Every so often, despite everything we advise, despite every preventive measure taken, despite the best of intentions, the unpredictable happens and we have heart health problems. We can tell patients what to eat and how to exercise, and they follow our advice to the letter, yet they get sick anyway, even diagnosed with the exact disease they’re fighting so hard to prevent. It’s frustrating, to say the least. This doesn’t happen often, but it sometimes does, and if it has happened to you, I want you to know you are not alone.

You may have heard that 80% of the time, heart health problems like heart disease are preventable. This is true, but some people are led to believe that this number is actually 100%. Unfortunately, 20% of the time, people will have a very difficult, if not impossible, time making an impact with lifestyle choices alone. Eighty percent chance of success—those are good odds, but they are no guarantee. As I write this, I can see the faces of my patients who fit into this category. Even after trying so hard, they are left with a diagnosis of hypertension, atrial fibrillation, high cholesterol, or even heart disease.

Disease processes are driven by two things: genetic propensity and lifestyle. Yet, these two factors do not occur completely separately. Epigenetics is the study of the influence of lifestyle on gene expression, meaning how you choose to live can “turn on” genes that make certain conditions more likely, or can leave those genes “dormant” and unexpressed. But a perfect lifestyle cannot always keep those genes from expressing themselves, resulting in the occurrence of these risk factors and diseases. In most cases, you can prevent heart health problems, but in some cases, even for those who try their hardest, the internal genetic makeup wins out.

Giving up on lifestyle improvements is certainly not the answer. For one thing, 80% is a promising statistic that makes a strong case for lifestyle intervention. This is true for everyone but especially for the genetically susceptible. For another, even when risk factors appear or disease surfaces, lifestyle changes can make a profound difference in how well someone weathers a health crisis. Getting high blood pressure, high cholesterol or heart disease is certainly no reason to give up on a healthy lifestyle—in fact, it is the best reason to ramp up your efforts because we know it improves outcomes.

One of my patients, who is in her early 50s, has spent years fighting her genetic code: Both hypertension and heart disease run in her family. She exercises five days a week and eats a mostly vegetarian, low-salt diet. She came to my office with a blood pressure cuff, a journal recording her blood pressure readings four times per day, and her diet plan. She explained to me that she had been making deliberate attempts to prevent hypertension because both her mother and father had high blood pressure and her mother had died of a heart attack. She was now post-menopausal, and showed me in her book the progressively increasing blood pressure readings she experienced over the past year.

What began in the 120s (120 is the highest “normal” systolic blood pressure reading) was creeping up into the 140s (140 or higher is considered significant high blood pressure) despite maintaining the same healthy diet and exercise routine. She was understandably frustrated and angry. She thought that doing everything she could would be enough and yet, in her case, she was going to need medication to intervene. But did I advise her to give up on her excellent lifestyle habits? Of course not! If she had not been doing those things, her numbers could have been even worse. And, although I can’t prove it, she could have prevented herself from getting a heart attack already.

Even when medication is required, lifestyle choices could minimize your dosage requirements or the need for multiple drugs. Lifestyle can optimize your situation, even when your genetic susceptibilities aren’t ideal.

Another patient with a history of atrial fibrillation was a runner and healthy eater. She came to my office due to her symptoms, except rather than being frustrated by her diagnosis, she just assumed that she would end up with the “family arrhythmia.” Yet, this expectation did not make her give up on her efforts. After watching her father suffer a stroke, all she wanted was to live a healthy and stroke-free life. For her, that was reason enough to stay completely focused on being as healthy as she could be for the rest of her life. Her lifestyle very well may prevent a stroke like her father had, even if it has not prevented her atrial fibrillation.

In other words, lifestyle changes matter, whether you prevent disease or risk factors completely or you don’t. Continue (or start!) your exercise program, keep choosing healthy foods in moderate portions, and maintain or even increase your stress management efforts. Stay hydrated and get adequate sleep. Don’t take supplements, herbal preparations, or vitamins without reviewing the potential side effects with your doctor. Do all these things and I assure you that 80% of the time, you will be able to keep the heart health problems, cardiac risk factors and medical diagnoses in check. And if you can’t, you will certainly minimize the risks you have and give yourself the best possible chance at success. You are in the driver’s seat as you navigate your future. Just know that sometimes, in spite of all that your do, you might need treatment. You might need medication. And that is okay.

The last point I want to make is an important one: People sometimes believe that “succumbing” to medication means they have somehow failed. This is absolutely untrue, so don’t let yourself be coerced into believing this potentially dangerous point of view. Medication does not mean that you have failed or have not tried hard enough! It simply means that you have to add one more useful intervention to your efforts to keep yourself on track. Trust your doctor if you are told that medication is important for you.

Meanwhile, continue to do everything you can to stay as healthy as you can and stay in touch with your doctor about your dosage requirements. Don’t give up, get depressed or feel defeated. Always remember: Genes are not destiny, and if you didn’t do everything you were doing, things could be much worse! Stay the course and take care of yourself. You are worth every effort.