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New Thinking on Heart Disease Prevention

Heart disease is the number one cause of death in the United States. There is a growing body of research demonstrating that cholesterol levels are no longer the best indicator of a person’s risk for a heart attack or stroke. In fact, half of the people who suffer a heart attack have completely normal cholesterol levels. Recent studies have shown that lowering cholesterol alone had no benefit on preventing a person’s first heart attack or stroke. Medical research is showing that far better indicators for risk of heart attack or stroke are oxidative stress, size of lipid particles, and inflammation status.


Cholesterol plays several important roles in the body. It is the backbone of all steroid hormones, including testosterone, estrogen, cortisol, and vitamin D, which are responsible for blood sugar regulation, mineral balance, blood pressure regulation, libido, and much more. Cholesterol is a component of bile salts, which help us to properly digest fats and its role in the brain makes it vital for learning and memory. Cholesterol is the major component of the cell wall and is responsible for maintaining the integrity of every cell in the body. It is so vital for health that every cell in the body has the ability to produce cholesterol and we could not survive without it.

Eighty percent of the cholesterol in your blood was actually produced by your own body; the other twenty percent comes from your diet. As more cholesterol is consumed in the diet, the body makes less. Studies have actually shown very little correlation between the amount of cholesterol consumed in the diet and blood cholesterol levels because of this regulatory system.

That is not to say that eating an unhealthy diet full of greasy burgers and french fries will not lead to heart disease, quite the contrary. But the cause is not about the amount of cholesterol so much as how these foods affect blood sugar regulation, fat deposition, inflammation, lipid particle size, and oxidization of fats.

Oxidative Stress

When oxygen is processed by the body, reactive oxygen species (free radicals) are formed. Under healthy conditions, the body neutralizes the majority of these metabolites with circulating antioxidants. When there is not a sufficient quantity of antioxidants available to limit oxidative damage, reactive oxygen species can cause damage to local tissues. In the cardiovascular system, this is especially important because when vessels are damaged, plaques can form, leading to atherosclerosis and heart disease.

Methods of reducing oxidative stress include eating a colorful whole foods diet, reducing inflammatory substances like trans-fats, cigarettes, alcohol and sugar and, when necessary, taking antioxidant supplements.

Size of Lipid Particles

Low Density Lipoproteins (LDL) are often referred to as the “bad cholesterol.” Under oxidative or inflammatory conditions, LDL particles can embed into vessel walls and form plaques that lead to heart disease. Gathering evidence is demonstrating that assessing the size of LDL particles is a far better predictor for heart disease than the shear amount of LDL in the blood. Smaller, denser LDL particles have been strongly correlated with heart disease risk, whereas larger, “fluffier” LDL particles are not. Two people with the same LDL levels can have much different risks of developing atherosclerosis, depending on whether their LDL particles are small and dense or large and fluffy.


Inflammation is the body’s attempt to repair. Think about what the healing process looks like when you cut yourself. The skin gets red around the cut and slowly over time lays down new tissue until eventually the wound is closed and healed. The same process happens when internal organs experience injury from extraneous sources. A poor diet, chronic stress, smoking, inactivity, and poorly controlled blood sugar are just a few sources of chronic inflammation and repair deficit that greatly increase the chance of developing atherosclerosis and heart disease.


Anyone still taking a cholesterol-lowering drug should discuss with their doctor whether it is appropriate, given the lack of evidence to support the efficacy of these drugs in preventing first time cardiovascular events.

The following tests can help determine individual risk of heart attack or stroke with better predictive value than cholesterol alone: CRP-hs (inflammation), Homocysteine (detoxification and methylation), Oxidized HDL and LDL, and LDL Subfractions (lipid particle size). FBN


Written by Dr. Ryan Sweeney

For a complete list of references cited in this article, please visit www.rootnaturalhealth.com and click on the “articles” tab.

Dr. Ryan Sweeney is a Naturopathic Physician at Root Natural Health in Flagstaff. His approach to medicine is to treat the cause of disease, not just address symptoms. In addition to being a primary care physician, his clinical focus is in Gastrointestinal Disorders, Men’s Health, Cardiovascular Health, and Diabetes.


Root Natural Health is Flagstaff’s newest integrative medical clinic offering Holistic Primary Care, Preventive Medicine, Nutritional Medicine, IV Nutrient Therapy, Herbal Medicine, Women’s Health, Endocrine and Hormone Balancing. For more information on Dr. Sweeney and the team at Root Natural Health, visit www.rootnaturalhealth.com or call 928-637-6795.
















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One Response to New Thinking on Heart Disease Prevention

  1. David @ Normal Cholesterol Levels June 27, 2012 at 1:09 AM #

    Whoot! Great article. Yours is only the second or third site I’ve seen mention of the importance of lipid *size* – something I’m sure is often overlooked when analyzing cholesterol numbers. Good call on calling out inflammation, a factor in probably every disease process. There’s a lot more to cholesterol numbers and their impact than just, well, numbers.

    Best Regards

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