Why We’re Missing the Mark on Heart Disease Prevention
Reviewed By Jennifer Chung, MD
One of the most unsettling things about cardiometabolic disease is how often it shows up without warning.
Studies of U.S. populations show that about 33% of deaths from heart disease are due to sudden cardiac death, or death occurring within an hour after the onset of symptoms. What is more disconcerting is that about 63.5% of sudden cardiac deaths happened in people who did not have a previous diagnosis of heart disease. In other words, for many people, the first sign of a problem is a major event.
Coronary heart disease does not happen suddenly, but rather a result of a long and quiet process. So why are more people not diagnosed with it?
The Limits of Conventional Screening
In a typical primary care setting, cardiovascular risk assessment is often limited to:
A brief visit
A standard lipid panel
Hemoglobin A1c
Possibly a marker like C-reactive protein (CRP)
A 10-year risk estimate using tools such as the Framingham Risk Score
While these tools are helpful at a population level, they can miss important nuances in individual risk.
This is not due to lack of care or expertise. It is a reflection of the current healthcare system:
Visits are short
Preventive care is often under-reimbursed
Physicians are forced to prioritize acute concerns over deep risk assessment
Unfortunately, many patients are categorized as “low risk” without a more thorough and individualized assessment.
Moving Beyond One-Size-Fits-All Risk
Cardiometabolic disease is complex and multifactorial. Two individuals with the same cholesterol level may have vastly different risk profiles depending on genetics, inflammation, metabolic health, and early vascular disease.
Today, we have the tools to assess risk far more precisely.
Advanced Biomarkers
Beyond a standard lipid panel, deeper insights can come from:
ApoB (a more accurate measure of atherogenic particles)
Lipoprotein(a)
Other emerging lipoprotein markers such as sdLDL-C
Insulin levels and markers of insulin resistance
Inflammatory markers beyond hs-CRP
Imaging for Early Detection
We can now visualize disease before symptoms arise:
Coronary artery calcium (CAC) scoring
Carotid intima-media thickness (CIMT)
Advanced vascular imaging
These tools help answer a critical question:
Is disease already present—even if standard labs look “normal”?
Genetic Risk
Polygenic risk scores are an emerging area that can:
Identify inherited susceptibility
Help guide earlier or more aggressive prevention strategies
What Personalized Prevention Looks Like
Personalized, functional, and lifestyle medicine allows for a deeper, more meaningful evaluation of cardiometabolic health.
This includes:
A comprehensive review of traditional and advanced biomarkers
Thoughtful use of imaging when appropriate
Consideration of genetic predisposition
Evaluation of lifestyle factors including nutrition, sleep, stress, and physical activity
Ongoing monitoring at intervals tailored to the individual—not just once a year
Just as importantly, it allows time—time to interpret data, connect the dots, and create a strategy that is both evidence-based and realistic.
From Reactive to Proactive Care
The goal is not simply to treat disease once it appears, but to identify risk years—if not decades—earlier.
A more personalized approach to cardiometabolic health isn’t about doing more testing for the sake of it. It’s about using the right tools, in the right context, with enough time to actually interpret what they mean.
If you’re someone who wants a clearer understanding of your risk—and a plan that goes beyond “we’ll recheck next year”—this is exactly the kind of work I focus on in my practice.
If this approach resonates with you, you can learn more about working together here.
