Preventive cardiology: the science of a healthy heart

Preventive cardiology is the forward-looking specialist area of cardiac medicine that is not concerned with repairing damage, but with its intelligent and scientifically sound prevention. It is the discipline that asks: „What do we need to do today to ensure that you remain healthy and fit in 10, 20 or 30 years“ time?" In Dr. Raphael Bruno's practice, the preventive cardiology The core of our philosophy. We use the latest scientific findings to assess your individual risk and develop a proactive strategy to protect your cardiovascular system.

The goal of preventive cardiology: maximizing healthspan

An important goal of preventive cardiology is to focus not only on lifespan, but above all on healthspan (or healthy lifespan). The goal is to extend as much as possible the number of years you spend in full physical and mental health, free from chronic diseases and limitations. Since cardiovascular diseases are the leading cause of premature death and disability, a preventive cardiology approach is by far the most effective means of achieving this goal.

The scientific basis of preventive cardiology: from Framingham to today

The preventive cardiology is not an opinion-based science, but an evidence-based science. Its foundation was laid by large, decades-long observational studies such as the famous Framingham Heart Study. This and many subsequent studies have enabled us to clearly identify the main risk factors for cardiovascular disease.

The central, scientifically proven findings are:

Linear risk of blood pressure: There is no safe threshold for high blood pressure. Each increase continuously increases the risk.
Causality of LDL cholesterol: An elevated level of LDL cholesterol is not only correlated, but causal for the development of arteriosclerosis.
The power of lifestyle: A healthy lifestyle can halve the risk of cardiovascular disease, even if you have a genetic predisposition.
Early detection is crucial: The treatment of risk factors is all the more effective the earlier it begins.

These scientific facts are the basis for any serious strategy in the preventive cardiology.

Preventive cardiology tools: risk stratification and imaging

In order to develop a personalized prevention strategy, a cardiologist must precisely assess your individual risk („risk stratification“). We use two complementary main tools for this:

Risk scores: Using validated calculation models (e.g. ESC-SCORE2), we use your basic data (age, gender, cholesterol, blood pressure, smoking status) to calculate your statistical probability of suffering a cardiovascular event in the next ten years.
Search for subclinical arteriosclerosis: Since scores only represent probabilities, we use the modern preventive cardiology one step further. Using non-invasive imaging (e.g. ultrasound of the carotid arteries), we look for arteriosclerosis that is already present but still asymptomatic („subclinical“ disease). The detection of such plaques immediately increases your risk and often requires more intensive prevention.

Therapeutic strategies in preventive cardiology

The therapeutic measures in the preventive cardiology are wide-ranging and depend on your individual risk profile. Their effectiveness has been proven in countless studies.

Evidence-based prevention measures

Preventive measure	Evidence level (scientific evidence)	Recommendation of the professional societies (ESC/DGK)
LDL cholesterol reduction with statins	Very high (class I, evidence level A)	Strong recommendation for all patients with high/very high risk and after events.
Consistent blood pressure control	Very high (class I, evidence level A)	Strong recommendation for all patients with hypertension, target values depending on risk.
Mediterranean diet	High (class I, evidence level A/B)	Strong recommendation as a basis for prevention for the general population and patients.
Regular physical activity	High (class I, evidence level A)	Strong recommendation (at least 150 min/week of moderate intensity).
Stop smoking	Very high (class I, evidence level A)	Urgent and absolutely necessary recommendation for all smokers.
ASA in primary prevention	Low to moderate, controversial	No longer recommended across the board, only in individual cases with very high risk after individual consideration.

Preventive cardiology in practice: your path with us

In our practice, we apply the principles of preventive cardiology into a concrete plan that you can understand.

Survey of the status quo: We determine your personal risk profile through a comprehensive preventive examination (heart check-up).
Joint target definition: We will explain your findings to you and work with you to set realistic and measurable goals (e.g. LDL target value, blood pressure target value).
Development of the strategy: We draw up a plan consisting of a combination of lifestyle recommendations and - if medically necessary - modern, well-tolerated drug therapy.
Continuous monitoring: Prevention is a marathon, not a sprint. We review the success of the measures at regular check-ups and adjust the strategy if necessary.

Frequently asked questions about preventive cardiology

Here you will find answers to frequently asked, scientifically oriented questions about heart care.

Why are the target values for cholesterol so much lower today than in the past?

Large scientific studies have shown beyond a doubt: „the lower, the better.“ The lower the LDL cholesterol, the lower the risk of heart attack and stroke. The lower target levels in the preventive cardiology reflect the current state of knowledge and aim to reduce the risk.

Why is blood pressure at night so important for preventive cardiology?

Normally, blood pressure should drop by 10-20% during sleep („dipping“). A missing or insufficient nocturnal drop is an independent, strong risk factor for future cardiovascular events. This important parameter can only be measured with a 24-hour blood pressure measurement, a core instrument of the preventive cardiology.

What does science say about dietary supplements for the heart (Q10)?

For most over-the-counter dietary supplements (such as coenzyme Q10), no relevant benefit for the prevention of cardiovascular disease has been proven in large, serious studies.

What does „primary“ vs. „secondary prevention“ mean in cardiology?

Primary prevention is aimed at people who have not yet had a cardiovascular event (such as a heart attack). Its goal is to reduce the risk of a first event. Secondary prevention is aimed at patients who have already experienced an event. Its goal is to reduce the risk of another event (recurrent heart attack), and it is generally even more intensive.

Is the measurement of „biological vascular age“ reliable?

Yes, methods such as measuring the pulse wave velocity or the intima-media thickness in ultrasound are scientifically validated procedures for assessing the stiffness and condition of the vessels. They can be used as part of the preventive cardiology provide valuable additional information on individual risk.

How safe are the new cholesterol drugs such as PCSK9 inhibitors?

PCSK9 inhibitors are a modern class of highly effective cholesterol-lowering drugs. Their safety and efficacy have been extensively demonstrated in large clinical trials. They are a potential option for high-risk patients for whom statins are insufficient or cannot be tolerated. Their use should be supervised by a physician, such as in preventive cardiology, as practiced by Dr. Raphael Bruno.

Why is more emphasis placed on apoB than LDL today?

Apolipoprotein B (ApoB) is a protein that sits on every potentially harmful blood lipid particle. The measurement of ApoB therefore directly counts the Quantity of the harmful particles. This is considered an even more accurate risk marker than measuring cholesterol levels.Salary in these particles (LDL-C).

My risk score is low. Can I ignore prevention?

No. A low score is a fantastic starting point, but no guarantee for the future. The preventive cardiology aims to ensure that your risk remains low. A healthy lifestyle is the key to maintaining this status, even at low risk.

I have a genetic predisposition. Is prevention pointless for me?

Quite the opposite. Especially if you have a genetic predisposition, the preventive cardiology is the most important thing for you. Studies show that an optimal lifestyle and consistent drug therapy can often more than compensate for the increased genetic risk.

Rely on scientifically sound prevention

The preventive cardiology offers you the opportunity to manage your heart health based on facts and scientific evidence. At Dr. Raphael Bruno’s practice, we translate the latest research findings into a personalized and actionable plan for you. Don’t leave your health to chance. Schedule an appointment for a comprehensive preventive consultation.