Do some people age primarily through their heart and others through their metabolism?

Ageing unfolds differently in every person. Genes, lifestyle, environment and psychological factors together determine whether you are more likely to develop heart problems first, or instead metabolic or kidney problems. That is not an exception -- it is a core feature of how ageing works¹.

Blood tests that measure hundreds of substances simultaneously show that people have their own metabolic profile. In people with coronary artery disease, 23 blood markers were linked to heart problems in general. But which type of heart problem a person develops varies from individual to individual. Certain fats in cell membranes specifically predicted heart failure, not a heart attack or stroke. This suggests that people develop heart problems through different pathways².

Individual variation also plays a role within the heart itself. Immune cells are involved in the formation of scar tissue in heart muscle at older ages. How those cells behave differs from person to person³. At the cellular level, the energy centres of the cell play a role in both cardiac and metabolic ageing⁴.

Clinical research confirms this picture. SGLT2 inhibitors, a class of diabetes medications, reduce the risk of hospitalisation for heart failure by 23% and slow kidney disease by 45%. The effect on heart attack, however, was limited to people who already had atherosclerosis. The same pill therefore delivers much more benefit in one person than in another⁵.

GLP-1 medications such as semaglutide show something similar. Weight loss is accompanied by loss of muscle mass: 15% to 60% of total loss, depending on the person and the drug. In younger people this is relatively harmless. In frail older adults, excessive muscle loss is a real risk⁶. Blood tests can already point a doctor in a certain direction, but truly personalised care at the molecular level is not yet standard practice¹.