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Table of Contents

Why heart health determines how long you live
ApoB and Lp(a): the biomarkers that actually matter
Blood pressure: lower is better, earlier is better
Heart-healthy diet: what the evidence supports
Building a proactive screening strategy

Why heart health determines how long you live

Heart disease is the leading cause of death worldwide, killing roughly 17.9 million people each year. But here's what matters for anyone thinking about longevity: cardiovascular disease is largely preventable. A 2024 study in the New England Journal of Medicine followed over 600,000 people across multiple countries and found that the absence of five classic risk factors at age 50 was associated with more than a decade of extra life expectancy compared to having all five ^[1]. That's not a marginal gain. That's an entire additional decade.

The catch is timing. Atherosclerosis, the buildup of lipid-rich plaques inside artery walls, starts in adolescence. It progresses silently for 20 to 40 years before showing up as a heart attack, stroke, or sudden death. By the time symptoms appear, the damage is extensive. Prevention needs to start decades before trouble arrives.

ApoB and Lp(a): the biomarkers that actually matter

Standard cholesterol panels report LDL-C, but that number can miss the real picture. Atherosclerosis is driven by apolipoprotein B (ApoB)-containing particles getting trapped in artery walls. Every LDL, VLDL, and Lp(a) particle carries exactly one ApoB molecule, so ApoB count is a direct measure of how many atherogenic particles are circulating. A 2025 expert consensus from the National Lipid Association confirmed that ApoB is superior to LDL-C for cardiovascular risk assessment, both before and during treatment ^[2].

Lipoprotein(a), or Lp(a), is a separate and independent risk factor. About 20% of people worldwide have elevated levels, and those levels are 70 to 90% genetically determined ^[3]. Lp(a) doesn't respond to lifestyle changes or statins. A single lifetime measurement is enough to know your risk. RNA-targeted therapies like lepodisiran and olpasiran are currently in phase 2 and 3 trials and could offer the first effective treatment for high Lp(a) within the next few years.

Blood pressure: lower is better, earlier is better

Chronic high blood pressure damages artery walls through mechanical stress, accelerating plaque buildup and endothelial dysfunction. The target for cardiovascular longevity is below 120/80 mmHg. Research published in 2024 showed that adults aged 45 to 60 who maintained blood pressure in the lower ranges over 10 years had significantly reduced cardiovascular risk 13 years later and lived approximately four years longer ^[4].

What actually moves blood pressure:

Aerobic exercise lowers systolic blood pressure by 5 to 8 mmHg on average
The sodium-to-potassium ratio matters more than total sodium intake alone
Each kilogram of excess weight lost reduces blood pressure by about 1 mmHg
Sleep deprivation and chronic stress are underappreciated drivers of hypertension

Heart-healthy diet: what the evidence supports

A 2024 meta-analysis of randomized controlled trials found that the Mediterranean diet significantly reduced major adverse cardiovascular events, including both heart attack and stroke ^[5]. The key dietary components backed by strong evidence include omega-3 fatty acids from fish (EPA in particular showed a 17% reduction in stroke risk at higher intake levels ^[6]), polyphenol-rich foods like olive oil and berries, fiber from whole grains and legumes, and minimal ultra-processed food.

Sauna use has also emerged as a cardiovascular intervention with growing evidence. Regular sauna bathing is associated with reduced risk of sudden cardiac death, coronary heart disease, and all-cause mortality, with effects comparable to moderate-intensity exercise on the vascular system.

Building a proactive screening strategy

A longevity-focused approach to heart health starts with knowing your numbers. Get ApoB, Lp(a), and hs-CRP measured alongside standard lipids. A coronary artery calcium (CAC) score provides a direct look at existing plaque burden and improves risk prediction beyond traditional risk factors alone ^[7]. Combine these with regular blood pressure monitoring and metabolic health markers like fasting glucose and insulin. The goal isn't to avoid heart disease reactively. It's to maintain a cardiovascular system that supports high physical performance and cognitive function into your 80s and 90s.

