No one is immune to heart disease. The American Heart Association reports 600,000 deaths per year due to heart disease, the leading cause of death in both men and women. We see 720,000 heart attacks and 800,000 strokes each year. The annual cost for cardiovascular disease is estimated at 108.9 billion dollars. Unfortunately, we are treating most of this vascular disease with end of the line therapy. We use stints to open arteries and perform numerous heart bypass operations in which new vessels are sewn into the heart. Don’t get me wrong. Lives are saved by these operations which are often done on an emergent basis. It’s just that we do so many procedures that could have been prevented by better coordination of preventive efforts and application of advanced heart testing. Unfortunately new cholesterol treatment guidelines are not very helpful being based on another unreliable risk calculator. The likely result is the increased use of statin therapy for primary prevention in those who will not benefit and leaving some patients off appropriate therapy. Fortunately, new testing is available which allows us to make a truer estimation of risk, a more informed use of medicine and the ability to follow the results of therapy (both medication and lifestyle) and adjust if progress is not made. The new testing involves inexpensive and safe imaging studies and both blood and urine tests which give far more specific information than ever before. This allows the thoughtful and informed physician to make better decisions to either prevent or reverse heart disease, stroke and all other vascular diseases. I’ve never been more excited or optimistic about prevention. Stay tuned for helpful discussions on all of this.