 medical myths and dogmas die hard. Researchers creating a new body of knowledge for prevention and control of heart disease had to disprove and displace a bunch of doozies. Like we used to think that heart disease was just an inevitable consequence of aging, or that cholesterol and blood pressure just naturally go up as we age. All these are now bygone notions, refuted by massive data. But other long-standing myths and dogmas about a number one killer epidemic persist. For example, this notion that major risk factors like cholesterol account for a minority of risk, and that many people have heart attack with no risk factors, so it's just kind of a crap shoot. Not much we can do about it. Wrong. There are rare genetic conditions that give people high cholesterol, no matter what they eat, but such genetic defects occur in no more than 1 in 200 people. This means, of course, that most persons with atherosclerosis acquire it by what they put in their mouth. The Interheart Study showed that for men and women, old and young, in all areas of the world, nine potentially modifiable factors like diet, exercise, and smoking accounted for more than 90% of the proportion of the risk of having a heart attack. And this has been confirmed in prospective studies. Follow men over time and those making healthy lifestyle choices associated with a 90% drop in risk. And with women, 92% of the risk gone. Same with diabetes, 91% of cases could be attributed to bad habits and behaviors. And the same healthy lifestyle, which includes not smoking, eating healthy diet, exercise, and maintaining an optimal body weight, may reduce the risk of multiple chronic diseases at the same time, not just heart disease and diabetes, but stroke as well. Up to 80% of strokes avoidable, with simple lifestyle changes. How does this all compare to drugs? Why change our diet? Lose weight, start exercising, if we can just pop some pills? Pharmacological therapies, including cholesterol-lowering statin drugs and blood pressure pills, typically only reduce cardiovascular disease risk, not by 90%, but only by 20% to 30%. So even on drugs, 70% to 80% of heart attacks still occur. One of the great things about this study, the Harvard Health Professionals' follow-up, is that they also looked at the effect of lifestyle changes on people already on medications. Even those on blood pressure and cholesterol-lowering drugs may still be able to get a further 78% drop in risk by eating and living healthfully. So the choice isn't diet or drugs, cardiovascular medication should be used as an adjunct to, not just a replacement for, healthy lifestyle practices. It takes time for new science to trickle down into mainstream medical practice. The practice of cardiology and medicine in general may correspond, on average, to what was being published 10 or 20 years before. So it's important to know if your doctor is still stuck back practicing 20th century medicine.