INTRODUCTION

As a preventive cardiologist with decades of experience, I’ve spent my career on the frontlines of the battle against heart attack —condition that is, tragically, all too common yet largely preventable. The same medical treatment that prevents heart attack also prevents stroke and vascular dementia - an added bonus. Over the years, I’ve seen firsthand the devastating impact these diseases have on individuals and families, especially as they approach what should be their most fulfilling years: retirement.

But here’s the truth many people don’t know: heart attacks, strokes, and vascular dementia are not inevitable consequences of aging. These are diseases we can prevent, and the earlier we act, the better our chances of living long, vibrant, and healthy lives. This book, "Forever Young: Protect Your Heart, Prevent Stroke and Beat Vascular Dementia After 55," is my response to the persistent misconceptions about aging and heart disease, and to shine a light on the role of the health insurers in promoting chronic cardiovascular disease rather than preventing them. It’s not about slowing down or resigning ourselves to the aches, pains, and limitations of getting older. Instead, it's about empowering you with the tools and knowledge to take control of your health, no matter your age.

In addition to improving your health and quality of life, early prevention can also significantly reduce the financial burden on our healthcare system—particularly on Medicare and Medicaid. Detecting vascular plaques early, through coronary artery calcium (CAC) scoring, and initiating multifaceted medical therapy before the age of 65 can stop a heart attack before it happens. This approach can not only save lives but also prevent costly hospitalizations, surgeries, and long-term care, alleviating the immense financial strain on public health systems.

Throughout my career, I’ve worked to bring cutting-edge medical science to the forefront of cardiovascular health. I’ve developed systems of care to prevent heart attacks before they happen, advocated for early detection methods like coronary calcium scoring, and challenged the traditional healthcare model that waits until a crisis occurs before acting. If we catch these problems early enough, we can drastically reduce the number of heart attacks, strokes, and cases of vascular dementia that occur later in life, which not only benefits individuals but also keeps our healthcare system sustainable by lowering costs for Medicare and Medicaid.

But prevention isn’t just about clinical tests and medications—it’s about embracing a multifaceted approach that includes lifestyle changes, informed medical decisions, and an understanding of how the choices we make today can impact our health decades from now. In this book, I’ll guide you through the science of prevention, drawing on the latest research, clinical trials, and my own experience working with thousands of patients to reduce their risk of heart disease, stroke, and vascular dementia.

Why Choose Age 55, not 50 or 60

We chose age 55 because it’s the ideal time period to start to identify silent heart disease before it causes serious problems. Approximately 20% to 30% of men have a heart attack before the age of 65. And while the plaque-stabilization benefit starts within weeks of the initiation of optimal medical treatment, maximum plaque-regression benefit may take as long as five years.

This means that while the majority of heart attacks in men occur around or after age 65, a significant portion happens earlier, which is why preventive measures starting at 55 are so crucial to catching and addressing silent heart disease before it becomes life-threatening. Starting at 55 gives us a full decade to stabilize dangerous plaques, prevent their growth, and even reverse them. And we should anticipate that some will wait until 60, and even in that situation, we still have sufficient time to get the benefits of medical therapy. The same medical treatments that prevent heart attacks also help prevent strokes and vascular dementia. By the time people reach Medicare at 65, the goal is to have their plaques stable, reducing the likelihood of heart attack, stroke, and vascular dementia in their retirement years ahead.

How This Book Will Develop Dynamically Section by Section, Chapter by Chapter

This book will take a structured approach, with each chapter building on the previous one, giving you a comprehensive understanding of heart disease, stroke, and vascular dementia prevention. Each chapter will break down key concepts, such as early detection of vascular plaques, the importance of controlling risk factors, and the power of lifestyle changes. But what makes this book truly unique is how I’ve chosen to blend text and video for a more dynamic learning experience.

• Hyperlinks and Thumbnails: In certain sections, you’ll find hyperlinks accompanied by thumbnails at the end of a section. A double-click on these links will take you directly to a short YouTube video that provides additional explanations, clarifies complex concepts, or shows demonstrations of practical steps you can take to improve your health. These videos will help break down the science into digestible, easy-to-understand segments, reinforcing the written content and helping you take action with confidence.

• Comments and Discussions: I also invite you to engage with this material by sharing your comments and insights. Each chapter will have a section where readers can contribute feedback, ask questions, and even suggest areas where more clarity is needed. These meaningful exchanges will help foster a sense of community around this important topic, while also giving me the opportunity to refine and improve the final version of the book before publication. Your contributions will be invaluable in making this resource as effective and helpful as possible.

• Fighting Medical Misinformation: In today's world, access to health information is easier than ever before, thanks to platforms like YouTube and social media. However, along with valuable, evidence-based insights, there has been a troubling rise in medical misinformation—false or misleading information that can have harmful consequences for individuals who rely on it. This misinformation is especially dangerous when it comes to chronic diseases like cardiovascular disease, where adherence to proven treatments can mean the difference between life and death. There are several harmful consequences of medical disinformation: reduced medication adherence, increased cardiovascular risk and undermining trust in healthcare providers. Our goal is to arm you with the knowledge you need to make informed decisions about your health and to recognize misinformation when you see it.

I’ve also decided to build a community around this book—because prevention isn’t something we should navigate alone. By sharing sections of this book online, I’m inviting readers like you to provide feedback, ask questions, and contribute to a growing conversation about how we can live longer, healthier lives without fear of the diseases that too often steal our futures.

This book is a personal mission for me. Over the years, I’ve developed clinical approaches that have helped countless patients prevent heart attacks, avoid unnecessary procedures, and live well into their 80s and 90s with full vitality. Now, I want to share these insights with you. The time to act is now—whether you're 55, 65, or 75. Prevention works best when we start early, but it's never too late to make a difference in your health.

Let’s take this journey together, using the power of science, practical wisdom, and real-life tools to ensure that your best years are still ahead of you. Together, we can live a full life without heart attack, stroke and vascular dementia—while also contributing to a more sustainable healthcare system for future generations.

Rolando L. deGoma, M.D., F.A.C.C., F.N.L.A.

Preventive Cardiologist - Lipidologist