The Four Horsemen of Chronic Illness

Risk Factors, Prevention, and Early Detection

Sep 27, 2023

In the early 1900s, life expectancy was modest, with many people succumbing to "fast" causes of death such as accidents and infectious diseases. However, as medical advancements and public health measures improved, a new set of challenges emerged. Today, for most of us, the journey towards longevity means confronting what Dr. Peter Attia aptly calls "slow" causes of death—the Four Horsemen of Chronic Illness. These formidable adversaries, which claim the lives of over 80% of individuals over 50 are heart disease, cancer, neurodegenerative disease (primarily Alzheimer's disease), and metabolic dysfunction, including type 2 diabetes.

Understanding the risk factors, prevention strategies, and early detection methods for these chronic illnesses is essential for extending our lifespan and, equally importantly, improving the quality of those years. In this blog, we'll explore each of these Four Horsemen in detail and delve into how we can proactively combat them to lead longer, healthier lives.

Atherosclerosis (Cardiovascular Disease and Cerebrovascular Disease)

Risk Factors

Atherosclerosis is a chronic inflammatory disease, encompassing cardiovascular and cerebrovascular diseases, and is the leading cause of death in industrialised nations. Atherosclerosis is the underlying cause of about 50% of all deaths in westernised society. This condition arises from the thickening and hardening of arteries due to plaque accumulation. Risk factors include smoking, diabetes, high levels of LDL cholesterol ("bad" cholesterol), and, notably, age. As time progresses, the risk of atherosclerosis compounds, emphasising the importance of early intervention.


Preventing atherosclerosis hinges on adopting a lifestyle that mitigates risk factors. Prioritising sufficient sleep, a balanced diet, regular exercise, and healthy nutrition habits can slow plaque buildup and maintain optimal cardiovascular health.

Early Detection

Early detection involves regular medical check-ups and discussions with healthcare providers. Recognizing symptoms such as chest pain, shortness of breath, and cognitive impairments related to reduced blood flow is critical for timely intervention.


Risk Factors

Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020, or nearly one in six deaths. While age is a factor, cancer risk is closely tied to behaviours like smoking and weight management. Around one-third of deaths from cancer are due to tobacco use, high body mass index, alcohol consumption, low fruit and vegetable intake, and lack of physical activity.


Many cancers can be cured if detected early and treated effectively. Preventing cancer entails multiple strategies. Avoiding risky behaviours such as smoking is paramount. Regular cancer screening is essential for early detection and treatment. Collaborating with healthcare professionals to determine suitable screening methods based on individual risk factors is crucial.

Early Detection

Timely detection is vital for better cancer outcomes. Regular screening, tailored to an individual's risk and age, should be an integral part of preventive healthcare.

Neurodegenerative Disease (Alzheimer’s Disease)

Risk Factors

Neurodegeneration is the third leading cause of death behind heart disease and cancer – all of which combine to account for 70% of deaths. These neurodegenerative diseases, including Alzheimer's which is the most common form of dementia, are marked by cognitive changes that hinder daily life. They typically develop later in life. While not everyone will suffer from dementia, almost all will experience some cognitive impairment as they age.


Understanding the potential for cognitive decline should inspire us to make the most of our current cognitive and physical capabilities. To minimise regret, embrace life now and do what you aspire to do while you still enjoy full cognitive and physical function.

Early Detection

Early detection of neurodegenerative diseases involves routine cognitive assessments and discussions with healthcare providers. Recognizing changes from baseline cognitive function is crucial to maintaining a high quality of life.

Metabolic Disease (Type 2 Diabetes and Related Conditions)

Risk Factors

A relatively high prevalence of the metabolic disease is a worldwide phenomenon. This prevalence appears to be increasing because of a parallel rise in the prevalence of obesity. Metabolic diseases, including type 2 diabetes, nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), insulin resistance (IR), and hyperinsulinemia, are closely associated with an inactive lifestyle and excess weight. These conditions significantly contribute to atherosclerosis, cancer, and neurodegenerative diseases. 

Image: Longevity Minded - The Four Horsemen, metabolic disease underpinning the three others


Preventing metabolic diseases necessitates lifestyle changes, including weight management, regular exercise, and dietary improvements. These changes are pivotal in enhancing metabolic health, reducing the risk of related conditions, and promoting overall well-being.

Early Detection

Early detection involves monitoring blood sugar levels, liver function, and relevant markers. Addressing risk factors proactively with healthcare providers can prevent the progression of these diseases. 


The Four Horsemen of Chronic Illness—atherosclerosis, cancer, neurodegenerative disease, and metabolic dysfunction—pose formidable challenges to our health and longevity. However, armed with knowledge of risk factors, prevention strategies, and early detection methods, we can significantly improve our chances of preventing these adversaries from ever knocking at our door.

It is Tenet IQ’s mission to leverage the power of technology, particularly artificial intelligence (AI), to enable the transition to [Medicine 3.0], aiming to prevent chronic diseases and extend healthspan. 

For more information about different behavioural protocols and significant levers to improve your health span and reduce the risk against chronic illness please see our blog: Secrets to Longevity.

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