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A growing number of publications evidencing the poor achievement of the therapeutic goals of the so-called atherosclerotic cardiovascular risk factors (especially hypercholesterolemia, hypertension, and diabetes). Many authors propose therapeutic inertia as the most compelling cause of this situation.

This article aims to provide a vision from a dedicated cardiovascular prevention physician's perspective, based on four pillars (in order of importance): "face-to-face" assistance with social responsibility, clinical research, teaching, and consulting. Beyond the bureaucratic vision, it proposes the necessary conditions to achieve an efficient medical ecosystem (evidence-based medicine, personalization, empowerment, access, and reflection). Likewise, the therapeutic failure palliatives, as called by the author (more guidelines, more high-tech drugs, and more combinations of drugs), are exposed. These palliatives feed into a vicious circle and are insufficient to mitigate a medical-social problem, as is the cardio-metabolic risk and diseases