In 2023 I insisted on a specific medical test. My doctor did not think it was necessary. Had I not taken it, I would almost certainly have had a heart attack soon afterwards, and quite possibly I would have died. I insisted because of something I had read.
It is not a long story. I have a family history of coronary disease. My father died of a heart attack at 62, an age I am not far from. My doctor knew this as well as I did. My blood tests showed I needed to bring my cholesterol down. He was watchful, but his EKG and my improving blood values convinced him that the condition could be managed.
That reassured me somewhat, but I also dug into the literature. Much of what I learned came from Peter Attia. Attia’s indefensible associations, revealed this year, make the following much harder to say, but his medical writings and podcasts for the general public are sharp, clear and persuasive. Through him I realised that bringing my cholesterol down a little was not enough. It needed to be much lower. Running through all of Attia’s work is the conviction that everyone should strive for the healthiest life they can, and not settle for anything less.
Importantly for me personally, he advised anyone with a family history of coronary disease to take a low-cost coronary CT scan, which produces a so-called CAC score. Nope, CAC here is not Customer Acquisition Cost, but Coronary Artery Calcium. The scan measures calcified plaque in the coronary arteries, a sign of accumulated damage, and so gives a far more complete picture of cardiovascular risk than cholesterol alone. High cholesterol does not automatically mean a heart attack is coming. And some people with acceptable cholesterol levels still carry a high risk.
One of the images from my 2023 coronary scan
I insisted on the scan. The German health system does not cover it. Luckily, that did not deter me. A score of 0 means no calcified plaque at all. Anything under 100 counts as low risk, and anything above 400 is considered severe. My score was 1,324, which put me in the 99th percentile for men my age. I was booked in for an angiogram straight away. It showed that one of my coronary arteries was more than 90% blocked, and the doctors placed a stent during the same procedure. It all went well. With an artery that narrow, a heart attack was only a matter of time.
My father did not have these tools, which would have allowed him to change his life in time. Routine CAC scoring only became mainstream in US clinical practice towards the end of the 2010s, although Dr. Arthur Agatston and his colleagues proposed the score as early as 1990. In Germany it is apparently still not routine today.
These technologies, the scan and its score, stents and statins, are remarkable. But I realised that what matters even more than the technology is knowledge. It’s knowledge that saved me.
That thought shapes how I look at my day job. With the fund I co-founded, we invest in consumer-facing startups using a model called media for equity. We invest across all consumer segments, from fintech, e-commerce and mobility to agetech, health and wellness. Whatever the segment, the value proposition is almost always about enabling consumers, about giving them more choice, more convenience, or helping them make or save money.
In health and wellness, enablement becomes even more powerful. With the advances in preventive and predictive medicine, we now have far better knowledge, and increasingly powerful means, to adjust how we live before calamity strikes. That also brings responsibility. The excuse that we can simply rely on the medical profession no longer holds. I can inform myself and make the effort. I don’t have to, but I can. And if I don’t, I have only myself to blame.
There is a big entrepreneurial opportunity here, and we are still only at the beginning. The best startups combine a technology with the knowledge consumers need to act on it. Gut health startup ZOE, for example, does not just let me monitor my gut health. It also tells me how to change what I eat.
Another example comes from our own portfolio. The link between oral and cardiovascular health is still little known outside medicine. The Finnish startup Koite Health, which grew out of cardiovascular research, makes Lumoral, a home device that uses light, together with a special mouth rinse, to clear away the bacteria that brushing leaves behind on teeth and gums. Gum inflammation is linked to heart disease, so this small daily habit tackles a source of chronic inflammation most of us never think about. I wrote about Koite Health in more detail in a previous post.
Enabling consumers to live better and longer lives is one of the biggest and most exciting investment themes today. Given my own experience, you can imagine how much it motivates me.