Some epidemics are hard to treat because medicine has no cure, while others, more insidiously, are hard to treat because people latch on to the wrong cure. Heart disease is a prime example of how a half truth turned into a partial cure, with many people being led down the wrong path, either by themselves or by their doctors.

Heart attacks turned into an American epidemic after World War II, and doctors were baffled to know why.  Intensive research was conducted, and as often happens when the cause of a disease is complex, there was no single reason why men in the vulnerable range for premature heart attacks, from age 40 to 60, were suddenly dying in greater numbers. What had changed in modern society to cause hundreds of thousands of heart attacks a year when in the past, before World War I, a physician might see one patient a month, or fewer, with the symptomatic chest pain known as angina pectoris? An X factor was missing and needed to be identified.

The physical evidence was plain enough when the victims’ hearts were examined after death. The coronary arteries that feed oxygen to the heart were no longer healthy. Healthy arteries are flexible, smooth, and resilient. But pathologists were seeing hardened arteries filled with tough fatty plaques even in men as young as their early twenties. This condition, known as atherosclerosis, is still the leading cause of death worldwide. Unfortunately, for the most part atherosclerosis is being treated the wrong way, based on mistaken assumptions about what causes the disease and its many complications.

In atherosclerosis, arteries become thickened and narrowed by arterial plaques. It’s a process that takes place over years and can occur in arteries anywhere in your body. Often there are no symptoms. No symptoms, that is, until an artery becomes so clogged that it can’t deliver adequate blood to your organs or tissues. If blood flow is reduced in the coronary arteries, the symptoms can include angina (chest pain), shortness of breath, and fatigue. If flow to the brain is curtailed, then stroke-like symptoms may occur, such as sudden numbness or weakness in the arms and legs, difficulty speaking, or drooping facial muscles. If the arms and legs don’t get enough blood, then numbness can develop and walking may become painful.

Sometimes, for reasons we don’t totally understand, plaques rupture and a blood clot forms. The clot can become stuck in an artery and block flow altogether. In a coronary artery, this can cause myocardial infarction—a heart attack. In the arteries that provide blood to the brain, the result can be a stroke.

If you ask most people—including many doctors—what causes atherosclerosis, they’ll tell you it’s having high blood cholesterol levels from eating a fatty, cholesterol-laden diet, plain and simple. The solution, they say, is to lower blood cholesterol levels, often by taking expensive cholesterol-lowering drugs (with dangerous side effects). Specifically, the goal is to lower levels of the “bad” cholesterol, LDL, and raise levels of the “good” cholesterol, HDL.

This narrow focus on lowering cholesterol levels has been promoted for the last three decades as the solution to our cardiovascular woes—and it hasn’t worked. Atherosclerosis and cardiovascular disease continue to be epidemics in this country and all over the globe. Atherosclerosis is a complicated disease, and much more is involved than simple cholesterol levels. As evidence, note that nearly three quarters of patients hospitalized for heart attacks had LDL levels within the recommended targets, and half of them had LDL levels that were considered optimal. What’s more, some people with sky-high cholesterol levels have no trace of cardiovascular disease.

Some salient facts have emerged that reveal the over simplification of the cholesterol approach.

1. The liver plays a key role in turning the fat in your diet into blood fats. For some people, a small amount of dietary fat can lead to high fats in the blood. For other people, a very high-fat diet can lead to normal fat levels in the blood. There is no simple correlation between the fat you eat and the fat than can damage your heart.

2. Stress plays a major factor in heart attacks. Indeed, several wide studies that are considered among the best in the world found stronger psychological correlations to early heart attack than physical ones. Strikingly, men who deal with their psychological issues in their twenties are less likely to suffer premature heart attacks. This was known fifty years ago but was slow to catch on, since cardiologists are experts in drugs and surgery, not psychology.

