that precedes clinical diagnosis.

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The Longevity Program

How this assessment integrates into the full program — from initial valuation to individualized protocol design under medical judgment.

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Featured evidence

The papers that structure
modern CV prevention

Three publications that quantify the modifiable window of coronary disease.

"Nine modifiable risk factors account for 90% of the population-attributable risk of acute myocardial infarction worldwide (52 countries, 30,000 participants)."
INTERHEART · 52 países
Yusuf et al.
The Lancet · 2004
"Adoption of five low-risk lifestyle factors at age 50 was associated with 14 (women) and 12 (men) additional life-years free from cancer, CVD, and T2D."
Cohortes US · 33 años
Li et al.
Circulation · 2018
"Ischemic heart disease was the #1 cause of death and #1 contributor to prolonged disability in Scandinavia, UK, and US in 2019."
WHO GHE · cohorte Danesa
Eriksen et al.
Scientific Reports · 2025

Frequently asked questions about ischemic heart disease

The most recurrent questions about advanced CV biomarkers, INTERHEART's 9 factors, and why modern lipidology asks for more than LDL-C.

01

Why is ApoB better than LDL-C for predicting CV risk?

ApoB quantifies the number of circulating atherogenic particles (each LDL, IDL, and VLDL carries one ApoB molecule), while LDL-C measures only cholesterol contained in LDL particles.

A patient can have normal LDL-C with many small dense particles (elevated ApoB) — high-risk situation invisible to traditional profile.

Sniderman et al. demonstrated in 2019 (JAMA Cardiol) that ApoB is superior to LDL-C and non-HDL-C as event predictor.

02

What is Lp(a) and why measure it only once?

Lp(a) is a lipoprotein structurally similar to LDL but with an additional apoprotein (apo(a)) conferring thrombogenic and atherogenic properties.

Its levels are ~90% genetically determined and stable throughout life — that is why it is measured once.

Lp(a) >50 mg/dL affects ~20% of the population and doubles CV risk independently of LDL-C.

ESC 2019 recommends measuring at least once in every adult.

03

What are INTERHEART's 9 factors?

Yusuf et al. (Lancet 2004) identified in 30,000 participants from 52 countries:

1. ApoB/ApoA1 ratio
2. Smoking
3. Hypertension
4. Diabetes
5. Abdominal obesity
6. Psychosocial factors (stress, depression)
7. Low fruit and vegetable intake
8. Physical inactivity
9. Regular alcohol consumption

Together they explain 90% of population-attributable MI risk.

04

Does Wellness Care prescribe statins or PCSK9?

We do not prescribe cardiovascular pharmacotherapy as the main route.

Decisions on statins, ezetimibe, or PCSK9 inhibitors belong to the cardiologist or general internist per applicable ESC/AHA guidelines.

Wellness Care identifies the advanced risk profile (ApoB, Lp(a), LDL-P, inflammaging), builds an individualized map, and coordinates with the specialist when pharmacological indication exists.

Our target is advanced primary prevention: optimizing metabolic, lipid, and inflammatory profile through non-pharmacological interventions and evidence-based supplementation.

05

What is hsCRP and why does it matter for CV risk?

hsCRP (high-sensitivity C-reactive protein) is a marker of low-grade systemic inflammation.

Elevated levels predict CV events independently of lipid profile. The JUPITER study (Ridker 2008 NEJM) demonstrated that patients with normal LDL-C but hsCRP >2 mg/L benefit from statins.

In longevity medicine, hsCRP is one of the central markers of 'inflammaging' — chronic low-grade inflammation associated with biological aging.

06

At what age should I start measuring my advanced CV profile?

Modern preventive cardiology suggests:

· Lp(a) at least once in every adult from age 20 (it is genetic and does not change).
· Advanced lipid profile (ApoB, LDL-P) and inflammaging markers (hsCRP, IL-6) from ages 30–40.
· Especially with family history of early MI (<55 in men, <65 in women).

Before the first event is where intervention changes trajectory. After is damage management.

The 90%-modifiable medicine

90% of heart attack risk is explained by 9 factors that can be measured. Cardiovascular longevity medicine is not magic — it is what modern cardiology should be doing and rarely does in general consultation.

Measure ApoB, Lp(a), LDL-P, inflammaging, and the 9 INTERHEART factors before the first event, intervene under indexed evidence, coordinate with the cardiologist when pharmacological indication exists — that is serious primary prevention.

Family history of heart attack?

Book an advanced cardiovascular assessment

We evaluate advanced lipid profile (ApoB, Lp(a), LDL-P, small dense particles), inflammaging (hsCRP, IL-6), insulin sensitivity, microbiota, and INTERHEART's 9 modifiable factors. If you have family history of early MI, dyslipidemia, or want to understand your real risk — this is what we do.

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