Chapter 1: Why I’m Writing This Book
Protect Your Heart, Prevent Stroke and Beat Vascular Dementia After 55
Year after year, 600,000 Americans become victims of largely preventable first heart attacks. It's a sobering statistic that despite the tremendous cost in human lives and huge economic burden, this epidemic is allowed to continue. We will examine why.
After twenty years of practicing traditional cardiology, which primarily focuses on diagnosing and treating advanced, symptomatic heart disease—often when patients present with an acute heart attack—I became convinced that there was a better way. That was in 2001.
My Personal and Professional Journey into Prevention
My journey into preventive cardiology didn’t happen overnight. Early in my career, I practiced in a traditional setting, treating patients only after they developed symptoms of cardiovascular disease. Like most cardiologists, my primary responsibility was diagnosing heart disease after it presented—whether it was through chest pain, shortness of breath, or worse, a heart attack. It was a reactive approach, where I could only intervene after the damage had already begun.
But in the early 2000s, I became aware of emerging research and medical advances that completely changed my perspective. Studies showed that coronary artery calcium (CAC) scoring could detect the presence of coronary plaque early, long before symptoms appeared. This was a game-changer. Along with these detection tools, drug therapies such as statins, aspirin, and antihypertensive medications had been proven to significantly lower the risk of heart attacks in high-risk patients by stabilizing and even reversing coronary plaques. I realized that instead of waiting for patients to suffer a heart attack, I could act earlier—detecting and treating disease before symptoms developed. The shift from reactive to proactive care became the cornerstone of my practice.
Shifting My Practice to Aggressive Prevention
In 2001, I fully embraced aggressive prevention. Every patient encounter became an opportunity to prevent a future heart attack or stroke. Using coronary calcium scoring for reliable risk assessment, I began detecting silent plaques in the arteries of high-risk patients. With this early detection, I could implement preventive therapies to stop the progression of disease before it caused an acute event. This approach wasn’t about quick fixes or temporary solutions; it was about long-term prevention and helping patients avoid the devastating consequences of heart attacks and strokes.
I was encouraged that in 2004, Dr. Wolk, the president of the American College of Cardiology, posed the question to its members: The Promise of Prevention - So, Why Aren’t All Cardiologists Preventive?
Like it or not, prevention is inevitable. But there was just so much invested in interventional treatment that prevention will have to wait.
To ensure consistent success, I developed a numerical goal-oriented clinical management system that guided treatment decisions. This system emphasized achieving specific targets for each patient, including optimal cholesterol levels, blood pressure control, and lifestyle modifications. By closing the treatment gap—ensuring that patients consistently received the care they needed—I watched as heart attacks and strokes became rare events in my practice.
After eleven years of status quo, I was hoping that positive changes will begin to emerge when Dr. Kim Williams made this statement: “It is time to turn off the faucet instead of just mopping the floor.”
While many agreed with him, insurers continue to block access to calcium scoring.
A Struggle Against the System
Despite the success I was seeing, I knew that prevention wasn’t the norm in most medical practices. I wanted to bring this approach to more people, so I began meeting with hospital CEOs to advocate for creating heart attack and stroke prevention programs in their hospitals. I believed that, by focusing on prevention, we could save thousands of lives. But what I encountered was a harsh reality: hospitals weren’t interested in prevention. The CEOs I met with told me that insurers only reimbursed for treating heart attacks and strokes, not for preventing them. To my dismay, they said that prevention didn’t make financial sense for them—they made money by treating heart disease, not by stopping it before it occurred.
This is the hospital charge for a 4-day hospitalization for an acute heart attack which included deployment of four stents. What is your “out-of-pocket” cost if you do not have Medicare?
It is not surprising that medical debt is the most common cause of personal bankruptcy. For hospital CEOs, preventing heart attacks does not make economic sense.
The opposition I faced from the healthcare system made me realize just how entrenched the focus on treatment over prevention was. It felt like David fighting Goliath. I was advocating for a system that valued patient outcomes over profits, but the financial structure of healthcare rewarded hospitals for performing stents and bypass surgeries, not for keeping people healthy.
Furthermore, the insurer’s denial for coverage for calcium scoring disproportionately impacts lower-income individuals who may not the means to pay for the test out-of-pocket. This exacerbates healthcare disparities and creates a healthcare dilemma - should a person’s ability to afford a potentially life-saving diagnostic test determine their access to early prevention? Such practices by insurers may result in avoidable harm to individuals who could benefit from early medical intervention but are denied that opportunity due to financial barriers.
Negligence in Denying Access to Calcium Scoring: The “Mammogram for the Heart”
If mammography is considered a standard of care for early cancer detection, calcium scoring should be viewed as the “mammogram for the heart,” playing an equivalent role in preventing heart disease. Both tests are non-invasive, safe, and capable of identifying diseases before they become symptomatic, allowing for early treatment. In fact, coronary artery disease is the leading cause of death worldwide, surpassing even cancer, yet insurers continue to downplay the importance of calcium scoring in routine prevention.
Just as it would be unacceptable to deny a mammogram to a high-risk woman, it is ethically and medically irresponsible to deny calcium scoring to a patient at intermediate or high risk for cardiovascular disease. By failing to cover this test, insurers are allowing heart disease to progress unnoticed in patients who could benefit from early intervention.
The cost savings from reduced heart attacks, strokes, and long-term disability would be distributed across all insurers, helping the healthcare system as a whole including Medicare, save money in the long run. No one insurer would be disadvantaged by being the one to pay for preventive care while another benefits from the improved patient outcome.
Results Speak for Themselves: Princeton Preventive Cardiology
Despite the resistance, I knew that prevention was the future of cardiovascular care. I established Princeton Preventive Cardiology and implemented my clinical management system in full. In 2006 and 2016, I published data on LDL cholesterol treatment success rate. The results were striking: heart attacks, strokes, heart failure, and hospitalizations for cardiac events declined steadily. After five years, these events became rare, and after ten years, they were almost unheard of in my patient population.
Reaching a Wider Audience
While my practice was thriving, I knew that educating the public and primary care physicians was essential to spreading the message of prevention. I created websites, produced YouTube videos, and shared my knowledge wherever I could. But now, I’m taking things to the next level with this video-enhanced ebook. Combining written content with short videos, this book will reach more people than ever before, providing clear, actionable information to help them prevent heart attacks, strokes, and vascular dementia.
My journey into prevention was personal, but now it’s time to share that journey with the world.
Conclusion: Why This Matters to You
The purpose of this book is to arm you with the knowledge you need to take control of your own health. You don’t have to wait for a heart attack or stroke to strike before taking action. The medical system might not prioritize prevention, but you can. By understanding the financial incentives that drive healthcare and taking proactive steps, you can prevent heart disease, protect your brain, and enjoy a long, healthy retirement.