In investing, we spend thousands of hours obsessing over the rate of return. But we often ignore the most critical variable in the compounding equation: Time. And if that goes to zero, the rest of the math doesn’t matter.
Recently, I realised that while I was managing my portfolio with extreme discipline, I was allowing a ‘Black Swan’ event to build up inside my own body. I am sharing these personal details because, as investors, we are in the business of survival. If you don’t manage your biological risk with the same rigour you apply to your financial risk, you are leaving your most important asset unprotected.
So, in a recent post, I shared about my heart stenting experience. Since then, I’ve had many people reach out with questions like:
- How could it happen to you?
- How did you catch the blockage?
- Were there warning signs?
- What tests actually matter?
I want to answer those questions as simply as possible. I’m not a doctor, but I’ve just had a crash course in “reality,” and there are things I wish I’d understood much earlier.
We’re conditioned to think a heart attack looks like a movie scene, where someone is clutching their chest and collapsing. For me, it was simply a persistent discomfort while walking. It wasn’t “pain” in the traditional sense, but a tightness, a sense that something was just off.
In behavioural finance, we call this Normalcy Bias, which is the tendency to underestimate the possibility of a disaster because it has never happened before. Because I could still function and work, it was incredibly easy to rationalise the red flags away. But I decided to stop guessing and start connecting the dots.
The Data: A “Lollapalooza” of Risk
Charlie Munger often spoke about the Lollapalooza effect, when a few forces all move in the same direction at once, the result isn’t just additive, but explosive. That’s what was happening inside me:
- Calcium Score (My score: 83): Two years ago, a Coronary Artery Calcium (CAC) scan showed a score of 83. In a young person, you want a 0. This was the “rust” in my pipes.
- Inflammation: I have an autoimmune condition that keeps my inflammation (hs-CRP) slighly elevated (around 5-6 mg/L; should be <1 mg/L). If plaque is dry wood, inflammation is the match that lights it.
- Family history: My grandfather had a cardiac arrest when he was 60. My father suffered a heart attack at 64. If your parents or siblings had heart issues early, your timeline is different. What usually happens to people at 70 might happen to you at 45.
Individually, these were concerns. Together, they created a Lollapalooza of risk that led to a couple of blockages (70-80% and 80-90%) in my LAD artery, which is crucial for supplying oxygen-rich blood to the front of the heart. A blockage here is often fatal, which is why it’s called the “widow-maker.”
I was lucky to get a diagnosis before an “event.” I had an angioplasty—a procedure where doctors use a tiny balloon to open the artery and place a stent (a small mesh tube) to keep it propped open. It’s an incredible mechanical fix that cleared my LAD. But once the mechanical fix was done, the question remained: Why did this happen to someone like me?
The “Aha!” Moment
Post-stenting, and after some research, I decided to get an Lp(a) test done, and my score came back at 462 nmol/L.
To put that in perspective, most doctors consider anything above 75 to be elevated or high risk. My number wasn’t just high; it was in the extreme tail of the distribution. It turns out that an Lp(a) of 462 puts me in the 99th percentile globally.
In simpler words, if I stood in a room with 100 random people, I would likely be the only one with a level that high. I have been telling my wife all these years what a “rare breed” I am. Now I have a number to prove it!
Finding this out was my “Aha!” moment. It explained why my calcium score was high and why my arteries were struggling despite my best efforts.
Lp(a) is a genetic, “sticky” cholesterol that acts like Velcro, trapping fat in your artery walls. It’s not something you can fix with more salads or more cardio. It’s a hardware issue.
Destroying My “Best-Loved Ideas”
This new data point is exactly why I had to follow Charlie Munger’s advice and “destroy my own best-loved ideas.” I had been deeply averse to taking statins (cholesterol-lowering medicines) for years, worried about the long-term side effects.
But when the facts changed, I had to change my mind. For someone in the 99th percentile of genetic risk, I now realise a statin is a necessary tool to level a very uneven playing field.
I’m not panicking about that 462 LP(a) score. I can’t change my genetics, but I can change my strategy to match the reality of the map. As Munger would say, I’m focusing on the “net positive” and controlling the variables within my reach, which include my medication, my monitoring, my insulin, blood pressure, and inflammation levels, and my awareness.
A Note on Luck and Hope
In investing, I often talk about the massive role that luck plays in our outcomes. Health is no different. I was lucky to experience that discomfort, and lucky to catch a “widow-maker” blockage before it became “eventful”.
In the market and in the body, you can have a great process and still get a bad result. But having a great process, combined with a lot of good luck, is the only way to tilt the odds in your favour.
To anyone else who finds themselves in the “99th percentile” of risk: have hope. This Lp(a) has likely been in my blood since I was five years old. The fact that I made it to 47 before needing intervention is proof of the body’s resilience and the “buffer” my lifestyle provided. Now that the “invisible enemy” has been identified, the game has changed.
We aren’t walking in the dark anymore. Science is moving fast, and our job is simply to “stay in the game” by controlling the controllables until the next software patch for our genetics arrives.
What I’d Want You to Know (Especially If You’re Under 45)
[Disclaimer: I am not a doctor. This is a personal account of my experience and research, not medical advice. Always consult with a medical professional.]
- Don’t wait for “classic” symptoms. If you feel weird tightness when you exercise or walk, get it checked. Don’t let Normalcy Bias be your downfall.
- The standard blood test is just the cover of the book. Most doctors only check the basic lipid profile (Total, LDL, HDL Cholesterol). At least once in your life, ask for an Lp(a) and ApoB test. Also check your fasting insulin, HbA1c, and hsCRP. These could save your life.
- A CAC scan is a reality check. If you’re over 35 and have a family history, get one. A score of 0 is peace of mind. A score like mine (83) is an early warning to change course.
- Take care of your metabolic health. Most cardiovascular problems are aggravated by high glucose and insulin levels, driven by the modern lifestyle we lead. Even if you look fit, high insulin acts like an accelerant, damaging the inner lining of your arteries and making it even easier for plaque to take hold. My fasting insulin that stood at aropund 22 µIU/mL a year ago, is now at 7 µIU/mL, and I’m trying to get it below 5 µIU/mL. A normal fasting insulin level is typically below 25 µIU/mL, but optimal levels for healthy individuals are often considered to be 2 to 10 µIU/mL.
- Fitness is not a shield. You can be a gym rat and still have “sticky” blood and inflamed arteries. Internal health and external fitness are two different things.
Charlie Munger said:
Every time you think some person or some unfairness is ruining your life, it is a very small step to thinking your own life is being ruined. It is a disastrous way to think.
Instead of seeing my 462 LP(a) as a “curse” that will ruin my future, I see the discovery as the ultimate gift.
A way to think of it is that I have survived 100% of my bad days so far (that’s around 15,370 days since I was five). What else can you ask for in life?
If sharing my “dots” helps you connect yours, then this journey was worth it. Thank you for reading.
— Vishal
P.S. Since this happened, I have received a lot of messages from family and friends asking: “How could this happen to you? You were always the one trying to stay fit and taking care of your health!” My reply to them is that things can happen even when you try to take care of everything else. Some things, like genetics, are simply outside our control. And don’t forget the role of luck. But that doesn’t mean we give up on the variables that are inside our control.
