https://harmonism.io/wheel-of-harmony/health/protocols/medical-interventions-preventing-death
The five levers are inputs, and the markers they move — blood pressure, glucose and insulin, lipids, body composition — are read as their scoreboard. Medicine enters at two points. The first is where a marker does not follow the levers: the inputs have been pulled for long enough and the number is still out of range, or it started so far out that waiting is itself the risk. The second is where the risk was never within the levers’ reach: an arrhythmia, a prior heart attack, a cancer growing below the threshold of any symptom. These are not substitutes for the Wheel of Health; they are what sovereignty adds to it. Correct the terrain first, then use the medical tool where the evidence says it saves lives, and at the point it says so, not later out of principle. The sections below follow the disease processes mapped at Causes of Death and Chronic Disease, largest first. Infection and injury, the two blocks the chronic terrain does not drive, fall outside this page.
Heart and blood vessels killed 19.2 million people in 2023, almost one death in three: ischaemic heart disease 8.91 million, the first single cause on earth, and stroke 6.79 million, the second, and the leading cause of lasting disability among the diseases on this page. They are largely one disease reaching two organs, and medicine meets it at three moments: years before the event, in the hour of it, and in the years after. Blood pressure is the largest modifiable cause of both; atrial fibrillation is the cause of stroke most often missed.
SPRINT treated 9,361 adults at high cardiovascular risk to a systolic below 120 or below 140. The intensive arm cut cardiovascular events by 25% and death from any cause by 27%, and the trial was stopped early for benefit. No drug decision carries a more direct line to stroke, heart failure and kidney failure, and none is paid for so silently when delayed, since the damage accumulates without symptoms.
Where medicine enters. The 2025 AHA/ACC guideline starts medication at once for stage 2 hypertension (140/90 and above), and for stage 1 (130–139/80–89) where there is cardiovascular disease, diabetes, chronic kidney disease or a ten-year PREVENT risk of 7.5% or more. In lower-risk stage 1, medication follows if three to six months of lifestyle change fail to bring the average below 130/80: the levers’ own window, written into the guideline. The number that decides is the seven-day home average held at Monitor, not a clinic reading.
For people at higher cardiovascular risk, lowering ApoB-carrying particles lowers heart attack and stroke. Across the statin trials pooled by the Cholesterol Treatment Trialists’ Collaboration (Lancet, 2010), each 1 mmol/L fall in LDL cholesterol cut major vascular events by about a fifth. Lipid management is read alongside metabolic health, never in isolation.
Where medicine enters: measure the artery, not only the blood. A coronary artery calcium (CAC) score converts a risk estimate into a measurement of plaque already laid down. The 2026 ACC/AHA dyslipidemia guideline gives it a Class I recommendation in intermediate and select borderline-risk adults where the treatment decision is uncertain, and ties the result to the LDL goal: a score of 1–99 to LDL below 100 mg/dL; 100–299 to a reduction of at least 50% and a target below 70; 300 or above to a target below 55; above 1,000 to management as though a cardiovascular event had already occurred. A score of zero is among the strongest negative risk markers in cardiology. The guideline does not recommend CAC for everyone; the Harmonist position is that one low-dose scan from the forties is worth taking regardless, because it replaces a population probability with a fact about this body, and a decade of ApoB decisions reads differently on either side of it. Elevated Lp(a), measured once per the levers page, moves a borderline case toward treatment.
In atrial fibrillation, adjusted-dose warfarin cut stroke by 64% against control in the Hart meta-analysis (Annals of Internal Medicine, 2007), and the direct oral anticoagulants that followed match it with less bleeding into the brain.
Where medicine enters. At the stroke risk the 2023 ACC/AHA guideline sets, a CHA₂DS₂-VASc score of two or more in men or three or more in women, where anticoagulation outweighs its bleeding cost. Atrial fibrillation is often silent, which is why a new irregular rhythm sits on the emergency list below.
