Podcast Transcript: Predicting and Preventing Heart Attacks

Second Opinion with Christina Farr, Ash Zenooz MD, and Luba Greenwood JD

Guest: Dr. Jeff Wessler, Cardiologist and CEO of Heartbeat Health

The following is the transcript of the Second Opinion podcast, to listen to it directly, check out these links below:

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Christina Farr: Heart attacks are almost completely predictable. Not to pinpoint exactly when someone is going to have one, but to be pretty close to knowing when your risk is getting so high that the time period is imminent. It's like a ticking time bomb. Yeah, that's a morbid way to look at it, but we now have really amazing diagnostic technology. And yet, the whole world still thinks of heart attacks as random events—someone collapsing on a subway.

This is Second Opinion. I'm Christina Farr. I'm Ash Zenooz. And I'm Luba Greenwood. Welcome to the pod, where each week we navigate what's really going on in healthcare through strikingly candid conversations with the entrepreneurs and investors leading the charge. Thanks for joining us. Let's dive in.

Christina Farr: Hi, everybody. Welcome back to Second Opinion. This week, I have an incredible guest: Dr. Jeff Wessler. But he says it's okay for me to call him just Jeff, so we'll go with that.

Jeff and I have known each other for almost a decade. We first connected when he was kicking around the idea of what you could do at the intersection of preventive health and cardiology. He's a physician by background and the CEO of Heartbeat Health.

I wanted to bring him on because we've both been closely tracking this longevity trend, and he's been a leader in prevention for a long time. So with that, I'll kick it over to Jeff to tell us a little more about what he's up to.

Jeff Wessler: Wonderful. Thanks, Chrissy. It's great to see you as usual. You've been part of our story from the beginning and got to know Heartbeat in its very early days.

Heartbeat is a virtual cardiology practice. We're now a pretty large medical group with cardiologists, advanced practitioners, nurses, care coordinators, medical assistants—everyone you’d expect in a big cardiology division—but we're cloud-based, doing mostly telehealth and remote diagnostics across the U.S.

Over the years, we've evolved the model quite a bit, but as you said, it's been amazing to see what’s happening with longevity lately and how it's reshaping prevention and cardiovascular risk reduction. I'm excited to get into all of that.

Christina Farr: Before we dive into the longevity economy, I want to ask you about behavior change more generally.

I’ve long been skeptical about the role of technology in actually creating meaningful behavior change. I mean, sure, some apps and interventions are better than others, but overall, I don't think there's overwhelming evidence that tech alone moves the needle.

Coming from a cardiologist’s perspective, where getting people to change their behavior is part of your day-to-day work, what’s your take? Agree? Disagree?

Jeff Wessler: Yeah, it's an important question. First, behavior change is just... so hard. There's not a day that goes by where we don't face that individually. At the population level, it’s even harder, especially for things like serious cardiovascular disease.

I think about two populations:

• Patients who've had an event like a heart attack or stroke and now need to change.
• People who are otherwise healthy, trying to stave off disease.

Behavior change looks completely different between those groups.

I share your skepticism. Tech hasn’t been the magical solution we hoped for. If it were, we would have seen drastic improvements in cardiovascular health outcomes by now—but we haven't. In fact, unfortunately, things have gotten worse. Cardiovascular disease, obesity, cardiometabolic health—they’re all trending in the wrong direction.

Christina Farr: And we have so much more tech now. You’d think we would have seen better outcomes.

Jeff Wessler: Exactly.

The one area where tech has really helped is making clinical interactions easier. Once you're actively managing blood pressure, diabetes, cardiovascular disease with a clinician, you see improvement.

Tech has made it easier to access that care across the country. But it’s not some AI robot fixing things autonomously—it’s still the patient-clinician relationship that drives outcomes.

Christina Farr: Okay. Taking a step back—you mentioned heart attacks. You’re a cardiologist. You still treat patients. How do I, and everyone listening, actually avoid having a heart attack?

Jeff Wessler: I love this question.

I was presenting to a few hundred health plan executives recently and asked them if they thought heart attacks were predictable. Almost no one raised their hand. Meaning, even highly informed people think heart attacks are random.

The reality is the exact opposite. Heart attacks are almost completely predictable. We have the data, the models, the pathophysiology understanding, and the diagnostics to see risk build up over time.

Christina Farr: So it’s like a ticking time bomb?

Jeff Wessler: Yeah, that’s a morbid but fairly accurate way to put it.

We know when risk is getting high. We have incredible diagnostic technology to show it. And yet, the broader public still sees heart attacks as sudden, random events.

Christina Farr: Maybe we need a PR campaign for heart attacks! The word “attack” makes it sound so random. Like, maybe we need a rebrand: "heart failure inevitability" or something less dramatic.

