I will never forget the time when my son Spencer was five years old and I told him that I was going to work to take care of people’s hearts. His response—only a five-year-old could have put it so simply—was, “Why can’t the people take care of their own hearts?” As much as it made me laugh then, in the seven years since that time, I have not stopped thinking about it.

Why can’t people take care of their own hearts? I think the answer is complicated, but rooted in one simple problem: They don’t really know how to prevent heart disease.

People have become much more proactive about prevention in the world of cancer, diligently planning their mammograms, colonoscopies and skin screenings. Yet people are far less proactive about heart health. Since heart disease kills more people than cancer—and is, in fact, the number one killer of women as well as men—perhaps our health diligence needs to be spread around a bit more. For example, we’ve all heard about the latest diets, but that hasn’t helped most people become any more aware of how the food they eat impacts the health of their arteries.

For many years, I have suggested that we change the paradigm for how we define heart disease. What if heart disease was not just something of concern after a diagnosis, whether a heart attack, a valve issue, heart failure or another form of illness, in which heart functioning has become dangerously dysfunctional? What if, instead, we could diagnose someone who doesn’t exercise—or who has high cholesterol or high blood pressure or any other risk factors for heart disease—with actual heart disease, long before they fell sick? The traditional paradigm is that we wait until disease strikes to do something about it. But from my vantage point as a preventive cardiologist, that is simply too late.

If heart disease were diagnosed according to how you live your life, would that change how you approached your days and made your decisions? Would you still choose the doughnut over the fruit…the French fries over the salad…the Netflix binge over the evening walk or the after-work gym session…if those choices would mean you have heart disease right now? 

Consider the American Heart Association’s “Life’s Simple 7,” which are seven factors that, when optimized, are generally considered to prevent 80% of heart disease cases. These seven factors to prevent heart disease are:

• Cholesterol level

• Blood pressure

• Blood sugar level

• Body mass index (your weight)

• Whether you exercise

• What you eat

• Whether you smoke

What if, when your numbers were optimal and you exercised for 150 minutes a week, ate a healthy diet and didn’t smoke, you would be considered heart-healthy? And what if, when you have abnormally high cholesterol, blood pressure, blood sugar or body mass index, or if you don’t exercise, if you eat junk food, or smoke cigarettes, your doctor could write “diagnosis: heart disease” in your chart?

Of course, this scenario I propose probably won’t happen, but if you think about it, you will see the logic of it. If you have high cholesterol, high blood pressure or high blood sugar, it’s likely due to your lifestyle choices. If you are overweight or obese, it’s likely due to your lifestyle choices. If you don’t exercise, that’s almost always a decision under your control. The same goes for what you choose to eat and whether you choose to smoke. We know all of these things are risk factors for heart disease, so if you are making decisions that put you at risk, you are essentially inviting heart disease.

So I say, consider yourself already there.

Let’s circle back to the question, How should people take care of their own hearts to prevent heart disease? The answer is simple. Exercise…Eat healthy food…Don’t smoke…And monitor your cholesterol, blood pressure and blood sugar. Work to get to a healthy weight and, if you have questions, ask your doctor for answers.

As doctors, we need to get better at providing information and resources to prevent heart disease, such as how to get access to the healthy food we suggest, when to get basic tests done, how often to exercise and how to lose weight in a healthy way. First and foremost, we need behavioral changes to go beyond being just a concept, to something we actually do every day as a treatment paradigm for a disease state. We need to see these behavioral changes as urgent. As life-saving. Because that’s exactly what they are.

Re-defining heart disease as something that exists before a heart attack happens can be incredibly empowering. Let’s consider heart disease as inevitable in the presence of risk factors. If we do this on a grand scale—even lobbying for insurance companies to pay for the testing and diagnostic studies needed for screening for eventual heart disease before the actual diagnosis is made—maybe we could actually demote heart disease from its current title as the number one killer of “the people.” What a victory that would be!

In the meantime, take a good hard look at yourself. How are you doing with Life’s Simple 7? Where do you fit in? If you have any of these risk factors—if you aren’t optimizing your numbers and behaviors—know that every day you procrastinate managing your diet ( “I’ll start tomorrow”), or starting an exercise program (“when I get motivated”), or trying to lose weight (“when the weather gets nice”), or managing your stress ( “when I can learn how to meditate”), you are one day closer to heart disease.

Look at it differently. If you say to yourself that this is heart disease—that you have heart disease right now, and that you are sick when these numbers are elevated—maybe your motivation will be different. Maybe you will shift your priorities.

If we want the people to take care of their own hearts, then I say let them—but let them do so with full awareness of the need, the urgency and the power they have to make the lifestyle changes that will translate into success. Give the people the ability to make it happen and the knowledge that if they don’t make it happen, then they do have heart disease…because eventually they will.

I want to be able to say to my son, “Spencer, finally the people are taking care of their own hearts. I don’t think I need to go to work today. Let’s go for a walk in the park!” Maybe I’ll see you there, too.