Ageing: the biggest modifiable risk factor for disease?

He sits across from me and I can feel a knot build in my stomach as he struggles to explain what has changed. 

“Look, I don’t smoke. My blood pressure’s fine. I exercise when I can. But I don’t feel right Doc. Everything is just a bit harder than it used to be.”

There’s no single diagnosis to reach for. No medications to be tweaked. No abnormal blood result that needs action. So the consultation ends, with the conclusion that there is no illness at play; a conclusion that should be reassuring, but seldom is. 

What he is experiencing isn’t unusual, and it's not mysterious. It is ageing, unfolding biologically long before it qualifies as disease. 

Healthcare rarely talks about this directly. 

We talk about cholesterol, diabetes prevention, cancer risk, and managing blood pressure to avoid a stroke. These are treated as separate problems, each with its own pathway and solution. Yet, ageing sits underneath it all, viewed as a quiet passenger on our journey through life, rather than the driver itself. 

Ageing is the strongest risk factor for most chronic diseases. This is such an obvious factor, it feels redundant to type it out. The increase in risk after midlife accelerates rapidly, steering us towards cardiovascular disease, metabolic dysfunction, neurodegenerative disease and cancer and whilst this is well described in epidemiological data, the fact is poorly integrated into how we deliver care. 

Part of the problem is how ageing is understood. 

It’s framed as time passing, instead of the cumulative biological changes that take us there. DNA repair becomes less reliable. Mitochondrial function declines. Inflammatory signalling increases. Immune processes become less regulated. Cellular waste collects without removal. These shifts begin years before symptoms appear and decades before a diagnosis is made.

By the time disease is visible, the underlying trajectory has already been established, often for a long time.

But these processes aren’t fixed. They’re influenced by how people live, sleep, move, eat. They’re shaped by our individual risks, our genetic makeup, our family history, our medical history, our unique metabolism and gut microbiome and the environment within which we live and work. Each of these shape how quickly biological ageing progresses. It’s observable, measurable and it can modified , even if thai sits awkwardly outside traditional models of care.

When the rate of ageing slows, risk doesn’t just fall for one condition. The risk of long term disease reduces across multiple systems at once, whilst restoring our sense of strength, energy and vitality in the present too. Despite the biological truth of this, this is rarely how prevention is discussed within the NHS and it creates tension with how healthcare is organised. The whole of the health system, from medical ‘specialties’ and hospital departments, to funding streams and pharmaceutical investment, is built around a disease-specific model.  Addressing ageing requires longer time horizons and the realisation that long-term coaching, personalised health planning, biological tracking and environmental change will deliver far more than prescriptions and hospital referrals for the majority of people. It also exposes the limits of a system built around late intervention. 

Most people I see are not trying to extend life indefinitely. They want to function well, stay independent and avoid a slow, silent drift into illness whilst being told "everything looks normal”. If prevention is taken seriously, ageing can’t remain an after thought. It’s the largest modifiable risk factor for disease, and continuing to treat it as inevitable is a choice rather than a neccessity. 

EverHealth is a private clinic supporting long-term health, performance and resilience through evidence-based longevity medicine. Appointments are now available in Chester, UK. 

Visit everhealthclinic.com to view our Longevity Programmes and for new bookings.