The Heart Health Paradox

Ammad Hasan
Basics of Heart Health


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Why is heart disease so prevalent if it is preventable? We identified three problems contributing to this paradox; People don’t know they are personally at risk, people have limited knowledge about the most important atherosclerotic cardiovascular disease (ASCVD) biomarkers, and lack of motivation to reduce risk factors that inhibit heart health progress.

Heart disease remains the leading cause of death worldwide, despite the fact that a staggering 80% of cases are preventable1. The paradox lies in why a condition that can be prevented still claims a life every 33 seconds in the United States.2

In this blog, we will delve into the three biggest problems that hinder people from achieving heart health mastery even when it is extremely preventable and provide steps to take to protect your most vital organ. 

Top Three Reasons

1. People don’t know they are personally at risk

2. People have limited knowledge about the most important atherosclerotic cardiovascular disease (ASCVD) biomarkers 

3. Lack of motivation to reduce risk factors that inhibit heart health progress 

Since the 1950s, cardiovascular disease has been the leading cause of death for Americans… So why hasn't it been resolved? 

If you're like most people, when you receive your lab results after visiting your doctor, you might feel uncertain about how to take appropriate action. For instance, you might notice that your LDL/A1C levels are higher than normal, but you may be unsure how to effectively lower these numbers. You might wonder what specific changes you need to make and how to begin implementing them. Well, you're not alone. This gap of knowledge from results to action has continued America's heart health epidemic….

Let's find out why.

Problem 1→  people don't know they, personally, are at risk today.

About half of all Americans (47%) have at least 1 of 3 key risk factors for heart disease: high blood pressure, high cholesterol, or smoking.3 Understanding the risk factors for heart disease is crucial for prevention. Factors such as high blood pressure, high cholesterol levels, smoking, obesity, diabetes, a sedentary lifestyle, stress, and a family history of heart disease can significantly increase the chances of developing heart problems. Identifying an individual's specific risk factors allows one to take targeted action toward mitigating them.

A Cleveland Clinic Population Study Revealed 4:  

77% of Americans believe that they should start getting their cholesterol tested in their 30s or later. But only 1 in 5 are aware that cholesterol testing should begin in a person's 20s.;

90% of heart disease is due to modifiable/controllable risk factors, only 8% of Americans know that.

Many individuals postpone taking charge of their heart health until after experiencing their first cardiovascular episode, however, by that point, the health damage has already been done, and the effects of heart disease can be irreversible. 

LDL and ApoB, two critical biomarkers for assessing heart health, exhibit a gradual increase in an individual's 20s, 30s, and 40s. A study performed by the American Heart Association stated that the risk of cardiovascular events associated with ApoB particles is greater in younger compared to older individuals.5 As these levels accumulate over time, it can silently progress towards Atherosclerotic Cardiovascular Disease (ASCVD) and pose a heightened risk of early heart attacks. As one ages, elevated levels of LDL and ApoB can place individuals in greater danger of developing ASCVD. However, if an individual finds out they are at risk early by cautiously and consistently monitoring their vital biomarkers, they can avoid the common progression of heart disease as they age. 

The prevention of atherosclerotic-related heart disease lies within anyone's grasp. Individuals possess a significant degree of control when it comes to modifying health behaviors and mitigating the risk factors involved. By taking proactive steps to understand the root causes and adopting healthy lifestyle, one can significantly reduce their chances of developing heart disease.

The answer to achieving optimal heart health is you.

Problem 2 → Limited Knowledge of Atherosclerotic Cardiovascular Disease (ASCVD) Biomarkers

Acquiring knowledge and understanding of key biomarkers pertaining to heart health is crucial information that you should possess. Merely having access to personal health data is insufficient; comprehending its significance and the implications it holds for your body is equally important. By grasping these key cardiovascular biomarkers, individuals can make well-informed decisions regarding their lifestyle, healthcare choices, and overall well-being:

Traditional Screenings Are Not Enough 

Most people have a perception that if they have a low LDL cholesterol which is referred to as "bad" cholesterol, then they shouldn't worry about plaque forming and that they are “heart disease free,”owever, knowing your LDL level is just one tool in accessing your heart health, there are more biomarkers you should know as standard practice. 

Did you know research found that: LDL-C: is an imperfect predictor and many individuals with normal LDL-C levels develop CVD6

Know your ApoB and A1C!

What is ApoB (Apolipoprotein B)? 

ApoB is a protein found on the surface of all plaque-forming cholesterol particles. It is responsible for binding to receptors like LDL and facilitating the transport of cholesterol into cells. Measuring ApoB provides a more accurate assessment of the number of LDL particles in the blood compared to measuring LDL cholesterol alone. The number of particles is directly correlated with potential risk for atherosclerosis which leads to cardiovascular disease (CVD). 

Although ApoB provides valuable insights into heart health, it is currently considered an ancillary test rather than a standard component of an annual lipid panel, and many doctors are still not familiar with it. However, its implications can significantly enhance individuals' understanding of their cardiovascular well-being and should be tested regularly by all individuals.

What is A1C? 

A1C is a test that tells you how your blood sugar has been doing on average for the past two to three months. It measures the amount of glucose (sugar) attached to the protein called hemoglobin in your red blood cells. This test is especially helpful for people with diabetes to keep track of their long-term blood sugar control. It gives you an idea of how well you're managing your blood sugar over time. Elevated A1C levels indicate poor glucose control and an increased risk of developing diabetes-related complications, including atherosclerotic heart disease (ASCVD).

