Updated: January 2026
The Four Horsemen
noun • Health & Longevity Context
Definition
The Four Horsemen refers to the four chronic disease categories responsible for approximately 80% of deaths in developed nations: cardiovascular disease, cancer, neurodegeneration (including Alzheimer's and dementia), and metabolic dysfunction (including type 2 diabetes). The term was popularized in longevity medicine to emphasize that these conditions share common root causes and can be addressed through integrated strategies rather than treated in isolation.
“The four major killers — cardiovascular disease, cancer, neurodegeneration, and metabolic dysfunction — share common root causes that are largely preventable. The strategies that address one typically benefit all four.”— Dr. Peter Attia, longevity physician and author of Outlive (2023)
The Four Categories
Cardiovascular Disease
17.9M deaths/yearHeart disease, stroke, and other conditions affecting the heart and blood vessels. The leading cause of death globally.
Source: WHO, 2023
Cancer
10M deaths/yearMalignant diseases characterized by uncontrolled cell growth. Over 200 distinct diseases share this classification.
Source: WHO, 2023
Neurodegeneration
55M living with dementiaProgressive loss of neuron function, including Alzheimer's disease, Parkinson's disease, and other forms of dementia.
Source: WHO, 2023
Metabolic Dysfunction
537M adults with diabetesConditions including type 2 diabetes, obesity, and metabolic syndrome. Often the root cause accelerating the other three.
Source: IDF, 2023
80%
of deaths in developed nations are caused by these four categories
Up to 45% of these conditions are preventable through lifestyle intervention.
Source: Lancet Global Health, 2024
Shared Root Causes
The Four Horsemen share several underlying mechanisms that accelerate disease progression:
This interconnection explains why interventions targeting one condition often improve markers for the others — and why a systematic approach to health optimization produces better results than addressing each disease in isolation.
Related Terms
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