We all think we are well-informed about cardiovascular health. But is what we think we know really accurate? Here, a renowned cardiologist describes the biological processes leading to heart and blood vessel disease. He challenges the conventional view that risk factors, poor diet, and lack of exercise are the biggest culprits. Each of these widely-described risk factors is individually discussed and Dr. Cohn concludes that their role in affecting cardiovascular health is often overstated. He promotes a greater emphasis on an individual's personal and largely inherited cardiovascular health by simple assessment of the function and structure of the arteries and heart. By identifying early disease likely to progress he advocates for early intervention, often with drug therapy, to slow disease progression and prevent symptoms of cardiovascular disease. ThroHe concludes that health care providers can better treat patients with medications that slow the biological processes that contribute to the development of artery and heart disease. These medications lower blood pressure and cholesterol, but their main effect is to slow progression of disease even in those whose blood pressure and cholesterol levels are not elevated. He describes a strategy for identifying and treating these early abnormalities before symptoms develop. Ultimately, early diagnosis and treatment, he argues, can contribute to better prevention and the slowing of cardiovascular disease progression that would otherwise shorten our lives.