For more than 100 years, heart disease has been the leading cause of death in America. Ivy League–trained emergency physician and CEO of Rocky Mountain Regenerative Medicine, Dr. Khoshal Latifzai, MD, explains that someone can be doing everything right on the surface and still have their cardiovascular “engine” breaking down under the hood—if they’re watching the wrong gauges. “It’s like ignoring a check engine light because the car still looks fine,” he says. We sat down with him to talk about cardiovascular health and learn what gauges are best.
For a health-conscious individual who already exercises and eats well, where do you typically still see hidden cardiovascular risk?
In cardiovascular prevention, one major blind spot is LDL-C: someone can have a “perfect” LDL-C on a standard panel and still have a high burden of atherogenic particles. That is why ApoB matters. It better reflects the number of plaque-driving particles. Lp(a) is another key blind spot because it’s a genetically driven risk factor that lifestyle often cannot fix.
Importantly, ApoB and Lp(a) are not included on a standard lipid panel, so they must be checked separately. Other hidden risks include chronic low-grade inflammation, insulin resistance, and poor sleep, all of which can worsen vascular risk even in otherwise healthy people.
Boulder is a community that values performance and longevity. How do you approach cardiovascular health differently for someone who wants to optimize, not just avoid disease?
Aiming to land in the middle of the bell curve is a very low standard. Optimization means understanding every measurable driver of your cardiovascular risk, striving for levels that are simply not associated with heart attacks and strokes, addressing outliers precisely, and tracking your response over time.
This approach should resonate with performance-minded patients. It means going beyond standard panels to particle-level lipid testing, inflammatory markers, endothelial health indicators (markers of blood vessel function), metabolic markers, body composition, and advanced coronary scanning, all reviewed regularly.
At what point does cardiovascular prevention become a more sophisticated, data-driven exercise rather than general lifestyle advice?
From day one, frankly. Yet current guidelines do not recommend comprehensive cardiovascular testing until age 45, unless someone is already symptomatic or diagnosed with hypertension or diabetes. By that point, atherosclerosis has often been developing silently for decades. The time for data-driven prevention is your 20s, 30s, and 40s, when early intervention yields its greatest returns.
For someone thinking in decades, not just years, what does an ideal cardiovascular prevention strategy actually look like today?
It means assembling a complete picture, well before symptoms, well before a diagnosis, with a comprehensive baseline. One that combines family history, comprehensive biomarker assessment, including particle-level lipids, inflammation, metabolic markers, hormonal health, and advanced imaging, with personalized lifestyle protocols and targeted therapy where the evidence supports it. And critically, it involves consistent monitoring over time.
Cardiovascular disease doesn’t develop overnight. It builds across decades. The quality of life you have at 75 is being shaped by the decisions you make today. That is the model we have built at Rocky Mountain Regenerative Medicine.