Heart & blood pressure

Get ApoB or LDL-C measured; it's cheap and it moves decisions. The relationship to heart disease is causal, log-linear, and cumulative — lower and earlier is better. Lifestyle moves it somewhat; when risk is high, medication moves it decisively, and that's a clinician conversation, not a supplement one.

In this stackMeasure ApoB (or LDL-C). It's causal and cumulative — lower and earlier is better.

Measure it — properly, more than once. Guidelines now flag ≥130/80. In high-risk adults, driving systolic below 120 cut cardiovascular events about 25% and deaths about 27% in a major trial. Lifestyle helps; when it's not enough, medication is effective and worth it.

In this stackKnow it from several proper readings; target roughly <130/80 with a clinician.

Eat mostly minimally-processed food, get enough protein and fiber, and let total energy intake match whether you want to lose, hold, or gain. The specific named diet matters far less than sticking to a decent pattern — adherence beats ideology, every time.

In this stackA Mediterranean-style pattern has the best cardiovascular trial evidence of any diet.

Accumulate easy aerobic minutes most weeks — conversational-pace Zone 2 — and add one or two harder sessions once the base is there. Going from low to even moderate fitness is the biggest mortality dividend in this entire guide, and it's mostly boring, repeatable volume.

In this stackCardiorespiratory fitness is a powerful, independent predictor of survival.

The idea that light drinking protects your heart was largely an artifact of comparing drinkers against a sicker mix of non-drinkers. Better-designed analyses — genetic (Mendelian randomization) studies and bias-corrected meta-analyses — find no mortality benefit at low intake and clear harm as intake rises. Alcohol is a Group 1 carcinogen and raises blood pressure. There's no safe level that improves health, and less is unambiguously better. The action here is simple: drink less.

In this stackNo amount improves cardiovascular health; less is better.

Subtraction.

High-sensitivity CRP measures background inflammation and nudges your cardiovascular risk estimate up or down at the margins. It's most useful when a treatment decision is borderline. It's non-specific — infections, injury, and obesity raise it too — so read it as one input, not a verdict.

In this stackOnly when a treatment decision is genuinely on the fence.

For a general healthy adult, ordinary fish-oil supplements show little to no effect on heart disease or death in large trials. Eating fish is still reasonable. The impressive 25% risk-reduction headline came from a high-dose prescription drug in a specific high-triglyceride population — don't generalize it to the capsules at the pharmacy.

In this stackGeneral fish-oil is near-null; high-dose prescription icosapent ethyl is for specific high-triglyceride patients.

For anyone with cardiovascular disease or high enough risk, statins are among the best-evidenced interventions in medicine: every ~1 mmol/L drop in LDL cuts major vascular events by about 21%, year after year. The muscle-symptom fear is mostly real but mostly not the drug. The diabetes signal is real but small. Whether you're a candidate depends on your absolute risk — a conversation for you and a clinician.

In this stackThe workhorse. Lowers LDL and events with strong evidence; a clinician decides by your absolute risk.

Ezetimibe is the reliable second-line lipid drug: one cheap daily pill, few side effects, and — proven in a large outcomes trial — modest additional LDL lowering that translates into fewer cardiovascular events on top of a statin. The added benefit is real but incremental. It's most useful when a statin alone leaves LDL too high, or when someone can't tolerate a full statin dose. A clinician's call.

In this stackAdds to a statin when LDL isn't low enough, or when statins aren't tolerated.

PCSK9 inhibitors are the heavy artillery of LDL lowering: a twice-monthly injection that cuts LDL by around 60% on top of a statin and, in two large trials, meaningfully reduced cardiovascular events. Safety looks reassuring even at very low LDL. The catch is cost and access — they're reserved for people at high risk who need more than statins and ezetimibe can deliver. Very much a clinician's, often a specialist's, call.

In this stackInjectables that drive LDL very low for high-risk patients; cost and access are the limits.

If you've already had a cardiovascular event, daily low-dose aspirin has a clear net benefit. If you haven't, the modern trials showed the bleeding risk roughly cancels out the benefit for most people — which is why guidelines walked the recommendation back. Do not start or stop aspirin on your own; it's a genuine risk-benefit call for a clinician.

In this stackValuable after an event; usually not worth the bleeding risk for primary prevention.