You’ve also likely heard that around 1 in 3 women and 1 in 2 men2 will develop heart disease. You’ve probably even heard that up to 90% of it is preventable.3 (Especially if you follow me on social media.)

As an actively-practicing, double-board-certified cardiologist, I’ve come to believe that these figures are so ubiquitous that they’re basically background noise now. Heart disease has somehow become something that just happens to people as they age.

As a culture, it feels like we’ve accepted widespread heart disease as inevitable. But I most certainly do not. And neither should you.

If we can, with today’s science, prevent 90% of heart disease — what would it look like if we were able to successfully DO that? What if we actually prevented all preventable heart disease?

How many lives would we save? How many good, healthy years could we give people back, to spend enjoying life with the people they love?

And perhaps the most important question: “If we can prevent 90% of heart disease, why the hell aren’t we?” Honestly, I could fill a year’s worth of Substacks trying to answer that question. Most contributing factors are entrenched, systemic, and massive. (e.g., our for-profit health insurance industry)

In any case, I personally believe that massive problems require radical solutions. They call for ambitious goals and audacious vision.

Audacious vision inspiration from Sweden

In college, my brother and I were broadsided by an 18-wheeler on a major interstate. After an overnight storm, the interstate was cleared of snow and open to traffic—though, as we’d later find out, authorities closed the highway not ten minutes after we’d driven onto it. It turned out the road was slick with black ice. When the massive truck hit the passenger side of our car, it actually carried us, pinned to its grille, for a mile and a half. Put simply: we shouldn’t have survived.

I'd begged my dad for a sporty sedan (the height of teen-girl cool in the early aughts), but it was a hard no. It was a Volvo or nothing, because “it's the safest car out there.”

My dad was right, and I credit that Volvo with saving our lives.

You might be wondering, “what does this have to do with heart disease?” Hear me out.

Volvo has led the industry in safety for decades, and it’s still chasing an audacious goal: zero deaths in a new Volvo.4 That was originally inspired by Vision Zero, a nationwide effort Sweden launched in the late 90s, aimed at reducing traffic deaths. They started with one question: how many deaths should we accept?5

They decided: zero. As one Swedish transport official put it, “We simply do not accept any deaths or injuries on our roads.”6 Reorienting their approach around doing everything possible to save everyone was remarkably powerful, and by 2010, road deaths had been cut in half.7

Again, I say: big, unwieldy problems call for audacious goals. How many preventable deaths due to heart disease should we accept? What does it look like if we, like the Swedes, were audacious enough to say “zero?”

A preventable American death every minute(?!)

Let’s do some quick back-of-the-envelope math. A 2013 CDC analysis estimated that at least 200,000 cardiovascular deaths a year could be prevented.8 That’s about 550 people a day, conservatively.

Now let’s go a little wider. Using that 90% figure from earlier, and knowing heart disease killed about 683,000 Americans in 2024,9 that’s roughly 615,000 lives a year.10 That works out to be more than one preventable death every single minute, around the clock.

As I said, back-of-the-envelope math. But any way you slice it, we have a mind-bogglingly enormous opportunity to save lives.

So why aren’t we preventing the preventable?

At a systemic level, our approach to heart disease prevention has been too conservative. We tell people we’ll “keep an eye on it.” We wait and see.

Thing is, I’m not a wait-and-see kind of person. And if you’re reading this, I have a feeling you’re not, either. I believe in aggressive prevention. Medicine tends to save the word “aggressive” for patients who’ve already had a heart attack or stroke, but I think it belongs years earlier. When it comes to the #1 killer, we should go after risk early and hard.

And good news! The advances in cardiology over the past couple of decades are incredible:

• CAC scoring: a CT scan that measures calcified plaque in your heart’s arteries

• Lp(a) testing: a one-time blood test for an inherited cholesterol particle that raises heart attack risk

• PCSK9 inhibitors: injectable medications that can cut LDL cholesterol by more than half, even on top of a statin.

• GLP-1s: drugs like semaglutide have been shown to cut heart attacks, strokes, and cardiac deaths by 20% in a major trial.11

Increasingly, official guidelines have caught up. In March, the new ACC/AHA guidelines called for treating cholesterol earlier and more aggressively, and for testing every adult’s Lp(a) at least once.12

Science is for everyone. It should help everyone, and theoretically, it absolutely can. Theoretically, it puts that audacious goal within reach.

But our system isn’t set up to connect cutting-edge science with actual healthcare, at least not on an individual level. Your insurance likely only covers ten-minute visits, once or twice a year, and only lets you see a specialist once you’re already sick.

Where I’m pivoting (and why)

The truth is, I can’t singlehandedly overhaul our nightmarish for-profit healthcare system. And as a physician, I believe my time is better spent directly helping and influencing people, not Congress. (I tried! But that’s a story for another day.)

I could stay in a broken system, earn a nice cardiologist paycheck, and do my best to save lives in a system that actively gets in the way of delivering quality care.

Instead, I chose the more audacious solution — strike out and build something new. Something that lets me deliver the best preventative care science has to offer.

#1 InfiniteHeart Health

First, I founded InfiniteHeart Health, a care model built on not waiting. Instead, it follows yet another audacious goal: do everything possible to lower each patient’s risk of a heart attack, stroke, or other major adverse cardiac event.

This approach takes time, far more than any insurance company will cover. My first visit with a patient often runs two hours, because that’s what I believe it takes to understand the whole picture.

We’ve helped hundreds of patients this way, but there are only so many hours in a day. The country loses more people to heart disease in a single day than I can treat in years.

We’re working on scaling out InfiniteHeart (with an incredible team of practitioners) so that we can treat as many people as possible. But helping individuals in a clinical setting can’t be the whole answer.

#2 Social & other media

When it comes to your heart health, doing some things is far better than doing nothing. So where I can’t treat someone as a patient, I still want to help them on an educational level. People need answers. The system isn’t giving them those answers, so they go looking — online, where they inevitably find a lot of noise. Not enough doctors and scientists are active on social media, and sadly, grift often fills that gap.

So I’m out there, doing my best to meet people where they are, and trying my best to fight misinformation, sometimes directly in the comments. 🫠

#3 The space in between

That brings me to the third piece, which starts right here on Substack. I want to create solutions for people who want to get serious about aggressive prevention, but who aren’t ready or able to become patients for whatever reason. Maybe you have a troubling family history, you’re in your 30s, and your labs still look great, but you want to get ahead of it. Maybe the InfiniteHeart Protocol isn’t in reach financially. Maybe you’re stuck with the heart care your insurance is willing to cover, which is rarely the best you can get. (That’s nobody’s fault but the system’s.) Maybe you simply want more info than I offer on shortform social media.

For you all, I’m building two things: on-demand courses, and this Substack, where I intend to do much deeper dives on popular social media topics like GLP-1s, statins, and the intersection of heart and hormones.

Courses are actively in development but still a WIP. After all, running a practice and making content both take a lot of time from me and my amazing team.

But here’s what I DO know. I want to teach you the science. And I want to help you advocate for yourself inside a broken system. More to come soon!

P.S. This is my first Substack post. If you enjoyed it, please share so more people can discover my work!