Heart Disease Is Preventable. So Why Does It Kill So Many of Us?

For more than a century, cardiovascular disease has remained the leading cause of death in the U.S. Yet these last 100 years have also brought about incredible medical advances that have transformed our ability to treat cardiovascular disease with life-saving devices such as stents, implantable cardiac defibrillators, and heart pumps, alongside breakthrough medicines. We understand today, more than ever, the importance of nutrition, physical activity, and sleep for cardiovascular health. But in 2024, more than 900,000 people in the U.S. died of cardiovascular disease—which is more than the number of Americans killed by cancer and accidental deaths, combined. 

So why can’t we prevent cardiovascular disease more effectively?

The evidence for what causes most cardiovascular disease today is very clear. A recent study that my colleagues and I published in 2025 identified that more than 99% of people who had a heart attack, stroke, or heart failure had at least one cardiovascular risk factor in the years prior. These results leave no doubt that unlike many other diseases, cardiovascular disease is preventable. But we keep failing to recognize and treat risk factors earlier, such as hypertension, high cholesterol, diabetes, chronic kidney disease, and tobacco use. 

Risk for most cardiovascular disease builds over years and often over decades. Yet we seem to be caught off guard when it happens; these heart events are often viewed as sudden or unexpected.

What if we could, years or decades before, predict the likelihood that a cardiovascular event may happen? In fact, we can: the science, data, and tools are now available to do just this. A few years ago, my colleagues and I led an effort for the American Heart Association to develop the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations, a new calculator released in 2023 to predict risk for cardiovascular disease. The PREVENT equations can predict a person’s risk for having a heart attack, stroke, or heart failure over the next 10 or 30 years. This calculator is now endorsed by the most recent national guidelines for cholesterol and blood pressure management released by the American Heart Association, the American College of Cardiology, and collaborating societies. These guidelines recommend clinicians use the PREVENT calculator for patients ages 30 to 79 to estimate their risk of cardiovascular disease.

Read More: How to Keep Your Heart Healthy in Your 20s, 30s, 40s, and Beyond

However, it is human nature for all of us to procrastinate, and our cardiovascular health isn’t any different. It’s easy to feel like heart health is a problem to deal with in the future—especially since we are talking about preventing something that may happen years or decades down the road. 

It doesn’t help that the leading risk factors that may already be present today are often silent. You may not even know your blood pressure is high, your glucose levels are abnormal, or your cholesterol levels are elevated. But that doesn’t mean the damage to your blood vessels and heart isn’t building over time when left untreated. Just as you start planning for retirement decades in advance, your health requires the same early and proactive investment.

Using the PREVENT calculator to measure your risk is a great first step, but protecting your heart doesn’t end there. Risk calculators are not perfect, and the PREVENT calculator isn’t for people who already have heart disease. Your unique circumstances will guide what comes next. Sometimes imaging may be needed, such as a computed tomography (CT) scan to check the arteries for calcium, for people with borderline or intermediate risk. Doctors may pay closer attention to heart health in particular stages of life for women, such as during and after pregnancy and menopause. Genetic testing based on your family history may help physicians, too. 

Read More: 9 Weird Symptoms Cardiologists Say You Should Never Ignore

Once you have a better understanding of your risk, you can develop an action plan with your doctor or clinician to help identify how best to modify your risk to prevent cardiovascular disease. This can include dietary changes, a new exercise routine, or medicines like cholesterol-lowering statins. Lastly, focusing on your heart health is a life-long activity. You should continue to monitor your cardiovascular health no matter your risk level. To do this, the American Heart Association created the My Life Check tool that can help you check out your health habits and get tips for how to improve them.

But we also must recognize the hard truth that sometimes, risk for developing cardiovascular disease isn’t entirely within a person’s control. An individual’s risk for cardiovascular disease is impacted by so much more than their own biology, including the environment around them. Access to healthy food, safe spaces, time to exercise, and affordable health care are critical. Prevention of cardiovascular disease is not just an individual-level responsibility. It is our collective societal obligation and requires that we come together to work towards building systems and policies that address these barriers.

We have to stop treating cardiovascular disease as unexpected or inevitable. It is predictable and preventable. The science is unequivocal. But we are waiting too long and falling behind. Recent projections suggest that more than 40 million Americans will be living with cardiovascular disease by 2050 if current trends continue. 

To be successful, our mindset has to shift from a reactive one—waiting to rescue people once a cardiovascular event occurs—to a proactive one that prioritizes preventing cardiovascular disease from happening at all.