A randomized trial of 213 adults with stable ischemic heart disease found that a pressure pain sensitivity (PPS)-guided intervention reduced major cardiovascular events by 56% over five years compared to controls. The intervention group experienced events in 19.8% of participants versus 43.8% in controls (odds ratio 0.32). The three-month program involved daily self-measurement of pressure pain sensitivity at specific body points, cutaneous nerve stimulation, mental and physical exercises, and telemedical support, followed by self-directed continuation. This builds on two decades of research suggesting pressure pain sensitivity reflects central autonomic nervous system dysfunction, a shared risk factor in heart disease and diabetes. The intervention's appeal lies in its simplicity and low resource requirements, potentially offering an accessible complement to standard cardiac care. However, several factors warrant caution in interpreting these results. The study population was relatively small, and the mechanism linking pressure sensitivity to cardiovascular outcomes remains incompletely understood. As this is a preprint awaiting peer review, these promising findings require validation through independent replication and scrutiny of methodology before clinical implementation. If confirmed, this approach could represent a paradigm shift toward personalized, biomarker-guided interventions in cardiovascular prevention.