A heart attack is a clot closing a coronary artery, and the heart muscle beyond it dies by the minute. In ISIS-2, 17,187 patients with a suspected heart attack were randomised; aspirin alone cut five-week vascular mortality from 11.8% to 9.4%, and aspirin with the clot-dissolving drug streptokinase cut it by 40% (ISIS-2, Lancet, 1988). Today the artery is reopened by catheter, balloon and stent (percutaneous coronary intervention) where a catheter laboratory can be reached within about two hours of first medical contact, and by a clot-dissolving drug where it cannot. The patient’s part is the first minute: call emergency services at once, never drive, and take aspirin only if the dispatcher confirms it, since allergy and bleeding risk change the answer.
Time is brain. A clot-dissolving drug can be given within about four and a half hours of the first symptom. For a blockage in a large vessel, a catheter can pull the clot out: in the DAWN trial, selected patients treated between six and twenty-four hours after onset regained functional independence in 49% of cases against 13% with standard care (New England Journal of Medicine, 2018). Every one of these decisions depends on knowing the minute the symptoms began, which is why the emergency list below asks for it.
In people who already had a cardiovascular event, the right combination of blood pressure management, lipid lowering, antiplatelet or anticoagulant therapy, and metabolic correction can greatly reduce recurrence and death.
Where medicine enters. At the event itself. This is the one setting where medicine and the levers begin together on the first day, and neither waits for the other.
After a stent, two antiplatelet drugs, aspirin and a second agent, are taken together for up to a year to keep the stent from clotting; stopping them early without the cardiologist is one of the ways a stent fails. Exercise-based cardiac rehabilitation, across 107 trials and 26,886 patients, reduced further heart attacks by 28% and hospital admissions by 35%, and probably reduces deaths (Cochrane). It is the point where medicine hands the patient back to the levers.
Cancer at all sites killed 10.6 million people in 2023, the second block after the vessels. Lung cancer kills the most people of any cancer, then colorectal, liver, breast and stomach. Screening earns its place one organ at a time.
Colorectal screening, cervical HPV testing and skin examination, where the target lesion is real, progressive and removable at the moment it is found. The claim has to be made screen by screen rather than for screening as a class: in the randomized-trial meta-analysis of lifetime gained (Bretthauer, JAMA Internal Medicine 2023) only sigmoidoscopy significantly extended life, while mammography, PSA and lung CT did not, and a mammography programme overdiagnoses roughly ten women for every breast-cancer death it averts. Which screens earn their place, and which manufacture patients, is held at Cancer-Prevention § Screening.
Colorectal, for both sexes. The strongest case of any cancer screen, because colonoscopy removes precancerous polyps in the same sitting it finds them. It begins at forty-five in the United States and at fifty or later in much of the world, and a stool test for hidden blood is the lower-burden alternative. The one large randomised trial of an invitation to colonoscopy, NordICC, enrolled 84,585 adults aged 55–64; over ten years, invitation cut colorectal cancer incidence by 18%, while colorectal cancer deaths did not differ significantly between the groups, and only 42% of those invited attended (New England Journal of Medicine, 2022). The benefit belongs to the person who actually goes. Because the disease is now rising under fifty, symptoms in younger adults are investigated rather than dismissed (Causes of Death).
Prostate, for men. The European randomised trial followed 162,236 men aged 55–69 for 23 years: PSA screening reduced prostate cancer deaths by 13%, one death prevented for every 456 men invited and every 12 diagnosed, while cumulative diagnoses rose from 12% to 14%, the overdiagnosis that turns harmless tumours into surgery and radiation (ERSPC, New England Journal of Medicine, 2025). The benefit is real and the harm is avoidable: PSA read in context and as a trend, never alone, and MRI before any biopsy, as Prostate-Health sets out. A man whose father or brother had prostate cancer, or who carries a BRCA2 variant, draws his first PSA at forty (Blood Tests).
Breast, for women. Surveillance, yes; mammography, no. The cancer protocol holds the reading: for every 2,000 women screened for ten years, about one avoids a breast cancer death and about ten are overdiagnosed and treated. Clinical and self-examination, ultrasound for dense tissue and a palpable finding, and annual MRI for women at high genetic risk carry the surveillance without repeated radiation.
Cervix. HPV testing on the standard interval finds a real, progressive and removable lesion with a wide window.
