A practice built on one finding
Most heart attacks and strokes are preventable.1
Standard care rarely acts on that.
We do.
In two landmark studies spanning 84 countries, the large majority of first heart attacks and strokes were attributed to factors that can be measured, treated, and followed over time. Ethos is a preventive-cardiology practice built to do exactly that: earlier, more deeply, and for decades.
The finding, honestly stated
Nine modifiable factors.
Over ninety percent of the risk.
In the largest case-control study of its kind, nine factors (lipids, smoking, blood pressure, diabetes, abdominal obesity, diet, exercise, alcohol, and psychosocial stress) accounted for over 90% of the population-attributable risk of a first heart attack.
That is a finding about populations, not a promise about any one person. A more conservative prospective estimate puts the figure closer to half. Either way, the conclusion is the same: the risk is largely measurable and modifiable, and the standard system measures it late, lightly, or not at all.
of population-attributable first heart-attack risk: nine modifiable factors, INTERHEART, 52 countries
of population-attributable stroke risk: ten modifiable factors, INTERSTROKE, 32 countries
the conservative prospective-cohort estimate, women (52.6% men): shown because you deserve both numbers
Why standard care misses it
Standard care measures what is easy.
Prevention requires measuring what matters.
A routine panel estimates cholesterol cargo. We count particles.
LDL-C measures the cholesterol mass inside the particles; ApoB counts the particles themselves, and it is particles that enter the artery wall. When the two disagree, the particle count is the better guide. A standard panel never measures it.
Lipoprotein(a): genetic, common, invisible to routine tests.
Lp(a) is almost entirely determined by your genes and is not part of any standard cholesterol panel. In a cohort of 1,718 patients undergoing coronary CT, adding Lp(a) reclassified risk meaningfully (net reclassification 16%). One measurement, once in a lifetime, closes that gap.
Risk calculators estimate. A calcium scan shows.
Traditional risk equations are only moderately accurate. Adding a coronary calcium score reclassifies 40–41% of people, including 24% of those advised to take a statin who turned out to have no detectable calcium at all. Imaging tells both directions of the truth.
Cholesterol is not the whole story. Inflammation is measurable too.
After lipids are controlled, residual arterial inflammation still drives events. In CANTOS, an anti-inflammatory reduced major events 15%, with no change in lipids at all. We measure that axis (hs-CRP, and deeper markers where the evidence supports them) rather than assume it away.
Fifteen minutes and a panel of 2,500 is not prevention. It is triage.
The proposed Ethos model caps panels at 600–800 members per physician, schedules 30 minutes or longer for preventive encounters, and guarantees review of your results with your physician: every time, on a defined clock.
The instrument · INTERHEART, verbatim
Nine factors.
Every one of them modifiable.
Each bar is that factor’s share of population-attributable risk in INTERHEART: the exact figures as published. They overlap, because factors travel together; together they account for over 90% of first heart attacks.
Population-attributable risk estimates the fraction of cases statistically tied to a factor if it were entirely removed. Factors correlate, so the values do not sum to 90%; they describe a web, not a pie.
- 01Abnormal lipids (ApoB/ApoA1)49.2
- 02Smoking35.7
- 03Psychosocial stress32.5
- 04Abdominal obesity20.1
- 05Hypertension17.9
- 06Too few fruits & vegetables13.7
- 07Too little exercise12.2
- 08Diabetes9.9
- 09Alcohol6.7
Population-attributable risk, % · INTERHEART (Yusuf, Lancet, 2004). Values overlap and do not sum to the combined 90% figure. Protective factors are shown by their absence.
The method
Measure. Interpret. Accompany.
An assessment built around the causes, not the billing codes.
Advanced lipids including ApoB, a one-time Lp(a), inflammatory markers, and, when your profile calls for it, coronary calcium imaging. Every test is ordered against one rule: only when the result can change what we do. Final selection is an individual clinical decision, made with you.
Absolute numbers, not relative-risk marketing.
A “36% reduction” can mean 1.1% in absolute terms. You will always see both figures: the relative and the absolute, the benefit and the number-needed-to-treat, because you are exactly the kind of reader who checks.
One physician, a defined clock, for decades.
The proposed model targets seeing your own physician at least 75% of the time, rechecks every changed number within 6–8 weeks, and replies within a guaranteed window. Prevention is a relationship measured in years, not a transaction measured in visits.
The physician
“As I have matured as a physician, I recognize that my role during those critical moments was akin to that of a fireman presenting himself at the scene of a burning home. […] I see my role to be that of a fire marshal aiming to fireproof your home and install detectors to identify and reverse disease processes at their nascency.”
Cardiovascular Disease, American Board of Internal Medicine, with advanced fellowships in imaging, and in heart failure & transplant cardiology.
Site principal investigator on major cardiovascular outcome trials: IMPROVE-IT, PROMISE, TRACER. He has read the evidence from inside.
Trust in physicians and hospitals fell from 71.5% in 2020 to 40.1% in 2024. The answer is not branding. It is showing the work: every claim, every source, every caveat.
Membership
A small panel,
by design.
The proposed model caps membership at 600–800 per physician, against panels of 2,500 in conventional primary care, priced as a monthly membership rather than per visit.
Every member receives the same evidence-based clinical core. Tiers differ in time, access, and intensity of service: never in which tests you are offered.
The first step
A conversation begins the work.
Tell us who you are and what you are looking for. A physician, not a scheduler, not a bot, reads every inquiry.
References · this page
Every figure, sourced.
- INTERHEART: Yusuf S, et al. Lancet, 2004. Nine modifiable factors accounted for over 90% of population-attributable first myocardial-infarction risk across 52 countries (90% men, 94% women). INTERSTROKE: O’Donnell MJ, et al. Lancet, 2016. Ten factors, ~90.7% of stroke risk across 32 countries. Conservative prospective estimate: 52.6–57.2% (NEJM, 2023).
- BioHEART-CT: 1,718 patients undergoing coronary CT angiography; adding Lp(a) yielded a net reclassification improvement of 16%.
- MESA: coronary artery calcium delivered the largest risk reclassification among tested markers; adding CAC to standard scores reclassified 40–41% of individuals (24% of statin-recommended had CAC = 0).
- CANTOS (Ridker, 2017): anti-inflammatory therapy reduced major events 15% with no lipid change. COLCOT (Tardif, 2019): 4,745 patients, 23% reduction. LoDoCo2 (Nidorf, 2020): 5,522 patients, 31% relative reduction.
- Perlis RH, et al. JAMA Network Open: trust in physicians and hospitals, 71.5% (April 2020) to 40.1% (January 2024). KFF: trust in one’s own physician, 93% (June 2023) to 85%.
- Physician voice: “However, as I have matured as a physician…”: Dr. Tushar Shah, About Our Practice, rendered verbatim with the marked omission.
- The Ethos model (panel caps, visit length, continuity targets, tier principle, and membership pricing) is a proposed practice design, pending launch. Figures describe the design, not an operating history.