All the above biomarkers of cardiovascular disease can be monitored and controlled. But all require you to know and understand their role early in relation to your heart health. Regular monitoring is essential to gauge progress towards achieving your goal of heart health, as most LDL and ApoB changes can be observed within a 3-4 month timeframe. While many individuals undergo annual testing, maintaining a consistent testing schedule allows us to track improvements and identify specific adjustments needed in our diet, exercise routine, and lifestyle factors. By adopting a proactive approach and testing regularly, we can effectively assess our cardiovascular health and make informed decisions to optimize our well-being.

Learn more about each of the biomarkers, here, and how to get tested.

Problem 3→ Lack of Motivation to Address Risk Factors That Promote Heart Health

Diet and Exercise are the most powerful lifestyle factors to prevent heart disease according to the American Heart Association, Harvard Medical School, CDC, the Mayo Clinic +More 7, 8, 9, 10;

Americans eat dangerous diets: Almost half of U.S. adults, or 46%, have a poor-quality diet as defined by the American Heart Association11

Diet plays a crucial role in maintaining cardiovascular health. By adopting a heart-healthy diet, one can significantly reduce the risk of cardiovascular diseases and promote a healthier heart. However, the American diet falls short of meeting the standards necessary to prevent the promotion of atherosclerosis; instead, it facilitates it. In a study done by the CDC, 12.3% and 10.0% of surveyed adults met fruit and vegetable intake recommendations, indicating a concerning gap in consuming essential nutrients.12 However, ultra-processed foods comprised a staggering 57.9% of energy intake, emphasizing the prevalence of unhealthy dietary choices in the American diet.13

Understanding the impact of dietary choices on our health is crucial, and researchers have identified two dietary patterns that play a key role in shaping our eating habits at a population level— prudent and Western diet. Prudent diets emphasize the consumption of foods like fruits, vegetables, legumes, whole grains, fish, and poultry. These all provide essential nutrients and promote well-being. On the other hand, Western diet is characterized by a high consumption of processed meat, french fries, desserts, sugary beverages, red meat, and high-fat dairy, all of which are proven to have adverse effects on our health due to the high levels of saturated fats, ultra-proccesed foods, and refined carbohydrates .

In a comprehensive meta-analysis of 22 cohort studies, it was discovered that individuals who closely adhered to a prudent diet experienced a remarkably 31% lower risk of atherosclerotic cardiovascular disease (ASCVD) compared to those with the lowest adherence. In contrast, following  Western diet pattern was associated with a worrisome 14% increase in ASCVD risk.14 These findings demonstrate the significant impact that dietary choices can have on our cardiovascular health. Check out our article on the most heart healthiest diet and take a look at some sample recipes. 

Only 28% of adults, regardless of rural-urban classification and region, met the combined aerobic and muscle strengthening guidelines, according to the CDC. 15

Americans are immensely inactive.

Numerous extensive studies have established a clear correlation between increased physical activity and a decreased risk of mortality. Furthermore, regular physical exercise has been found to have a modest positive impact on life expectancy, primarily by significantly reducing the likelihood of developing CVD and respiratory diseases.16

According to Dr. Kerry Stewart, the director of Clinical and Research Exercise Physiology at Johns Hopkins Bayview, “One of the key benefits of exercise is that it helps to control or modify any of the risk factors for heart disease.” Exercise has multiple long-term health benefits, including lowering your blood pressure, lessening your risk of developing diabetes, and helping you maintain healthy body weight, all of which lower your risk of developing cardiovascular disease.17

How You Can Start Being Heart Healthier Today 

Becoming heart-healthy is just like any goal. It takes an action plan with steps, goals, and milestones. It can be infeasible to switch all parts of one's life in one day, however, a gradual plan towards becoming heart healthier will pave the way to a heart-healthier future. Join the Endless Health Heart Health Blog to discover actionable steps, valuable tips, tricks, and expert advice on how to embark on your journey towards better heart health. Each day, strive for that 1% improvement, and gradually foster a healthier lifestyle and a stronger heart.


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2. CDC. Heart disease facts. Centers for Disease Control and Prevention (2023).

3. CDC. Know your risk for heart disease. Centers for Disease Control and Prevention (2023).

4. Wheeler, T. Cleveland Clinic survey: Most Americans don’t know heart disease is leading cause of death in women. Cleveland Clinic Newsroom (2020).

5. Sniderman, A. D. et al. Age and Cardiovascular Risk Attributable to Apolipoprotein B, Low-Density Lipoprotein Cholesterol or Non-High-Density Lipoprotein Cholesterol. J. Am. Heart Assoc. 5, (2016).

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12. Lee, S. H., Moore, L. V., Park, S., Harris, D. M. & Blanck, H. M. Adults Meeting Fruit and Vegetable Intake Recommendations - United States, 2019. MMWR Morb. Mortal. Wkly. Rep. 71, 1–9 (2022).

13. Martínez Steele, E. et al. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open 6, e009892 (2016).

14. Yu, E., Malik, V. S. & Hu, F. B. Cardiovascular Disease Prevention by Diet Modification: JACC Health Promotion Series. J. Am. Coll. Cardiol. 72, 914–926 (2018).

15. Abildso, C. G., Daily, S. M., Umstattd Meyer, M. R., Perry, C. K. & Eyler, A. Prevalence of Meeting Aerobic, Muscle-Strengthening, and Combined Physical Activity Guidelines During Leisure Time Among Adults, by Rural-Urban Classification and Region - United States, 2020. MMWR Morb. Mortal. Wkly. Rep. 72, 85–89 (2023).

16. Nystoriak, M. A. & Bhatnagar, A. Cardiovascular Effects and Benefits of Exercise. Front Cardiovasc Med 5, 135 (2018).

17. Exercise and the heart. (2023).