Lung. Low-dose CT for long-term heavy smokers reduces lung cancer deaths in the large trials, without a demonstrated gain in total lifespan, and its first requirement is that the smoking stop.
Skin. Periodic examination for melanoma, more often with fair skin, many moles or a family history, finds a cancer whose early excision is usually curative.
Diabetes (2.00 million deaths in 2023), chronic kidney disease (1.52 million) and cirrhosis (1.28 million) make up the metabolic block, 4.8 million deaths, and the count understates it: people with diabetes and failing kidneys most often die of heart attack and stroke and are counted in section 1. Most chronic kidney disease is caused by diabetes and high blood pressure.
Managing diabetes prevents kidney damage, neuropathy, retinopathy, and cardiovascular events. For Type 2 diabetes, improving insulin resistance is more fundamental than merely lowering blood glucose. Medications that suppress glucose without addressing the underlying metabolic dysfunction are treating the symptom while the disease continues. See Diabetes-Protocol for the root-cause reversal that makes them unnecessary — a taper the body’s own markers set the pace of, with the prescribing clinician engaged as the instrument of that taper, never a unilateral stop. Carbohydrate withdrawal on insulin, a sulfonylurea or an SGLT2 inhibitor is a pharmacological event, and the protocol opens with what that requires.
Where medicine enters. An HbA1c at or above 6.5% is diabetes, and diabetes with established cardiovascular or kidney disease is where the drug classes with cardiovascular and kidney outcome trials behind them, the SGLT2 inhibitors and GLP-1 receptor agonists, earn their place. Below that line, insulin resistance is the levers’ territory, and fasting insulin is the marker that shows it years before glucose does.
Kidney disease is silent until late, and two tests find it years earlier: the urine albumin-to-creatinine ratio and kidney function estimated from creatinine and cystatin C, both on the annual panel at Blood Tests. Once it is found, blood pressure control and, in diabetes or established kidney disease, the SGLT2 inhibitors slow the decline.
The liver is as silent. Fatty liver shows first in ALT and GGT, and fibrosis from the FIB-4 score, which combines age, the liver enzymes AST and ALT, and the platelet count, and sorts those who need an elastography scan from those who do not. Where fibrosis is moderate or advanced and cirrhosis has not yet set in, two drugs are now approved for metabolic steatohepatitis in the United States: resmetirom in 2024 and semaglutide in 2025 (Healio). The other two roads to cirrhosis are alcohol, whose target is zero at the levers, and viral hepatitis. A single hepatitis C test is recommended for every adult in the United States, and the infection it finds is now cured in more than 95% of cases by eight to twelve weeks of antiviral tablets.
Chronic lung disease killed 4.2 million people in 2023, 3.43 million of them through chronic obstructive pulmonary disease, the third single cause of death, which is overwhelmingly the disease of tobacco smoke and polluted air. Medicine has one intervention that changes its course, and it is stopping smoking; nicotine replacement and prescription cessation drugs raise the odds of success, and the evidence on e-cigarettes for the adult smoker sits at the levers. Pulmonary rehabilitation, supervised exercise for damaged lungs, restores breath and function that inhalers alone do not.
Alzheimer’s disease and other dementias killed 2.21 million people in 2023, the fifth single cause of death. Medicine’s entries are few and specific. Blood pressure control is the strongest, for the vascular half of dementia. Hearing aids are the most surprising: in the ACHIEVE trial they did not slow cognitive decline across the whole trial, but among older adults already at risk they slowed it by 48% over three years (ACHIEVE, Lancet, 2023). Hearing loss and untreated vision loss both sit on the Lancet Commission’s list of fourteen modifiable risk factors, and both are corrected in an afternoon.
Bone density by DEXA identifies the fracture risk that turns a fall into a terminal event, and what to do with the result, secondary causes first, then loading, then the pharmacological agents where a deficit and a fracture are already on the record, is held at Bone and Joint Health. The dental examination is annual, less for the teeth than for what the gums report about the terrain, which is carried at Oral-Health.
Trend-watching, which belongs to Monitor, is the right default and it has one exception: a small set of readings and symptoms are acted on the moment they appear, and none of them waits for a second measurement.