Rethinking Heart Health: Peter Attia's Approach to Longevity

How Peter Attia's bestselling book "Outlive", changes the way we Look at Cardiovascular Health: through the lens of advanced biomarkers. Knowledge is power.

Peter Attia, MD, a renowned longevity expert, opens up about his personal connection with heart disease in his book "Outlive". Driven by a family history of early cardiovascular events, Attia embarks on a relentless quest to unlock the secrets of heart health. This journey uncovers crucial insights, challenging traditional approaches and emphasizing proactive disease prevention.

Mito Health shares this philosophy. By offering advanced biomarker testing, we provide individuals with a deeper understanding of their unique cardiovascular health – extending beyond conventional testing. This aligns with Attia's approach in "Outlive," where he advocates for a comprehensive, personalized assessment of risk factors to empower individuals to take control of their health.

This blog post explores the groundbreaking revelations from "Outlive," focusing on how it revolutionizes the way we look at cardiovascular disease management.


  1. LDL-C is limited: Traditional "bad" cholesterol levels don't tell the whole story about heart disease risk.
  2. ApoB matters: A high number of cholesterol-carrying particles (apoB) is a more accurate predictor of potential plaque buildup.
  3. Inflammation is key: Chronic inflammation damages blood vessels, setting the stage for cholesterol buildup and heart disease.
  4. Advanced tests reveal more: Beyond standard labs, tests like Lp(a) and coronary calcium scans uncover hidden risk factors.
  5. Knowledge is power: Knowing your specific cardiovascular risks allows for targeted lifestyle shifts and proactive prevention

Beyond LDL-C: Why Traditional Heart Health Markers Fall Short

  • "Bad" Cholesterol and Its Role: LDL-cholesterol, often referred to as "bad" cholesterol, measures the amount of cholesterol being carried in specific lipoproteins (a protein-fat complex) that carries cholesterol throughout the body. Cholesterol itself is a waxy substance essential for various bodily functions, including hormone production and cell membrane health.
  • However, when LDL levels become elevated, excess cholesterol can accumulate in the walls of our arteries. Over time this buildup forms fatty deposits called plaque. In some cases, plaque can harden and narrow the arteries, a condition known as atherosclerosis. This narrowing reduces blood flow to the heart and other organs, significantly increasing the risk of heart attack, stroke, and peripheral artery disease (PAD).
  • The Limits of LDL-C: It's important to note that not all LDL is created equal.  LDL-C measurements only tell us the total amount of LDL cholesterol, not the size or composition of the LDL particles. Smaller, denser LDL particles can more easily squeeze through the arterial lining, contributing to plaque formation. Additionally, LDL levels can be misleading -  some people with low LDL-C still develop heart disease, while others with high LDL-C remain plaque-free.

It's important to note that cholesterol isn't inherently bad. In fact, our bodies need LDL-cholesterol to function properly. However, the problem arises when LDL-C levels become excessively high. Here's where the limitations of LDL-C testing come in. 

Research indicates that the size of LDL particles (whether small and dense, or large and fluffy) may not significantly impact overall cardiovascular risk. While smaller particles mean more circulating LDL "cargo ships", each one carries less cholesterol. Conversely, larger particles are fewer in number but deposit more cholesterol per particle. This seems to create a balance in overall risk.  As a result, testing for LDL particle density may not be as clinically useful. Instead, focusing on ApoB concentration, which reflects the total number of circulating LDL particles, provides a more reliable indicator of potential cardiovascular disease risk.

  • ApoB's Importance: Apolipoprotein B (apoB), a protein attached to cholesterol-carrying particles, is a far more accurate predictor of cardiovascular risk. Here's an analogy: 
  • Imagine LDL cholesterol as packages of cargo being transported throughout the body, and apoB as the unique shipping labels on each package. The more packages circulating (higher apoB level), the greater the risk of them accumulating and causing a blockage in our arteries, leading to atherosclerosis.

Heart Health and Inflammation

  • The Hidden Killer: Chronic inflammation is like a silent saboteur of cardiovascular health. "The endothelial barrier, in particular, is uniquely vulnerable to damage from inflammation," says Attia. Imagine your blood vessels as smooth highways; inflammation roughens their surface, creating 'potholes' where cholesterol particles (the metaphorical cars) are more likely to get stuck, initiating the process of atherosclerosis.
  • CRP and Other Markers: In addition to LDL-C, other blood tests can provide valuable insights into underlying inflammatory processes that contribute to cardiovascular risk. High-sensitivity C-reactive protein (hs-CRP) is a particularly useful marker. Elevated hs-CRP levels indicate low-grade inflammation throughout the body, potentially increasing the risk of not only heart disease but also other chronic conditions. Beyond hs-CRP, advanced testing may include panels that measure various inflammatory markers, creating a more comprehensive picture of your individual inflammatory profile

The Power of Advanced Testing

  • Lp(a): Lipoprotein(a), or Lp(a), is a modified form of LDL with a unique 'sticky' structure. Attia describes the dangers of Lp(a): "As the LDL particle passes through the bloodstream, Lp(a)  scoop up bits of oxidized lipid molecules and carry them along. Because of its structure, Lp(a) may be even more likely than a normal LDL particle to get stuck" within blood vessel walls.
  • Importantly, the number of Lp(a) particles you have is primarily determined by your genes and isn't easily altered by medications or lifestyle changes. That's why some cardiology societies recommend testing your Lp(a) levels once in your life – the results are unlikely to change significantly. Having genetically elevated levels of Lp(a) increases your risk of heart attack, stroke, and heart valve issues like aortic sclerosis.
  • CAC Score + More: Coronary artery calcium (CAC) scores go beyond cholesterol numbers. This non-invasive test uses specialized X-rays to detect the presence and amount of calcium buildup in your coronary arteries. The presence of calcium indicates the formation of plaque, a hallmark of atherosclerosis. A higher CAC score suggests a greater risk of future cardiovascular events like heart attack or stroke.