Jeff Wessler: Yeah, you’re onto something.

When the term "heart attack" first became common, we knew much less than we do now. We thought of it as plaque rupturing suddenly. But now we know that plaque build-up is predictable, detectable, and manageable. Coronary disease management is all about preventing that final occlusion event—a heart attack.

Christina Farr: Honestly, when I asked you, I thought you were just going to say "eat well, sleep well"—you know, the standard advice we've all been given.

And you probably agree with all that too. But something about that advice just doesn't land with people anymore.

I think that’s part of why I’m excited about the longevity trend. It's moving from "trust us" to "try it." You experiment, you measure the results—whether that's supplements, changes in diet, etc.—and you see if it's working through actual blood work or diagnostics.

Can you talk about that shift?

Jeff Wessler: You’re highlighting a really important point.

Telling people to exercise and eat better without any feedback loop is hard because the payoff—preventing a heart attack—is often 30 years away. You don't see results day-to-day.

Now, though, we have ways to measure progress much sooner. Advanced lipid testing, lipoprotein(a), and other surrogate risk factors can give you feedback within months.

Some of these markers can actually improve with lifestyle changes, and having that immediate feedback loop is critically important. It’s motivating.

Also, there’s a renewed energy around prevention. It’s not necessarily new, but it’s finally getting real attention again, which is a good thing.

Christina Farr: Yeah.

At first, I was skeptical about all this early wearable and testing data—wondering if it would just send people into unnecessary health anxiety.

But now I've seen friends using tools like Function Health to run diagnostics, and when they change behaviors—sleeping more, drinking less—they actually see results. Some people even found clinically relevant issues through full-body scans from companies like Ezra or Prenuvo.

I'm still a little confused though. Can you help me find clarity in this debate?

Jeff Wessler: It's confusing because two things are simultaneously true.

One, inappropriate testing in low-risk people can lead to overdiagnosis—finding things that would never have caused harm—and that leads to unnecessary treatment and side effects.

Two, if done carefully, early detection and targeted intervention can absolutely save lives.

It’s about:\n- Targeting the right population.

• Studying the outcomes.

If you’re healthy, exercise regularly, eat well, don't smoke, and don't have major risk factors, you might not benefit much from constant scanning.

But if you’re slightly sicker, even marginally, early detection can have tremendous impact.

Christina Farr: Okay, putting on my VC hat—it sounds like longevity companies could actually be a great referral pathway for Heartbeat Health.

If someone gets testing through Function Health or Prenuvo and finds a cardiovascular risk, you could step in with tailored clinical intervention. Is that where you're headed?

Jeff Wessler: Definitely something we think about.

We actually wrote about "Apple Watch Syndrome" years ago—people getting abnormal ECG alerts from their watches, calling cardiologists in a panic, and often being totally fine.

Real quick:
An ECG is an electrocardiogram—a rhythm strip of your heart's electrical activity. Smartwatches can now check for arrhythmias like atrial fibrillation, which can cause strokes and heart failure.

But now, with longevity companies, we’ll have even more people showing up with "abnormal" results.

Heartbeat’s goal is to catch the ones truly at risk and reassure those who are fine, without clogging up clinical care for patients who urgently need it.

Christina Farr: Such an important distinction—the "worried well" vs. patients truly at risk.

I recently interviewed an entrepreneur who said longevity is basically just a rebrand of "prevention."

That got a lot of people talking. Is longevity just prevention with better marketing?

Jeff Wessler: I love that framing. It resonates with me.

There are actually four types of prevention:

• Primordial: Prevent risk factors from ever developing.
• Primary: Manage risk factors to prevent the first event.
• Secondary: Prevent a second event after something like a heart attack.
• Tertiary: Prevent complications after multiple events.

Longevity mostly lives in the primordial space—relatively healthy people trying to stay that way.

It’s incredibly important. But to really change outcomes at the population level, we need scale—tens of millions of people—not just a few hundred thousand.

From a return-on-investment perspective, focusing on primary and secondary prevention gives us bigger, faster wins.

Christina Farr: That definitely resonates.

But here's where I want to push a little.

I've known family members and friends who had a heart attack—and even after that, they were reluctant to change. One person I’m thinking of eats a lot of fast food, a lot of saturated fat. Nothing the family says moves him.

But... he listens religiously to longevity influencers like Casey Means or Bryan Johnson.

He’s more willing to follow their advice than his own cardiologist. How do we reach that kind of person?

Jeff Wessler: I'm glad you brought this up.

This gets back to how insanely hard behavior change is—even after a heart attack.

But you're absolutely right: there's a distinct subculture now—especially among men—around these health optimization influencers. They're remarkably effective at getting people to make changes.

