In this interview Dr. Charles Mok and Dr. Araha discuss a proactive approach to cardiovascular disease (CVD) prevention, arguing that the optimal window for intervention is roughly a decade before a heart attack occurs. They highlight systemic barriers, especially insurance policies that deem preventive screening and interventions “not medically necessary,” which limits patient access to early detection and treatment. The conversation moves through conventional prevention strategies—lifestyle modifications such as resistance and cardio exercise, smoking cessation, blood‑pressure control, and nutrition—emphasizing that these are the foundation for risk reduction. Pharmacological lipid management (statins and newer agents) is presented as the most potent tool once lifestyle measures are insufficient. The doctors then explore emerging metabolic therapies, particularly GLP‑1 receptor agonists and SGLT2 inhibitors, noting recent evidence that these drugs improve cardiovascular outcomes beyond weight loss, but stressing the need for personalization and attention to skeletal‑muscle preservation. They also touch on longevity‑focused, aggressive interventions like hormone replacement therapy. Throughout, the speakers stress that heart‑attack mortality is not inevitable and that clinicians must look beyond insurance constraints to offer comprehensive, individualized preventive care.
Chapters
The best time to treat cardiovascular disease is a decade before the heart attack.
Correct.
You know, in this case, my family member, his doctor was saying, well, wait till you have a heart attack. I know exactly what to do. And that's actually, quite frankly, until Congress mandates otherwise, insurers do not consider cardiac prevention medically necessary. Therefore, they're not going to cover screening and not going to cover intervention unless they're now, of course, they'll pay for medications and stuff. Hi, I'm Dr. Charles Mok. I'm here with Dr. Araha from Synergy Longevity.
Firstly, thank you for having me. It's always a pleasure to be here.
I want to talk about kind of some conventional treatments. And what I think about it is a little bit more unconventional treatments that are clearly beneficial now, but the world's too new to know about it. So talk about conventional treatments that you use in your practice. Maybe some of the more high line treatments that you do.
It's great because some of the newer treatments are becoming conventional and we'll touch on that in a second. But when people are low to medium, low risk, I always start with lifestyle and then jump into, into therapeutics. Those therapeutics can be pharmacological, they can be supplemental. And we have a very frank discussion about it. You know, it's easy to tell somebody, all right, well, you know, you need to work out for half hour of resistance training and a half hour of, you know, cardio training a day and get back to me in three months. Well, if the person travels for four days a week and, you know, doesn't have access to those things or can't monitor their nutrition as much as you'd like, you want to make a real sustainable plan for them. The next we can touch on to supplemental, you know, supplements or pharmacological interventions and for modifying risk factors. You know, smoking is a huge, huge risk factor for ascvd, right. You're causing constant, essentially scraping of your endothelium. And that scraping of the endothelium is a perfect place for plastic plaque to sit and form. And that's one of the mechanisms that smoking causes ascvd, hypertension, which is high blood pressure, a very strong risk factor as well. Lastly, with lipids, it's a similar approach. If people can modify their nutrition, can modify their diet, can get into the gym and exercise. And although exercise in and of itself doesn't impact the lipid, it's through another mechanism which exercise helps. But if people can do those things, optimize their sleep and focus on their nutrition, that is hugely important for lipid management. But I think by far and no doubt pharmacological intervention for lipid management is the most potent and the most effective. And what I like to explain is firstly the decision needs to be personalized.
So let's talk about some of the unconventional things. The GLP1 drugs, the SGLT inhibitors and other things, they're kind of like showing up, they're showing some, definitely some signal of promise, certainly in people with heart disease, but also in people that don't have heart disease but have a risk for it, such as diabetes. What's been your kind of thoughts on those drugs?
Yeah, I think I was a little bit skeptical on the mechanism for GLP1s to impact cardiovascular risk. And what I had initially assumed was well, people losing weight, obesity and visceral fat is a predisposition for atherosclerotic cardiovascular disease. And so that's kind of the mechanism that it works. But in the last year or two there's actually been some literature that the GLP1ras in and of themselves are showing improvement for cardiovascular risk. I think the mechanism is still being studied and looked upon, but it seems to be much more than just weight loss. So I think they're phenomenal medications. Again, has to be personalized, has to be for the right patient and extremely, extremely important to focus on not losing skeletal muscle. I think that that's, that's where it becomes a little bit more work sometimes when people want to do it because a lot of times it's the thought of I'll take the shot, I'll keep doing exactly what I'm doing and I'm just going to lose weight and you know, my health is going to get better. But if you're not, if you're not focusing on skeletal muscle, working out, getting the right amount of protein in, you're actually doing more harm than good for your longevity.
Spin on this with my bias is that I think it's almost an excuse for people to overeat because if you're not exercising and you're taking a GLP1 drug and you're relying on taking say two and a half milligrams per kilogram of protein, you got to eat ultra processed food to get it because you're having to eat a supplement or just a bunch of red meat. So I've got this double edged sword where I'm thinking about longevity and the, you know, occasionally we have people protein restrict to have them to create longevity. So a great discussion. I kind of want to leave this with the idea that dying of a heart attack can be optional. And the I think the biggest mistake somebody can make is thinking that, well, my insurance won't cover it. My doctor won't order it, therefore, it should not be done. Your doctors, in general, they're they're burdened with whatever the insurance company tells them. That's all they're going to do. So we've stepped outside of the world, then, doing very unique things, such, such as doing the hormone replacement, doing some we do some longevity specific, aggressive treatments.
We do we want to help people live a long, healthy life. And we use the traditional healthcare method, plus all the additional kind of supplements and services that and when I say supplement, I mean the additional testing and blood work and things like that, to supplement what traditional healthcare does so that people can live a long, healthy life.
