Author’s Note: For those of you who don’t have the time to read this entire 4,600 word guide to using nutrition to fight heart disease , I’ve also written a much shorter, tl/dr post. It’s got the meat of the story–the major recommendations, dietary changes, and supplements–and nothing else. Of course, you’ll get a lot more benefit if you eat your vegetables along with the meat!
With the new statin guidelines having been released, millions more Americans will potentially be prescribed this cholesterol-lowering drug. Whether this is good or bad has been the subject of much debate, and to be fair, the new guidelines will also take many individuals off statins, but either way it brings the focus back to America’s most frequent killer: cardiovascular disease.
Cardiovascular disease (also called heart disease, or CVD for short) is unlike many other diseases. Rather than being characterized by a discrete progression (think of cancer, which typically follows a normal route), CVD is characterized by risk factors which, as implied by the name “risk factors”, predispose an individual to either a higher or lower risk of cardiovascular related events, most notably heart attacks and strokes.
While we can assess an individual’s overall risk of suffering an event in the future, there is no definite timeframe, and risk factors are exactly that—factors which demonstrate risk, not necessarily ‘cause’ disease (this is a matter of some debate, which we’ll explore shortly). Individuals with all the risk factors may never suffer a heart attack or stroke, and some individuals with no risk factors at all will (very rarely) have an unexpected heart attack. Despite the outliers, examining risk factors are in general excellent at estimating risk.
There are five common risk factors for CVD, and one factor which is considered ‘risky’ but isn’t fully understood. The most important factors are your cholesterol levels, blood pressure, physical activity level, smoking status, and whether or not you have diabetes. The sixth, less understood factor is homocysteine level. The more risk factors you have (e.g., high cholesterol, high blood pressure, low physical activity level, etc.), the higher your overall risk.
The relationship of risk factors to CVD can be hard to understand, but think of it this way. If you are biking to work, there are a number of safety protocols you can employ that will increase or decrease your odds of getting hit by a car. You could wear muted clothing or bright clothing. You may have lights on your bike, reflectors, or nothing at all. You can bike on the sidewalk, bike lane, or in the middle of the road. You could use signals to declare your intentions, or just turn without alerting anyone. You could bike when it’s light out, or when it’s dark. All of these choices either increase or decrease your risk of getting hit by a car, but in no case are they what actually injures you—the car is what causes the injury!
It’s the same way with CVD risk factors. Even though many now question whether cholesterol itself causes CVD, that question is really beside the point. High cholesterol levels don’t need to be the discrete cause of a heart attack for them to increase risk, and we have very good research done on very large populations which show that high cholesterol is correlated with increased risk of CVD. Similarly, we don’t need bike lights to play any direct role in a car-bike collision—we know that biking in the dark without lights create conditions conducive to collisions. In both cases, we’re not blaming the risk factors for the event, we’re simply using them to assess risk. This is why it’s still a good idea to lower cholesterol levels (or blood pressure, or increase physical activity, or quit smoking) even though none of these factors, in and of themselves, are “heart disease”.