Hi ,

We hear a lot about longevity these days: biological age tests, new supplements, and the promise of living longer and better. All of that is exciting. At the same time, the number one cause of death worldwide is still cardiovascular disease – heart disease and stroke.

Several risk factors influence our personal risk for cardiovascular disease, but three basic numbers form the core:

1. Blood pressure
2. Blood glucose
3. Lipids, especially LDL cholesterol (LDL-C)

If we are serious about long-term health, these three need to be on target.

Unfortunately, as a large global analysis of more than 1.6 million people living with type 2 diabetes from both developed and developing countries shows that we are not doing as well as we might hope.

The percentage of people who met guideline targets was below 50% in each of the three categories.

• Blood glucose: about 44% (roughly 4 in 10 people)
• Blood pressure: about 41% (about 4 in 10 people)
• LDL-C: about 47% (just under 1 in 2 people)

The more important question is, how many people had all three controlled at the same time?

The numbers are sobering. Only about 12 percent did, which is roughly 1 in 8 people. If we gathered eight people with type 2 diabetes in a room, on average, only one of them would have blood pressure, blood glucose, and LDL cholesterol at target at the same time.

I consider ApoB100 a better marker than LDL-C. I have written earlier about ApoB100 and Lp(a).

Although this study focused on people with type 2 diabetes, we already know from other research that blood pressure and lipids are major drivers of cardiovascular risk even in people who do not have diabetes.

What does this mean for you?

Regardless of what any study shows, the key question is: are your top three numbers at target?

1. What is your blood pressure?
2. What are your blood glucose or HbA1c levels?
3. What is your LDL-C, or preferably your ApoB100 level?

What numbers should you aim for?

As a functional medicine doctor, I usually aim for stricter targets. An HbA1c of 7 may be acceptable, but it is not optimal. For blood pressure, I consider 120/80 mmHg an ideal upper limit, but a little lower for women.

For lipids, in people at the highest risk of heart disease and stroke, many guidelines recommend an LDL-C target below 55 mg/dL (1.4 mmol/L). The exact target depends on whether we are preventing a first event (primary prevention) or a second event after a heart attack or stroke (secondary prevention).

In high-risk situations, lower LDL or ApoB is usually better. The important nuance is how you get there. Most people need both prescription medications and lifestyle changes, not one or the other.

So, what are your numbers, and which of these three is furthest from target right now?

This is a conversation to have in detail with your healthcare provider. It may seem simple, but addressing all three together requires long-term, individualized care.

I often focus on one area at a time to avoid overwhelm. Many of my patients are pleased when, for example, their triglycerides drop from 250 to 140. I am pleased as well, but I am also thinking, “We are better, but not done yet.”

Long-term health requires long-term attention. We already have good tools, both lifestyle and prescription. If less than half of us are reaching targets, that would have been considered a failing grade in my medical school, which means there is plenty of room for improvement.

New therapies will continue to emerge, but they work best when they are built on strong control of these fundamentals.

Wishing you better numbers in the coming year!

Best regards,

Shabnam

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Dr. Shabnam Das Kar, MD

Functional Medicine Doctor

Tiny Habits Coach

Email: info@drkarmd.com

References

Kacha, Ghanshyam, et al. "Global guideline recommended target achievements in glycaemic, blood pressure, and lipid control in type 2 diabetes: An updated meta-analysis of 1,618,972 participants." Diabetes Research and Clinical Practice (2025): 113001.