Each year 1.5 million people suffer heart attacks. Some of these heart attacks are fatal, about one third. Prevention programs have proven effective in reducing heart attack rates by about 50%, but are not as yet being widely promoted. Instead, intensive efforts are in place to treat the acute heart attack in a way which is high-tech and expensive. Prevention is expensive but doesn’t pay the doctor much. The cost would be to all of us. Prevention would be more effective if it were all inclusive. The problem of prevention is discipline. As a nation we have grown fat and want our cake and eat it too. This may be a result of our extreme affluence, but I suspect that we have forgotten that freedom and discipline are a paradox. Both are essential. Without the one, the other disappears. Genetics is important. Without detailed understanding of the chemistry of aging, we will have little chance of truly understanding the complex chemistry of heart attack. At the molecular level, aging produces changes in the lining of the arteries which produce clotting instead of smooth flow. Basic research is essential to understand this problem. As a nation we could fund our basic research better. However that would involve cognitive rather than emotive decision making regarding the use of funds. Habits would have to change if we were to reduce heart attack rates. We need bike lanes for inexpensive safe paths for using the bicycle as a routine method of transportation. This involves how we set out our cities and work place grids. Walking should be encouraged. Exercise breaks are essential to the sedentary worker. Food hype needs to be balanced with scientific fact. Witness the hype of margarine. We know that canola oil is the best vegetable oil in its content of linoleic acid. Linoleic acid is an essential fatty acid for the lining of the blood vessels. Yet there is media hype that margarine is better than butter. The reverse is true. When we thicken the vegetable oil by saturating the C=C bonds with hydrogen, we change the rotation of the fat molecule from cis to trans. That process makes the molecule of the essential fatty acid toxic to the cells which line the blood vessel. We would be better off if we diluted butter with unadulterated canola oil and thickened it with powdered skim milk, (better butter). At least we would have a product which would spread easily and allow us taste without toxicity. How much of our heart attack rate is produced by our incessant need for speed? Fast foods are a problem both in the food itself and the lack of fellowship. We know that workplace stress increases heart attack rates. Responsibility without authority creates an antagonistic environment which raises BP and creates a hypercoagulable state. How much salt is enough? In our culture we need about 2 grams of salt per day and often our diet exceeds 20 grams per day. Blood pressure often is not controlled. Partly this is so because of ignorance and partly because of cost. Some of the problem comes from the medications themselves. Side-effects are common, at least in the older less costly antihypertensive medications. Unfortunately the HMO formulary usually allows these older drugs and may disallow the newer more expensive drugs. For some bean-counters death maybe cost effective if the disease has little warning and has a fatal ending. Being consistent is important. The sympathetic nervous system functions to get us off the railroad track when a train approaches. The parasympathetic nervous system helps us to digest food. There is a place for both. Where we get in trouble is trying to have both at the same time. Eating on the run is an oxymoron like military intelligence. It places us in a situation where we partially digest fast foods improperly. The result is activation of the coagulation factors, raising our blood pressure and giving ourselves confusing messages. The most dangerous message a heart can receive is a message to slow down at the same time as it is to speed up.