Cardiovascular Disease: It's Time to Rethink Prevention

Let’s begin with a wake-up call.

Cardiovascular disease (CVD) remains the leading cause of death worldwide—and it doesn’t discriminate. In the U.S., it claims more lives than any other condition, affecting both men and women. One in five CVD deaths occurs in adults under 65. In the time it takes you to read this, 15 Americans will suffer a heart attack.

Each year, 800,000 people in the U.S. have heart attacks. About 10% are fatal. Of the survivors, 26% of women and 19% of men will die within 12 months.

And the economic burden? Over $400 billion every year.‍

So the question is: What are we doing about it?‍

And maybe more importantly: Is it enough?

Prevention Needs a Paradigm Shift

Once we grasp how widespread, deadly, and costly CVD is, we have to ask: Are our prevention strategies actually working?

Let’s zoom out.

Each year, around 400,000 people in the U.S. are diagnosed with breast or colon cancer combined. We prioritize routine screening for both—with mammograms recommended every two years for women aged 40–74, and regular colonoscopies or stool-based tests for adults 45–75.

And yet, for CVD—the #1 cause of death—our screening strategies are far less aggressive.

Why?

The Flaws in Traditional Risk Assessment

The American Heart Association recommends assessing CVD risk with a 10-year ASCVD score. It factors in age, sex, cholesterol levels, blood pressure, smoking status, and diabetes.

Helpful? Yes.
Comprehensive? Not even close.

What it doesn’t consider:

• Family history of heart disease
• Weight or BMI
• Lifestyle factors like diet, exercise, or alcohol use
• Inflammatory markers or genetic predispositions
• Advanced lipid testing

And it only predicts risk over the next 10 years.
But if you’re in your 40s, 50s, or 60s, are you only trying to avoid a heart attack in the next decade—or are you aiming for long-term vitality?

Let’s be honest: relying on outdated, limited tools is like bringing a knife to a gunfight.

Redefining Prevention: Let's Go Upstream

If we really want to prevent heart attacks, we need to start earlier and smarter.

Let’s reverse-engineer a heart attack:

• At the final stage, there's a cardiac event.
• One step back, we might use a stress test—but guidelines don’t recommend this unless you’re already showing symptoms.
• Go further back, and you’ll find the coronary artery calcium (CAC) scan—a non-invasive tool that reveals even early signs of calcified plaque.

The CAC scan can detect silent, developing disease years before symptoms appear. Yet, it’s underutilized, weakly recommended, and rarely covered by insurance despite costing $99 or less.

By the time plaque shows up on a CAC scan, it's likely been forming for a decade or more.

Need more proof?
Autopsies of young adults (average age 26) who died of non-cardiac causes found that 78% already had coronary artery disease, and 1 in 10 had a critical blockage.

And still—we don’t screen for CVD the way we do for cancer.

It’s like trying to mop up a flooded house without turning off the faucet.

CAC scans have allowed me to uncover hidden heart disease that might otherwise go detected. I’ve used it to save lives and prevent heart attacks. One patient in particular stands out, a 60-year-old man with a strong family history of heart disease. On the surface, he was the picture of health: fit, proactive, and feeling great, but his CAC score revealed high risk results. That single $99 test led to a cardiac catheterization and ultimately life-saving open-heart surgery. Even more striking is that with the advanced screening techniques I’ll discuss next, this could have been identified earlier and intervened on before his disease ever reached this critical stage.

A Holistic, Personalized Approach

Most cardiologists are trained to manage disease, not prevent it. To change outcomes, we must go deeper and address the root causes of CVD.

That starts by evaluating:

1. Endothelial function
2. Oxidative stress and inflammation
3. Lipid-related damage beyond standard cholesterol tests

These insights are already accessible with advanced diagnostics—but they’re not reflected in traditional guidelines, and often not covered by insurance.

For instance, 20% of people have a genetic variation in cholesterol that is not tested on traditional blood work and does not respond to statins—the most commonly prescribed cholesterol medications in the U.S.

The Bottom Line

Here’s the good news: CVD is largely preventable.
And the power is in your hands.

Simple, daily choices can create lifelong impact:

• Eat more nutrient-rich foods
• Move your body regularly
• Prioritize quality sleep
• Manage stress intentionally
• Get tested—early and thoroughly

This journey is personal. Doctors should act more like architects or financial consultants—helping you design a health strategy that fits YOUR vision as opposed to telling you what the vision should be.

So ask questions. Be curious. Advocate for yourself.
Because when it comes to heart health, prevention isn’t just powerful—it’s life saving.