It was about seven years ago, while I was doing an outpatient orthopedic residency, when I began to notice something about our patients.

When I stepped back and started to look at our fairly typical "orthopedic" patient population, I realized that the vast majority of those patients had at least moderate risk for cardiovascular disease. They often presented with multiple risk factors, including hypertension, obesity, diabetes, or physical inactivity. In fact, it was rare if a patient didn't have at least one risk factor. Many of these patients had heart disease, too.