Since the early postwar era, many studies have found that being chronically stressed greatly increases your risk of heart disease, in part by raising circulating levels of cortisol, one of a number of “stress hormones.” In fact, one study found that people with high levels of cortisol had five times the risk of dying from cardiovascular disease

3. The body is listening to non-physical changes in one’s lifestyle. Things like meditation, stress reduction, and exercise may seem far removed from the lining of a coronary artery, yet every thought, feeling, and action gets turned into physical signals sent to every cell in your body. Positive lifestyle changes are the natural way to prevent atherosclerosis.

Yet the search for a pharmaceutical holy grail continues. In 2007 a new cholesterol-lowering drug, torcetrapib, was evaluated in clinical trials. It was found to have exactly the desired effects: it dramatically lowered LDL-cholesterol and raised HDL-cholesterol levels. But the trial was cut short. Why? Because the drug was killing the people using it. Deaths increased by 58% among patients taking torcetrapib. Cardiovascular events, including heart attacks, increased by 25%. Now, a similar drug, anacetrapib, is being touted as our new savior from cardiovascular disease. When there’s a possibility of making spectacular profits, drug companies have a very short memory.

To understand why current treatment is ineffective, we need to look at why plaques form in the first place. Arterial plaques are the body’s healing response to injury to the arteries—only in this case, the “healing response” can do a great deal of damage. For the most part, we injure our arteries through having unhealthy lifestyles—by being chronically stressed, consuming too many refined carbohydrates, eating processed foods and fast foods full of trans fats, having a sedentary lifestyle, smoking, drinking too much, and being overweight. All these bad habits injure the delicate, thin inner layer of the arteries and create lesions—wounds.

When an arterial lesion forms, macrophages—cells of the immune system—come to the site of injury as part of the body’s inflammatory (healing) response. Together with cholesterol and other lipids, connective tissue, calcium, and various other substances, they form a plaque inside the wall of the artery. An arterial plaque is essentially a scab formed to prevent blood loss, just like a scab on the surface of your skin.

 The chemistry of cholesterol is far from understood completely. There’s increasing evidence that overall cholesterol numbers don’t matter: what matters is the size of the cholesterol particles. Large cholesterol particles are fluffy, buoyant, and unlikely to penetrate into the blood vessel wall. Small cholesterol particles are tiny, dense, and able to penetrate into the arterial wall. They are more atherogenic—more likely to form arterial plaques in a blood vessel that’s been damaged. They are also more likely to become oxidized, becoming what’s termed oxLDL. OxLDL may well play a significant role in the formation of plaques. Having a high level of small-particle LDL-cholesterol increases your risk of having cardiovascular disease and is associated with insulin resistance, diabetes, and obesity.

Fatty diets aren’t always the culprit. One factor is eating too many refined carbohydrates and starches. These high-glycemic-index foods raise your blood glucose level, which has the overall effect of increasing the number of small LDL- and HDL-cholesterol particles in your blood.

Lifestyle choices remain the best way to prevent heart attacks and strokes.  Avoid eating high-glycemic-index foods like potatoes, white rice, sugar, and white flour, which raise your glucose and triglyceride levels and ultimately increase small-particle cholesterol. Eat plenty of whole grains, fruits, and vegetables instead. Be sure to eat foods rich in unsaturated fatty acids, especially those with omega-3 fats, such as fatty fish and extra-virgin olive oil. They have been shown to reduce your risk of cardiovascular disease.

Aerobic exercise does wonders for your body, including optimizing your cholesterol levels and decreasing small-particle cholesterol. Anerobic exercise (like weight training) complements aerobic exercise and improves glucose uptake, further aiding small-particle cholesterol reduction.

Yoga is well known as a stress-reducer, and studies have found that doing yoga measurably reduces cortisol levels. Meditation has been found to have similar effects. One study found that meditating 20 minutes a day for just 5 days measurably lowered anxiety and cortisol levels.

Prevention is the great cure that Americans continue, by and large, to ignore. Therefore, nothing I’ve said will come as a great surprise or groundbreaking news.  But there’s no alternative to repeating the cure that works. One by one, each person can then decide how and when to make the changes in lifestyle that spell the end of the epidemic, so far as a single individual is concerned.

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