Prevention vs treatment

Modern medicine is extraordinary at fixing things that break. If you have a heart attack, a broken hip or a severe infection in Europe today, your chances of surviving are better than at any point in history. But most healthcare systems are built to react to disease once it has appeared. Longevity health asks a different question: how do we stop it from appearing in the first place?

Neither approach is better. You need both. But understanding the difference changes how you use your doctor, your tests and your time.

Two approaches, side by side

Disease starts long before diagnosis

Most chronic diseases develop silently for years before anyone gives them a name.

• Heart disease. A Spanish study of more than 4,000 office workers aged 40–54, none with symptoms, found that around 63% already had plaque in their arteries. Atherosclerosis often begins in early adulthood.
• Type 2 diabetes. Insulin resistance can build for a decade or more while fasting blood sugar still looks normal. By the time glucose rises into the diabetic range, much of the underlying damage has been done.
• Dementia. The brain changes behind Alzheimer's disease begin 15–20 years before memory problems appear.
• Cancer. Many cancers take years to grow from the first abnormal cells to a detectable tumour, which is exactly why screening works.

The later you act, the more you're managing damage rather than preventing it.

"Normal" is not the same as "optimal"

When a lab report says your result is "within range", it usually means you fall inside the middle 95% of a reference population. That population includes many people who are overweight, inactive and on their way to disease. Normal describes what's common, not what's healthy.

Two examples:

• An HbA1c of 5.6% is "normal". It's also close to the prediabetes threshold of 5.7%, and a sign worth acting on.
• An LDL cholesterol result may be flagged as fine for the average person, while the level linked with the lowest long-term heart risk is lower, particularly if you have other risk factors.

This isn't a criticism of doctors. Reference ranges are designed to catch disease, not to define peak health. The Testing & tracking chapter gives the targets this course uses at each level.

The three levels of prevention

Public health describes prevention in three stages:

1. Primary prevention stops disease from starting: not smoking, exercise, a healthy weight, vaccinations.
2. Secondary prevention catches disease early, before symptoms: blood pressure checks, blood tests, cancer screening.
3. Tertiary prevention limits the damage of disease you already have: cardiac rehabilitation, diabetes management.

Most healthcare spending goes on the third. EU countries spend only around 3% of their health budgets on prevention. Longevity health means doing much more of the first two, earlier.

Use what's already free

Before paying for anything, make sure you're using the prevention your health system already offers. National screening programmes for bowel, breast and cervical cancer are free across most of the EU and have strong evidence behind them. Take the invitation when it comes. Stay up to date with vaccinations, including flu and, at the recommended ages, shingles and pneumococcal vaccines.

The traps of doing too much

Longevity health has its own risks. Testing everything, all the time, can lead to false alarms, unnecessary follow-up procedures and anxiety. Whole-body MRI scans, for example, frequently find harmless abnormalities that lead to further tests. More data is only useful if it changes what you do. That's why this course uses levels: cheap and high-value tests first, expensive and uncertain ones only when the basics are sorted.

Working with your doctor

Your doctor is your most important partner, not an obstacle. A few ways to get more from appointments:

• Bring your numbers and your trend, not just today's reading.
• Ask "what's my 10-year risk of heart disease?" and "what would lower it?"
• Ask whether your Lp(a) has ever been measured. It's largely genetic, it's a significant independent risk factor for heart disease, and European guidelines recommend testing it at least once in every adult's life.
• Mention your family history, especially heart disease, cancer, diabetes or dementia in close relatives.
• If something is "borderline", ask what you could do now, rather than waiting for it to become a diagnosis.

Key numbers
~63%: symptom-free 40–54-year-olds with plaque in their arteries in one large study.
~3%: share of EU health spending that goes on prevention.
Once: how often most adults need an Lp(a) test.

This week

• Check whether you're up to date with your country's cancer screening programmes and vaccinations.
• Find your last blood test and look for any result marked "normal" that sits near the edge of its range.
• Ask your doctor, at your next appointment, whether your Lp(a) has been measured.

In the journal

The journal is a prevention tool. Every evening page is primary prevention, done in ten boxes.

Sources: Fernández-Friera et al., Circulation 2015 · Kronenberg et al., European Atherosclerosis Society consensus on Lp(a), European Heart Journal 2022 · OECD/European Commission, Health at a Glance: Europe · Jack et al., Lancet Neurology 2013