What are the Four Horsemen of Longevity?
World Health Organization data shows that Singapore is one of the longest-lived societies in the world with an average life expectancy of 83.9 years. The healthy average life expectancy, or the number of years that a person can expect to live in full health, is currently 73.6 years. Both of these numbers have been increasing over the past two decades.
Longevity, however, is not merely restricted to the number of years that a person lives, but to ensure that the number of years are spent in good health, and free from major diseases and disability.
Lifespan: The number of years you live.
Healthspan: The number of years that you live in good health.
The predominant barriers to longevity are chronic diseases.
Dr Peter Attia, a physician and longevity expert, introduced the concept of the “Four Horsemen of Chronic Diseases” – these are the four chronic diseases that are responsible for the majority of morbidity and mortality worldwide.
Cardiovascular disease accounts for around 19 million deaths globally per year.
Cancer accounts for approximately 10 million global deaths per year.
Neurodegenerative disease, such as Alzheimer’s, accounts for 9 million global deaths annually.
Metabolic disease, such as type 2 diabetes and obesity, leads to negative health outcomes in several chronic diseases, making their prevalence hard to calculate. Zooming in on diabetes, this disease alone accounts for roughly 1.5 million global deaths.
Fortunately, these conditions do not arise overnight. Rather, they develop over the years. The emergence of the Four Horsemen can therefore be prevented – or their progression stopped – through proactive measures such as treatments and lifestyle adjustments.
The Importance of Early Detection, Prevention, and Lifestyle Interventions
Early detection and preventive care minimize the impact of these diseases. Some of these diseases have silent precursors, such as high blood pressure, insulin resistance, or mild cognitive decline, which can be addressed before the disease fully manifests in its full-blown stage.
These interventions include proactive health screening, which includes checking blood glucose, cholesterol levels and certain biomarkers to identify early warning signs; adopting a diet that is rich in whole, unprocessed foods reduces inflammation and supports metabolic health; physical activity that includes cardio and strength training; as well as proper stress and sleep management.
Medicine 3.0: Prevention Over Treatment
While traditional medicine focuses on the treatment of diseases once symptoms are apparent, a preventive approach aims to avoid these diseases altogether – or significantly delay their onset.
Dr Attia also advocates for Medicine 3.0, a proactive, personalized approach that emphasizes early, and aggressive prevention over treatment, unlike the conventional reactive medical model (Medicine 2.0). In addition, in Medicine 3.0, healthspan is given at least as much effort and importance as lifespan.
Taking a Closer Look at the Four Horsemen of Longevity
The Four Horsemen – heart disease, cancer, neurodegenerative disease, and metabolic disease – are the biggest threats to one’s healthspan, but they are not inevitable.
The First Horseman: Cardiovascular disease
Cardiovascular disease (or problems that affect your heart) is the most common cause of death in Singapore. This encompasses conditions like heart attacks and strokes, which are often driven by hypertension, high cholesterol, and metabolic dysfunction.
How it Happens
The most common cause of heart disease is narrowing or blockage of the blood vessels that supply blood to the heart – this is called coronary artery disease and this happens gradually over a period of time. Other kinds of heart problems may happen to the valves in the heart, or the heart may not pump well and cause heart failure.
Risk Factors
Risk factors include high blood pressure, high cholesterol, smoking, and lack of exercise. Other risk factors such as your age, race or ethnicity, or family history cannot be controlled.
Diabetes can also contribute to other risk factors for heart disease, such as obesity, high cholesterol, and high blood pressure.
Preventive Measures
Preventive measures include a heart-healthy diet, regular exercise, keeping a healthy weight, managing stress, avoiding smoking and monitoring cholesterol and blood pressure.
The Second Horseman: Cancer
Cancer remains to be a major cause of mortality globally despite advances in treatment.
How it Develops
This is a disease in which some of your cells grow uncontrollably, spreading to other parts of the body. Genetics and lifestyle influence the development of cancer, but it is the lifestyle and environmental factors that play a bigger role in most cases.
Risk Factors
Risk factors for cancer include age, family history, and lifestyle factors such as exposure to cancer-causing substances, chronic inflammation, alcohol, tobacco, and obesity.
Common Types
In Singapore, the most common types of cancers (2017-2021) include:
| Men | No. of Cases | Women | No. of Cases |
|---|---|---|---|
| Prostate | 6,912 | Breast | 12,735 |
| Colon & rectum | 6,697 | Colon & rectum | 5,542 |
| Lung | 5,567 | Lung | 3,388 |
Preventive Measures
Preventive measures include avoiding smoking, exposure to radiation, eating a nutrient-rich diet, maintaining a healthy weight, and regular health screenings. It would also be best to avoid factors that may affect the risk of cancer such as alcohol, a sedentary lifestyle and obesity.