References

Get your ApoB tested, not just LDL

ApoB measures the total number of atherogenic particles in your blood and is a more accurate predictor of heart disease risk than standard LDL cholesterol. Ask your doctor for this test at your next checkup.

pmc.ncbi.nlm.nih.gov

Check your Lp(a) once in your lifetime

Lipoprotein(a) levels are 70-90% genetically determined and don't change with lifestyle. About 20% of people have elevated Lp(a), which is an independent risk factor for heart attack and stroke. One test tells you your lifelong risk.

pubmed.ncbi.nlm.nih.gov

Prioritize the sodium-to-potassium ratio

Instead of just cutting salt, focus on increasing potassium through bananas, avocados, spinach, and beans. The ratio of sodium to potassium matters more for blood pressure control than sodium restriction alone.

pubmed.ncbi.nlm.nih.gov

Combine zone 2 and high-intensity training

Zone 2 cardio (3-5 hours per week at conversational pace) builds your aerobic base and fat-burning capacity. Adding 1-2 sessions of high-intensity intervals per week further improves VO2max, one of the strongest predictors of cardiovascular longevity.

Consider a coronary artery calcium score

A CAC scan uses a low-dose CT to detect calcium deposits in your coronary arteries, a direct measure of existing plaque. It improves risk prediction beyond standard risk factors and can guide decisions about prevention intensity.

www.sciencedirect.com

Resting heart rate as a health metric

A resting heart rate of 50-60 bpm indicates good cardiovascular fitness. Track trends over weeks. Sudden increases may signal overtraining, stress, or illness.

HRV tracking for recovery

Heart Rate Variability (HRV) reflects autonomic nervous system balance. Higher HRV generally means better recovery. Measure first thing in the morning for consistent readings.

What foods are good for cardiovascular health?

The most heart-protective foods include fatty fish (salmon, mackerel, sardines) rich in omega-3 fatty acids, leafy greens, berries, nuts, legumes, whole grains, and extra virgin olive oil. These form the core of the Mediterranean diet, which multiple meta-analyses have shown to significantly reduce heart attacks, strokes, and cardiovascular mortality. Limiting ultra-processed foods, added sugars, and excessive sodium is equally important for maintaining healthy blood pressure and lipid levels.

What is ApoB and why is it better than LDL cholesterol?

ApoB (apolipoprotein B) is a protein found on every atherogenic lipoprotein particle, including LDL, VLDL, and Lp(a). While LDL-C measures the cholesterol content carried by LDL particles, ApoB counts the actual number of particles that can enter artery walls and form plaques. Two people with identical LDL-C can have very different ApoB levels and therefore very different cardiovascular risk. Expert consensus now recommends ApoB as the preferred biomarker for risk assessment.

How can I improve my cardiovascular health?

Start with the basics: 150 minutes of moderate aerobic exercise per week (ideally zone 2 training), a Mediterranean-style diet, not smoking, and maintaining healthy body weight. Beyond that, get proactive with testing: measure ApoB, Lp(a), hs-CRP, and blood pressure. If any values are elevated, work with your doctor on targeted interventions. Sleep quality and stress management are often overlooked but have measurable impact on blood pressure and inflammation.

At what age should I start worrying about heart disease?

Earlier than most people think. Atherosclerotic plaques begin forming in adolescence and grow silently for decades. Getting baseline measurements of ApoB, Lp(a), and blood pressure in your 20s or 30s gives you the longest possible window for prevention. A 2024 study showed that maintaining lower blood pressure between ages 45 and 60 translated to four additional years of life. The earlier you start, the more time compounds in your favor.

Is it ever too late to improve heart health?

No. While earlier prevention yields the best results, improvements at any age reduce risk. Quitting smoking at age 30 adds about 10 years of life expectancy. Starting regular exercise, even in your 60s or 70s, measurably lowers cardiovascular mortality. Cholesterol-lowering medications reduce the risk of second heart attacks even when started after a first event. The cardiovascular system retains remarkable capacity for positive adaptation throughout life.

What is a healthy resting heart rate?

For adults: 60-100 bpm is normal, but lower generally indicates better cardiovascular fitness. Athletes often have 40-60 bpm. Optimal for longevity appears to be 50-70 bpm. Track trends over weeks rather than single measurements. Sudden sustained increases (10+ bpm above baseline) may indicate overtraining, illness, or stress.

What is HRV and how do I improve it?

Heart Rate Variability (HRV) measures the variation in time between heartbeats. Higher HRV indicates better autonomic nervous system balance and recovery capacity. Improve it through: regular Zone 2 cardio, quality sleep, stress management (meditation, breathwork), and avoiding alcohol. Measure first thing in the morning for consistent readings. HRV is highly individual — compare your own trends, not others' numbers.