Broccoli, not bypasses.

Cardiovascular diseases are the number-one cause of death for Americans, with coronary heart disease and stroke killing more than 650,000 people every year. Many more suffer a heart attack or stroke and survive.

We spend more than $30 billion a year on drugs to lower cholesterol and blood pressure, according to the consulting firm IMS Health. We undergo more than 500,000 heart bypass operations, almost 600,000 artery-opening angioplasties, and over a million procedures to diagnose heart disease each year, at a cost of $70 billion. Overall, high blood pressure, heart disease, and stroke cost the nation more than a quarter of a trillion dollars a year.

But bypass operations, angioplasties, and invasive diagnostic tests are not risk-free and they are not cures. About 30,000 Americans die after having those procedures every year. Even successful bypasses frequently have severe physical and mental side effects. And expensive cholesterol-lowering statin drugs are not magic bullets: they lower the risk of a heart attack or stroke by only about 25 percent.

Ironically, the causes of cardiovascular disease are well-known. Risk is determined largely by diet, physical activity, and tobacco use. A diet that is low in saturated fat, trans fat, cholesterol, and sodium and high in fiber-rich foods lowers the risk dramatically.

That kind of diet is based largely on vegetables, beans, whole grains, fruits, seafood, and low-fat animal products, with only occasional servings of cholesterol-raising meats, cheese, and other foods.

Eat that way and you wrap a protective shield around your heart and arteries. Not surprisingly, in studies of Seventh-day Adventists, vegetarians have half the rates of hypertension, diabetes, and fatal heart attacks as non-vegetarians and live about three years longer. Of course, smokers need to give up cigarettes, the all-purpose killer.

And everybody needs to exercise, the all-purpose protector. (People with stubbornly high cholesterol levels still might need to take statin drugs.)

It is a terrible indictment of the entire medical establishment that we experience such high rates of cardiovascular diseases, suffer such misery, and spend so much money on a medical approach to a largely avoidable disease. Dean Ornish, the late Nathan Pritikin, Caldwell Esselstyn of the Cleveland Clinic, and others have found that many of their heart patients could avoid the knife or drugs by adopting a lifestyle that includes exercise, lentil soup, and broccoli instead of burgers and fries.

While the government gives lip-service to healthier diets, its brochures and policy statements have little impact. And doctors are much more likely to prescribe drugs or surgery than cantaloupe and carrots.

It's high time that physicians, the American Heart Association, schools, parents, and the food industry made healthful diets the norm rather than something that people must make a Herculean effort to consume.

Instead of just reimbursing endlessly for surgery and drugs, the government should mount hard-hitting campaigns that promote healthy diets, give bonus food stamps for fruits and vegetables, ban trans fat, limit sodium levels in processed foods, and require chain restaurants to at least disclose calories and other nutrition information on menus. It should also reward farmers who raise leaner cattle and deliver milk that's lower in saturated fat.

And to help people who already have cardiovascular disease, it should train a Heart Corps of thousands of non-physician specialists who would help motivate patients to adopt healthy lifestyles.