The Third Horseman: Neurodegenerative disease
Neurodegenerative diseases, such as Alzheimer’s and Parkinson’s, progressively impair one’s motor and cognitive functions, reducing mobility and quality of life.
How it Happens
Neurodegenerative diseases occur when nerve cells in the brain or peripheral nervous system lose function over time and then eventually die. There are some treatments that help relieve some of the symptoms associated with these diseases, but slowing their progression is not possible at the moment, and no cures have been found.
Risk Factors
Risk factors include age, genetics, exposure to toxins, alcohol consumption, obesity, smoking, sleep deprivation, lack of physical activity, lack of mental stimulation, traumatic brain injury and diabetes.
Preventive Measures
Preventive measures include:
Regular physical activity
Recovery which includes good quantity and quality of sleep, stress management and avoiding harmful substances such as excessive alcohol and tobacco.
Community, which includes mental stimulation and social connections
A diet rich in omega-3 fatty acids and antioxidants
The Fourth Horseman: Metabolic Disease
Metabolic diseases such as type 2 diabetes and obesity, lead to negative health outcomes in several chronic diseases, making their prevalence hard to calculate.
How it Happens
One major cause of metabolic disease is a person’s weight. Fat cells, particularly in the abdominal area (visceral fat) can raise your free fatty acids, increasing your risk for diseases like diabetes or fatty liver disease, by affecting how your body controls your blood glucose levels. This may lead to insulin resistance, which eventually results in elevated levels of glucose in the blood. People with metabolic syndrome often have insulin resistance.
Why it Matters
Insulin resistance contributes to conditions like type 2 diabetes, cardiovascular disease, neurodegenerative disease, and cancer, among others.
Risk Factors
Anyone can potentially experience a decline in their metabolic health. However, there are some risk factors that are strongly linked to metabolic dysfunction and metabolic syndrome. These include lack of exercise, unhealthy diet, lack of sleep or poor quality sleep, smoking, alcohol use, ageing, genetics, obesity and polycystic ovary syndrome (PCOS).
Preventive Measures
Get plenty of physical activity, reduce your consumption of sugars and starches, and prioritize sleep and manage your stress levels.
Regular screening of your metabolic health markers allows you and your doctor to detect any problems with your metabolic health as early as possible. A test known as HOMA-IR can detect early signs of insulin resistance.
Achieving Healthy Longevity: Taking a Preventive and Proactive Health approach
In many of these cases, obvious symptoms are not that apparent, especially in the early stages of the disease. That is why it is important to take a proactive approach and detect problems early to prevent or delay the onset of chronic diseases – before any significant damage is done.
Early Preventive Testing (including retesting to monitor progress): The best way to get a baseline of your health status is through early screenings of your key biomarkers. This allows you and your doctor to detect any problems with your health as early as possible and to develop a plan to address these – quickly and aggressively – to protect your long-term health.
Exercise. Try to get at least 20 to 30 minutes of cardio exercises on most days, and add in strength training to maintain muscle mass.
Diet. Reduce your consumption of sugars and starches, and quit smoking and alcohol consumption (if you haven’t done so).
Sleep. Sleep is as important as nutrition and exercise when it comes to achieving good health. Studies have shown that adults who do not sleep enough or get poor-quality sleep for long periods are at higher risk of many health problems. Sleep also regulates many hormones that impact metabolic functions. Adults who sleep poorly tend to have higher blood pressure and are 20 to 32% more likely to develop hypertension.
Stress Management. Stress affects the brain structure and the immune system. Diseases that have been linked to stress and inflammation include cardiovascular diseases, diabetes, cancer, autoimmune syndromes and mental illnesses.
Social Connections. Social engagement contributes to the overall health of most people. Studies have found that social connections offer powerful protective health effects.
The Benefits of a Personalised Approach to Healthy Longevity
Take the proactive approach and stay ahead of the Four Horsemen. This means taking control of your health and making lifestyle changes as early as you can.
Health optimisation is not one-sized fits all. A health professional can help you better tailor health screenings to address key concerns as well as tailor intervention strategies to your needs to help you achieve the results you are looking for.
NOVI Assessment Max is designed for prevention and to improve your healthspan (Medicine 3.0!). While traditional health checkups often provide limited insights and fail to detect early warning signs of these chronic diseases, NOVI Assessment Max goes beyond the standard diagnostics, offering a deep, data-driven evaluation of over 100 biomarkers to assess cardiac, metabolic, hormonal, and age-related health risks.
With doctor-led guidance before and after testing, NOVI Assessment Max gives you clear, personalized insights and an actionable health plan. This allows you to have a better understanding of your health risk – so you can take the right steps toward better long-term health.