A new model for heart disease🫀

20% of Americans die from heart disease, yet sadly the progression of our #1 killer is not well understood by most medical professionals.

A new friend that works with a high-end team of researchers to manage his cardiovascular health recently showed me an interesting review paper that cleared up a lot of my questions about the evolution of cardiovascular disease (CVD). He avoids seed oils like the plague

“The critical issue linking lipids and inflammation: Clinical utility of stopping oxidative stress”

TL;DR Thesis: Cholesterol is crucial to human metabolism, and many individuals with high LDL cholesterol are disease-free. The main culprit is environmental sources of oxidative stress which cause LDL particles to get stuck in your arteries. Limit these and live fearlessly.

First principles:

LDL cholesterol, and more recently “apolipoprotein B” or apoB are the two current boogeymen of mainstream medicine. Lower is said to be better, no matter what, which is why 35% of Americans are on prescription statins

An LDL-cholesterol molecule is essentially a molecular sphere made of fat and protein molecules (lipoprotein). Its purpose is to shuttle fat and cholesterol around the body for energy.

Cardiovascular disease occurs when LDL particles get stuck in the walls of your arteries, and eventually dislodge into your bloodstream and get stuck somewhere, causing a heart attack or stroke.

LDL cholesterol plays an important role in human metabolism, especially if you are consuming a diet rich in animal fat, so some of us are a bit hesitant of lowering it with drugs.

A world of paradoxes:

The French Paradox and the Israeli Paradox are opposing paradoxes, the French have the highest cholesterol in Europe and the lowest heart disease.

The Israelis consume mostly seed oils, have very low cholesterol and have high rates of heart disease.

Clearly it’s possible to have high cholesterol and not have heart disease, so the mere presence of cholesterol cannot be sufficient to cause CVD.

The mechanism for CVD:

First the more technical breakdown from the paper:

1. LDL-molecules (lipoproteins), which carry cholesterol and fats in the blood, pass through the inner lining of the artery wall (endothelium) and become trapped in the innermost layer of the artery.

2. The trapped lipoproteins, especially those containing apolipoprotein B (apoB), stick to molecules called proteoglycans within the arteries. Proteoglycans are produced by smooth muscle cells that have transformed from their normal state into a diseased state.

3. The retained lipoproteins become oxidized, which means they undergo chemical changes due to oxidative stress. Oxidative stress occurs when there is an imbalance between harmful reactive oxygen species (ROS) and protective antioxidants in the body.

4. The oxidized lipoproteins trigger an immune response, causing inflammation in the artery wall. Immune cells called monocytes enter the intima and turn into macrophages, which try to digest the oxidized lipoproteins.

5. If the process continues, the macrophages become overloaded with oxidized lipoproteins and turn into foam cells. Foam cells accumulate and form fatty streaks, which can develop into plaques.

6. As the disease progresses, the plaques can grow and narrow the artery, limiting blood flow. The plaques can also rupture, leading to the formation of blood clots that can completely block the artery, causing a heart attack or stroke.

CVD Simplified:

Two conditions make it such that LDL particles are likely to get stuck in your arteries, and both are broadly caused by increased oxidative burden.

1: Your arterial walls are diseased and sticky (see point 2 above)

2: LDL particles become oxidized before they can exit your arterial walls

In many healthy individuals with high cholesterol, neither of these conditions are met and they are free from arterial plaques.

Lowering oxidative stress:

The paper spells out 15 or so health areas to pay attention to, from air quality to gum health, its worth a read. Diet and seed oils come into the picture in that omega-6 fats oxidize easily, and additionally are proven to cause LDL particles to oxidize, see the paper below.

Limiting environmental stressors and avoiding seed oils is likely your best way to avoid heart disease. This understanding can help you feel a bit more comfortable saying no to statins if your numbers come in slightly high.

Omega-6 vegetable oils as a driver of coronary heart disease: the oxidized linoleic acid hypothesis