As a cardiologist and scientist, Elizabeth Nabel has shaped the dialogue on the prevention of cardiovascular diseases for years. Her message was clear: precise prevention starts before symptoms emerge. This is precisely where modern heart care comes into play – with smart tests that reveal risks before they become a reality. For high performers, this means securing energy, focus, and longevity, rather than leaving it to chance.

Heart care involves early recognition of personal risks and taking targeted action. Three key components are central: electrical activity, vascular health, and genetic predisposition. An electrocardiogram (ECG)pain-free measurement of electrical heart activity to detect arrhythmias shows whether the heart is beating in rhythm or if silent arrhythmias are lurking. The CT coronary angiographyhigh-resolution X-ray imaging of the coronary arteries with contrast agent to visualize deposits and stenoses makes plaques and potential narrowing visible – long before a heart attack threatens. And the genetic risk assessmentanalysis of hereditary variants that influence individual susceptibility to cardiovascular diseases provides clues as to whether the cards in our genetic makeup are stacked against us. These three pieces of information complement classic factors such as blood pressure, cholesterol, blood sugar, and lifestyle – enabling precise, personalized prevention.

Those who sit a lot diminish heart fitness – with noticeable consequences. A large analysis of over 31,000 individuals clearly links long sitting times to an increased risk of cardiovascular diseases; the risk noticeably increases after about 250 minutes of sitting per day and rises sharply beyond 750 minutes ^[1]. For people over 60, the effect is pronounced. The message is pragmatic: movement interrupts biological stress patterns, improves vascular function, and stabilizes heart rhythms. Imaging can additionally reveal “silent risks”: CT coronary angiography detects plaques and assesses stenoses; newer techniques even capture inflammatory activity in the perivascular fat – an indication of “residual risk” that classic markers overlook ^[2]. Rhythm diagnostics via ECG, in turn, uncover arrhythmias that can jeopardize performance and safety – from atrial fibrillation to ventricular tachycardias ^[3].

Regarding genetics, the findings are both sobering and helpful: a systematic evaluation of cardiogenomic profiles found a robust association with heart disease risk for individual variants such as 9p21, but current gene panels are hardly suitable as stand-alone screenings; their predictive power only marginally improves risk classification, and clinical benefits have not yet been demonstrated ^[4]. The practical value lies rather in starting behavior and therapy earlier and more consistently. In rhythm diagnostics, modern evaluation methods of ECG data show that arrhythmias can be reliably and automatically detected, facilitating early diagnosis in everyday life and making screening more practical ^[3]. Imaging underscores the strength of CT coronary angiography in high-resolution plaque detection and functional stenosis assessment; additionally, analyzing perivascular fat allows for an assessment of vascular inflammation, which signals individual residual risk beyond mere stenosis measurement ^[2]. Taken together, the evidence suggests that the best prevention combines clinical factors with smart imaging and targeted rhythm screening; genetics is currently an add-on for fine-tuning, not the primary driver.

- Expanded ECG Screening: Consider having a resting ECG if you experience palpitations, performance drops, syncope, or blood pressure fluctuations – or as a baseline from age 40+ with risk factors. Use wearables as indicators, but confirm any abnormalities clinically. Early detected arrhythmias like atrial fibrillation can be effectively treated and reduce stroke risks ^[3].
- CT Coronary Angiography: Discuss a CT coronary angiography with your physician if at high risk (strong family history, multiple risk factors, exercise-dependent symptoms). Advantage: plaque characterization and detection of subclinical atherosclerosis; in specialized centers, perivascular inflammation can also be assessed – helpful for guiding the intensity of lifestyle and medication measures ^[2].
- Genetic Risk Assessment: Consider genetic testing if there have been early heart attacks/strokes in your family. Benefit: raise awareness, start prevention consistently. Limitations: predictive value alone is limited; gene profiles do not replace classic risk scores or imaging ^[4].
- Anti-Sitting Protocol: Implement 5 minutes of movement for every 30–45 minutes of sitting. Goal: remain under 7–8 hours of total sitting time per day; for desk work, incorporate active meetings, standing desks, and short stair intervals. Already reducing long sitting blocks measurably lowers cardiovascular risk ^[1].
- Performance Medicine in Everyday Life: Combine 150–300 minutes of endurance training per week with 2–3 strength sessions; add 1–2 HIIT impulses if medically approved. Track blood pressure, fasting blood sugar, LDL, hs-CRP, and sleep – and escalate measures if values fall outside the target range (e.g., diet, statin discussion in high risk, stress management).

Heart care becomes strong when you combine behavior, smart diagnostics, and – where useful – genetics. Those who break sitting, check rhythm, and visualize vessels invest in energy today and longevity tomorrow. The best time is now.