The 4 Horsemen of Ageing And How to Outrun Them

Why These Four Kill Most of Us

Most people won’t die in a freak accident. It won’t be a plane crash or a sudden heart attack on the golf course. For the vast majority of us, the end will come slowly, quietly, and predictably.

We die from the same four illnesses, again and again.
Doctors know it. Insurance companies know it.
Most people don’t.

These four diseases are responsible for the overwhelming majority of deaths after age 50:

• Heart Disease

• Cancer

• Neurodegenerative Disease (like Alzheimer’s or Parkinson’s)

• Metabolic Dysfunction (like Type 2 Diabetes and insulin resistance)

They’re what physician Peter Attia calls “The Four Horsemen.”
They creep up over decades. They feed off one another. And they win, almost every time, if you wait too long to act.

The good news? They are not inevitable.
They are not just “a part of getting older.”
And for many people, they are largely preventable.

The 4 Horsemen at a Glance

Heart Disease
Often starts with silent damage to the arteries. Plaque builds over time. Eventually, your heart can’t keep up. Most people feel nothing until it’s too late.

Cancer
We all have rogue cells. Cancer happens when they grow out of control. Some forms are more genetic. Many are lifestyle-driven. Most are diagnosed late.

Neurodegeneration
Conditions like Alzheimer’s and Parkinson’s begin years before symptoms show. The brain slowly loses its ability to protect, repair, and clear itself.

Metabolic Dysfunction
Often starts with poor blood sugar control. Leads to insulin resistance, inflammation, Type 2 Diabetes, and eventually damages the heart, brain, and more.

What Links These Diseases Together?

Beneath each of these conditions, you’ll find the same root issues:

• Chronic inflammation

• Insulin resistance

• Mitochondrial dysfunction (your cells can’t make energy properly)

• Poor sleep, stress, and inactivity

• A diet full of ultra-processed food and sugar

These aren’t rare. They’re everywhere.
And they’re often dismissed until it’s too late.

The Conventional Approach: Drugs First

When people are diagnosed with one of these conditions, the treatment is almost always pharmaceutical:

• Heart disease: statins and blood thinners

• Cancer: chemo, radiation, surgery

• Neurodegeneration: memory drugs, often with little effect

• Metabolic dysfunction: metformin, insulin, strict food rules

Sometimes, these drugs are life-saving. But often, they just manage the symptoms. They don’t fix the root cause. And they come with side effects that are rarely discussed.

More importantly, they’re usually offered after the damage is already done.

A Better Way: Lifestyle Before Lifelong Prescriptions

The truth is this:

• You can reverse insulin resistance through food and movement

• You can lower heart disease risk through daily habits

• You can reduce cancer risk by managing stress and inflammation

• You can protect your brain with better sleep, exercise, and nutrition

You don’t need to be perfect.
You just need to start before it’s too late.

This is about front-loading health — doing the work now, so you’re not stuck managing decline later.

How to Outrun the 4 Horsemen: Your Starter Protocol

Here’s a simple starting point. No white coats or personal trainers required.

Next: Deep Dive Into Each Horseman

This post is just the overview. If you want to go deeper into each disease — what causes it, how treatments work, and how to avoid it — check out the full breakdowns below:

Each one explains how the illness works, how drugs are typically used, what the side effects are, and how to build a better plan before you need them.

Final Thought

Getting older is inevitable. Decline isn’t.
You don’t have to wait until your first diagnosis to change direction.

Start now. Go slow if you need to.
Just don’t wait.