However, CAC scores are just one piece of the puzzle. Other advanced tests can provide even more granular insights into your cardiovascular health by visualizing the extent and composition of plaque buildup. Tests that measure the health and elasticity of your arteries offer additional clues. By combining these advanced tests with traditional cholesterol panels and inflammatory markers, healthcare professionals get a comprehensive risk assessment for targeted preventative strategies.

From Knowledge to Action

"Outlive" highlights how a deep understanding of your unique risk factors allows for personalized, preventative plans involving optimized lifestyle changes:

  • Dietary Interventions: If tests reveal elevated apoB, triglycerides, or markers of inflammation, Attia advocates for dietary shifts, reducing processed carbohydrates and prioritizing whole, nutrient-dense foods for better blood sugar balance and inflammation control. Many people also see an apoB reduction by limiting saturated fat – though individual results can vary, highlighting the need for personalized testing.
  • Focus on whole, nutrient-dense foods for better blood sugar balance and inflammation control. Many people also see beneficial apoB reductions by limiting saturated fat – though individual results can vary. 
  • Stress Management: Chronic stress worsens cardiovascular health. Attia emphasizes techniques like mindfulness, meditation, and prioritizing restorative sleep to reduce stress and improve inflammatory markers like hs-CRP.
  • Targeted Supplements: Based on specific biomarker findings, supplements may be beneficial. Fish oil (or purified EPA) can lower triglycerides and hs-CRP. Vitamin K2 and magnesium could be considered in individuals whose testing suggests suboptimal levels, as both vitamins and minerals play roles in cardiovascular health.

A Proactive Health Approach: "It’s not as if they were about to have heart attacks. The atherosclerotic process moves very slowly”  Attia writes. Early detection is crucial! By knowing your risk early on, you can implement proactive strategies. Over time, this aims to lower negative biomarkers (apoB, Lp(a), inflammatory markers), slow or prevent the progression of atherosclerosis, and ultimately reduce your long-term risk of heart disease.

In Conclusion

Mito Health's philosophy mirrors the approach highlighted in Peter Attia's "Outlive". It's the belief that comprehensive biomarker testing provides invaluable insights for understanding your cardiovascular health, even when traditional metrics look normal. This knowledge is power. Understanding your biomarker profile grants you agency in your health journey, allowing for personalized, preventative strategies. Through this approach, you not only add years to your life, but crucially, add more life to those years.

Ready to unlock a deeper understanding of your cardiovascular health? Sign up for Mito Health's flagship biomarker package today.  This comprehensive panel includes crucial tests like ApoB and hs-CRP,  going beyond traditional cholesterol metrics that could better reveal your true cardiovascular risk. Take charge of your health – it's a pivotal step towards proactive health management and a vital investment in a longer, healthier life.

  • Attia, P. (2023). Outlive: Your path to longevity. Simon & Schuster.
  • Sniderman, A.D., Thanassoulis, G., Glavinovic, T., Navar, A.M., Pencina, M., Catapano, A., Ference, B.A. (2019). Apolipoprotein B Particles and Cardiovascular Disease: A Narrative Review. JAMA Cardiology, 4(12), 1287-1295.
  • Nordestgaard, B.G., Chapman J.M., Ray, K., Borén, J., Andreotti, F., Watts, G.F., Ginsberg, H., Amarenco, P., Catapano, A. Descamps, O.S., Fisher, M., Kovanen, P.T., Kuivenhoven, J.A., Pella, D., Sever, P.S., Taskinen, M-R., Tokgözoglu, L., Tybjærg-Hansen, A., and European Atherosclerosis Society Consensus Panel. (2013). Lipoprotein(a) as a cardiovascular risk factor: current status. European Heart Journal, 31(23), 2844-2853.
  • Ridker, P.M. (2003). Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation, 107(3), 363-369. 
  • Khera, A.V., Everett B.M., Caulfield, M.P., Hantash, F. M., Wohlgemuth, J., Ridker, P.M., Mora S. (2013). Lipoprotein(a) Concentrations, and Residual Vascular Risk. The New England Journal of Medicine, 369(24), 2272-2283.
  • Blaha, M.J., Cainzos-Achirica, M., Greenland, P., McEvoy, J.W., Blankstein, R., Budoff, M.J., ... & Agatston, A.S. (2016). Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: the multi-ethnic study of atherosclerosis (MESA). Circulation, 133(9), 849-858.
Written By
Gabriel Sim
April 19, 2024
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