I wish more of these influencers were truly evidence-based and less commercially motivated. But overall, if they’re getting people to move, eat better, and pay attention to their health, that’s directionally positive.

We just need more rigorous, guideline-driven voices to be part of that conversation too.

Christina Farr: Totally.

Honestly, I wish someone like you had millions of followers. You actually know what you’re talking about! But...you definitely speak like an academic sometimes. (No offense.)

The reality is, we live in a society right now where people aren't listening to experts the way they used to. They listen to relatable voices who sound like them.

So how do doctors adapt?

Jeff Wessler: It’s happening—slowly.

Doctors are realizing that the one-patient-at-a-time office model isn't enough. They need to be on social media, creating content that can influence a million people at once.

A good example is Peter Attia.

When patients started coming to me saying, "What do you think about Peter Attia’s work?" I had to dig in.

He’s evidence-based, effective, and he's communicating at scale. That's where more of us need to go.

The more tech platforms elevate clinician voices and bring clinical rigor into the conversation, the better the outcomes for everyone.

Christina Farr: One of my friends’ husbands obsessively follows Peter Attia now.

He used to hate walking, but now they do evening walks after putting the kids to bed—all because of what he’s read about healthspan and aging.

So to that end, Jeff, tell us: if we’re relatively healthy but starting to feel that creeping fear of aging (late 30s, early 40s), what small changes should we focus on?

Jeff Wessler: The biggest one: exercise.

Specifically, if you're not exercising 5+ days a week, that's where to start.

Christina Farr: Okay, but be specific. What kind?

Jeff Wessler: Let’s get granular.

Zone 2 cardiovascular exercise — where your heart rate is about 70-80% of your max.

• For a 38-year-old, that's roughly 105–115 beats per minute.
• You should be a little sweaty but still able to hold a conversation.

Three sessions a week of 30+ minutes in Zone 2 is key for fat loss, cardiovascular health, and long-term aging.

You can hit Zone 2 by:

• Brisk walking (for non-athletes)
• Treadmill walking at an incline
• Biking
• Stairmaster
• Swimming
• Rowing

Also, strength training is critical.

People in their 30s and 40s often focus only on cardio, but you need to build and maintain muscle mass decades before you become frail. You can’t fix sarcopenia overnight—you have to start early.

Christina Farr: I think you’ll be impressed: I've switched most of my Zooms to phone calls so I can walk while talking. About three hours of walking a day now!

Jeff Wessler: That’s amazing!

Next level: add a weighted backpack while you walk—or, you know, just pick up one of your kids!

Christina Farr: Hah, I’ve got a few of those lying around.

Okay, last question. A lot of my doctor friends have their own "stack"—metformin, supplements, etc. What about you? Do you have a stack?

Jeff Wessler: Honestly, I don't.

I’ve thought about it. I’ve researched whether to take metformin, GLP-1s, or a statin preventively—but I’ve decided no for now.

At a personal level, I believe the potential risk outweighs the unproven benefit—at least until we have long-term outcome data.

And thankfully, I don't have any major risk factors that would require intervention.

Christina Farr: I’m curious: Why a no on GLP-1s specifically? A lot of people I know are "microdosing" them to lose weight.

Jeff Wessler: Mainly because we just don't have the long-term data yet.

We don't know what happens if you microdose GLP-1s for 5, 10, or 20 years. Potential harm could emerge.

If you don't have a modifiable risk factor that needs treating, there’s no strong evidence to justify it yet.

I'm very evidence-driven: until there’s proven long-term benefit, I won't do it.

Christina Farr: Fair enough.

So what do you do?

Jeff Wessler: My "stack," if you can call it that, is diagnostics:

• I’ve checked my lipoprotein(a) level—a genetic cardiovascular risk factor everyone should get measured once.
• I’ve gotten a coronary artery calcium score to assess for hidden plaque buildup.

Those tests aren’t perfect, and they aren’t accessible to everyone yet, but they’re very good predictors of long-term heart risk.

If my numbers had been bad, it would have changed how aggressively I manage my health.

Christina Farr: I have a fun idea: you should create an AI called "Jevidence." People could ask if a new health trend actually has evidence backing it!

Jeff Wessler: I love it. You’re getting producer credits if I ever launch it!

Christina Farr: Perfect.

Jeff, thank you so much for coming on the show. You've given me (and hopefully the audience) so much food for thought about heart health and longevity.

Even in your 30s, 40s, 50s—there's still so much you can learn and do to reduce long-term risk.

Heart disease is still the number one killer. It's definitely worth investing time and energy into prevention.

Jeff Wessler: Thanks, Chrissy. This was a lot of fun.