Heart Attack Prevention: More than Cholesterol

Seventy-two percent of patients admitted in American hospitals for their first heart attack have blood cholesterol levels in the normal range (American Heart Journal, January 28, 2009). This means that the cholesterol guidelines are missing the majority of patients who have heart attacks because either 1) the guidelines are not low enough or 2) something other than a bad LDL cholesterol is causing most heart attacks in the United States.

Many good studies support the present guidelines that everyone should get their bad LDL cholesterol below 100. However, it now appears that some other risk factor must be affecting many people who suffer heart attacks. In November 2008 I reported on the Jupiter study which showed that statin drugs caused people with normal cholesterol but with high C-reactive protein levels to suffer 54 percent fewer heart attacks, 48 percent fewer strokes, 46 percent fewer angioplasties or bypass operations and 20 percent fewer deaths from any cause than those taking placebos (NEJM, November 9, 2008). Statins are known to reduce inflammation as well as to lower LDL cholesterol. A C-reactive protein test (CRP) measures inflammation. Inflammation is caused by anything that keeps your immunity active such as chronic infections or anything that damages tissue such as smoking, having high cholesterol or high blood pressure.

I also reported a theory to explain why eating mammal meat causes inflammation and is associated with increased risk for premature death, cancers and heart attacks. Meat contains a molecule called Neu5Gc that humans do not have, so the immune system of humans attacks this protein as if it was an invading germ and eventually attacks the host itself to destroy the blood vessels and increase risk for heart attacks and strokes. On the basis of this theory I strongly recommend avoiding meat from mammals, including beef, pork and lamb. Today, the best strategy for avoiding a heart attack includes lowering LDL cholesterol by avoiding saturated and partially hydrogenated fats and refined carbohydrates; and eating plenty of fruits, vegetables, whole grains, beans, seeds and nuts. Reduce inflammation by treating chronic infections and high blood pressure, avoid being overweight, smoking and eating meat. Exercise regularly, and work up gradually to a program that includes some intense exercise. Your doctor may recommend statins both to lower cholesterol and to control inflammation.