Why can healthy lifestyle choices eliminate 90 percent of our risk of heart attack, while drugs can only reduce the risk by 20% to 30%?
In the typical American diet, atherosclerosis—the hardening of the arteries, the leading killer of men and women—has been found to begin in our youth. Investigators collected nearly 3,000 sets of coronary arteries and the aorta (the aorta is the main artery in the body) from victims of accidents, homicides, and suicides who were 15 to 34 years old and found that fatty streaks in the arteries can begin to form in our youth, turning into atherotic plaques. 30s and it can be dangerous. In the heart, atherosclerosis can cause heart disease. In the brain, it can cause a stroke. See the progress below and at 0:35 in my video Is Cholesterol Too Low?.
How common is this? All the young people they looked at—100% of them—still had fat growing inside their veins. By their early 30s, many already have those arteries blossoming into atherosclerotic plaques bursting in their arteries. From the age of 15 to 19, their aorta had fatty streaks building up everywhere, but no plaques yet, on average, as shown below and at 1:15 in my video.
Plaques began to appear in the abdominal aorta in their early 20s and worsened in their late 20s, by which time fatty streaks had crept in. In their early 30s, their arteries were in bad shape, as seen below and at 1:25 in my arteries. video.
But that’s just the abdominal aorta, the main artery that runs down the middle of our legs. What about the arteries that feed the heart?
The researchers found the same pattern: fatty streaks in young people, the first signs of plaque in the early 20s that improve with age, and by the early 30s, most people have plaques in their coronary arteries, as shown below and at 1:47 in mine. video.
Atherosteosis it starts at the beginning of puberty.
That is why we should not wait until heart disease becomes a symptom to treat it. If it starts in our youth, we should start treating it while we are still young. If you knew you had a cancerous tumor, you wouldn’t want to wait until it grew to a certain size to treat it. If you have diabetes, you don’t want to wait until you start noticing it before you do something about it. So, how can you treat atherosclerosis? Lower LDL cholesterol by eating foods low in fat and cholesterol—foods that are free of eggs, meat, dairy, and junk food.
If we want to stop this epidemic, we must “change our lifestyle accordingly, starting young or at a young age. (Healthier food? Big?!) It may take a lot of commitment to change our behavior, but atherosclerosis is our number one cause of death. In the case of tobacco, we have done very well, reducing the rate of smoking and reducing the rate of lung cancer. And, yes, healthy eating is safe. According to the Academy of Nutrition and Dietetics, the largest and oldest association of nutritionists in the world, even a plant-based diet is good for all stages of life, starting with pregnancy. (NutritionFacts.org is among the websites recommended by the Academy for more information.)
The subject of an important study published in Journal of the American College of Cardiology states: “Treating Atherosclerosis Should Be the Next Goal of Cardiovascular Prevention.” What evidence do we have that lifelong suppression of LDL will do? There is a genetic mutation in a gene called PCSK9 that about 1 in 50 African Americans are lucky to be born with because it gives them about a 40% lower LDL cholesterol level for life. Indeed, they were found to have significantly lower rates of coronary heart disease—an 88% reduction in risk compared to those without the mutation, despite some of the worst cardiovascular risk factors on average. Most had high blood pressure and were overweight, about a third smoked, and about 20% had diabetes, but that highlights how a lifelong history of low LDL cholesterol levels can reduce the risk of heart disease, even if there are multiple risk factors.
This nearly 90% reduction in events such as heart attack or sudden death occurred at a median LDL level of 100 mg/dL, compared to 138 mg/dL in those without the mutation. This means that LDL can drop below 100 mg/dL. Why does a reduction in LDL cholesterol of about 40 mg/dL from a lucky genetic mutation reduce the risk of heart disease by about 90%, while the same reduction with statin drugs only reduces it by about 20%? The most likely explanation? Time frame. When it comes to lowering LDL cholesterol, it’s not just how low it is, but how long it’s been low.
That’s why choosing a healthy lifestyle can eliminate about 90 percent of our risk of heart attack, while drugs can only reduce it by 20 to 30 percent. If you are treated with drugs later in life, you may need to get your LDL below 70 mg/dL to stop the progression of coronary atherosclerosis. But if we start making healthy choices early, it may be enough to lower LDL cholesterol to 100 mg/dL, which most of us should achieve. That’s consistent with national data that suggested that death from heart disease would decrease with a population average of about 100 mg/dL, as shown below and 5:21 in my video.
But that’s only if you can keep your LDL cholesterol down for life.
If you rely on drugs later in life to stop the progression of the disease, you may need to get your LDL below 70 mg/dL, and if you’re trying to use drugs to reverse a lifetime of bad food choices, you may not reach heart disease events until your LDL drops to about 55 mg/dL. If your heart disease is so bad that you’ve already had a heart attack but you’re trying not to die from one, well, you might want to lower your LDL to 30 mg/dL. Once you’re that low, you’ll not only avoid any new atherosclerotic plaques, but you’ll also help strengthen the plaques you already have so they’re less likely to burst and kill you.
Is it even safe to have cholesterol levels that low, though? In other words, can LDL cholesterol ever be too low? We’ll find out next.
Doctor’s Note
Did I know that atherosclerosis can start at such a young age? Look Heart Disease Begins in Childhood.
For more on drugs vs. lifestyle, watch my video Real Food Profit vs. Drugs.
Do you want to learn more about what is called primordial prevention? Look Where Low risk means high risk.
Does Cholesterol Matter? Watch the video to find out.
