As per the current medical stance, the two major leading cause of heart attacks today are abnormal lipids and Hypertension ( apart form smoking). Therefore, the solution is to use cholesterol lowering medications and hypertensive drugs.
This data included sales from 83 countries covering 74% of the estimated 2018 world population of 7,631,091,000 people. In 2018, an estimated 172.6 million people (3.1%) used lipid-modifying agents and 145.8 million people (2.6%) used statins. Use of all lipid-modifying agents increased from a total of 2,904,258,689 standard units in January 2008 to 5,509,412,107 in December 2018. ( reference below).
Now , let’s look at the statistics of heart attacks in our society .
Acc to WHO, An estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke.
‘If high cholesterol causes plaque in arteries, and that causes heart attacks, how can there be that many heart attacks every year if so many people are taking those drugs?’
To answer this question, let’s look into a few fundamental things.
Our health of the arteries depend on the lining that is present in the arteries called the endothelium. A healthy endothelium is a healthy artery . Our endothelium is where the rubber meets the road in terms of potential for plaque to form in the arteries or not. A healthy, resilient, and robustly functioning endothelium makes us all but impervious to this process developing, whereas endothelial DYSfunction is the prerequisite and breeding ground for it.
Any damage or scratch to this linings results in a cascade of repair mechanism that are naturally inherent in the body. Cholesterol is one of the body’s arsenal that is shoved into the damaged site. It begins to form a fatty streak that later consolidates into plaques and can ultimately lead to a reduction in blood flow. This is a well known phenomenon and studied extensively in medicine.
So, as you can see cholesterol plaques are a secondary result from the injury to the endothelium.
So, what causes the damage to the endothelium?
“Infinite insults” is a term Dr. Mark Houston of the Hypertension Institute in Nashville, Tennessee, uses to describe in general all the various things that can harm the health and function of our endothelium,
Certainly, excessive levels of cholesterol carrying molecules like the infamous LDL or ‘bad cholesterol’ can fit into the category of infinite insults, However, there are other factors that can equally contribute to the list of insults and are well studied.
- Oxidative stress
- Blood sugar
- More obscure factors such as Lp(a), TMAO, endotoxins, heavy metals, various types of bacteria, viruses, and other microorganisms
- Many more (hence the term “infinite”)
An additional factor to consider, is the concept of “susceptibility”, as it pertains to the vascular endothelium itself. In other words, if we are evaluating for the potential for damage to occur to a structure (the endothelium in this case) the most thorough evaluation would not only include assessment of the harmful factors noted above, but also the structure itself, and how susceptible, or vulnerable it is to damage.
This brings us down to Nutrition and Genetics.
Superior nutritional status, which assesses and accounts for both genetic factors such as Lp(a), MTHFR, and others, as well as specific nutrients crucial to optimal production and function of blood vessels will provide the most results when it comes to suceptibility factors. These nutrients include:
- Amino acids like Arginine, Lysine, and Proline
- Macrominerals like Potassium, Calcium, and Magnesium
- Vitamins A, B Complex, C, and E
- Trace Minerals like Copper, Zinc, and Manganese
- Additional phytonutrients like nitrates, and flavonoids.
Now, let’s revisit the question – If we are to prevent cardiovascular events, should we treat cholesterol ?
Yes, maybe, since its shown to contribute to the plaque formation . Cholesterol lowering medications have also shown to reduce inflammation in some studies and thereby reducing one of the insults on the endothelium. It could be beneficial in certain populations especially the atherogenic profiles as seen in Familial hypercholesterol. Hence, in my practice I may favour them in certain situations to bring the levels to a lower value temporarily while we work on underlying factors. There are studies on targeted nutrients as alternatives for drugs which can be used in tandem or on its own to improve cholesterol values.
So, the whole idea of solely relying on a drug to lower heart attacks- Doing so, are we exploring or treating the root cause for the cholesterol build up in the plaques or are we just addressing the secondary effects from it?
Are we repairing the damage to the lining of the arteries ?
If our current model of prevention starts and finishes with an aspirin and a statin or other cholesterol lowering drug, we are missing out on a tremendous opportunity to further improve our chances. Drugs cannot satisfy nutritional needs of the body nor do they do a good job from helping or protecting us from the infinite insults aside from a few specific causes.
A thorough approach which may or may not need to include medications , trying to identify and eliminate any and all such factors that may contribute to the insults and moving beyond just the cholesterol alone will improve our chances further.
The body is infinitely wise and knows what to do. We just need to give it a good chance.
The role of cellular micronutrient analysis, nutraceuticals, vitamins, antioxidants and minerals in the prevention and treatment of hypertension and cardiovascular disease Ther Adv Cardiovasc Dis (2010) 0(0) 119 DOI: 10.1177
Pathophysiology, diagnosis and prognostic implications of endothelial dysfunction
Pages 180-196 | Published online: 08 Jul 2009
Toxic effects of mercury, lead and gadolinium on vascular reactivity
Non-Transferrin-Bound Iron in the Spotlight: Novel Mechanistic Insights into the Vasculotoxic and Atherosclerotic Effect of Iron
Homocystine-induced arteriosclerosis. The role of endothelial cell injury and platelet response in its genesis
Impact of Lifestyles (Diet and Exercise) on Vascular Health: Oxidative Stress and Endothelial Function
Personalised AND Precision Integrative Cardiovascular Medicine, Book by Mark Houstan.