Arteriosclerotic cardiovascular disease, commonly known as heart disease, remains one of the leading causes of death worldwide. Fortunately, we now have a deeper understanding of how to prevent this chronic condition that uses tools beyond diet and lifestyle.
Cardiovascular diseases related to atherosclerosis, commonly referred to as heart disease, have been the leading cause of death globally for decades. In the United States alone, around 655,000 people die from heart disease each year, accounting for 1 in every 4 deaths. The prevalence remains staggeringly high, with coronary heart disease affecting 6.2% of American adults aged 20 and older from 2015-2018.
While advances in treatment have helped improve survival rates in recent years, the overall burden of heart disease remains immense. From 2009 to 2019, the global prevalence of cardiovascular diseases increased by a staggering 26.6% according to the American Heart Association’s 2022 statistical update. With over 523 million people affected worldwide, heart disease represents a public health crisis desperately in need of new preventative solutions.
Innovative strategies to reduce the risk of atherosclerotic cardiovascular diseases have been on the rise and we will discuss the most promising ones here. Conventional thinking does not use a multi-pronged approach and primarily focuses on cholesterol testing. Because of heart diseases connection to metabolism it is important to assess metabolic and vascular health through advanced biomarker testing.
The Insulin Resistance Factor
While elevated LDL cholesterol is still considered a risk factor, there is mounting research on the primary role of insulin resistance in the development of atherosclerosis and heart disease. The REVERSIRIC study found insulin resistance was a stronger predictor of coronary events than LDL levels in men.
To evaluate insulin sensitivity, use markers like fasting insulin, triglyceride/HDL ratios, HbA1c, and advanced glycation end products. Based on these assessments, prescribe interventions such as low-carb diets, intermittent fasting protocols, and exercise regimens to improve insulin sensitivity and reduce heart disease risk.
Moving Beyond Basic Lipid Panels
Simply measuring basic LDL and HDL cholesterol levels does not provide a complete picture of residual heart disease risk. Instead use advanced lipoprotein tests like:
- LDL particle number (LDL-P)
- Apolipoprotein B (apoB)
- Small dense LDL particles
- HDL subclass analysis
Several long-term studies back this up, showing improved predictive value for heart disease when using these advanced tests in conjunction with basic lipid panels. The Multi-Ethnic Study of Atherosclerosis, for example, identified LDL-P as one of the most potent predictors of cardiovascular events.
Evaluating Endothelial Health
A key aspect of this approach is monitoring the health of the arterial lining (endothelium), which is often overlooked. Use test markers of endothelial dysfunction like:
- Asymmetric dimethylarginine (ADMA)
- Symmetric dimethylarginine (SDMA)
- Arginine levels
Higher levels of ADMA and SDMA can impair nitric oxide production and promote atherosclerosis, while arginine is a precursor for nitric oxide which promotes arterial dilation. Attia emphasizes lifestyle factors like exercise, avoiding pollutants, stress management, sufficient sleep, and ensuring adequate intake of nutrients that support endothelial health.
Comprehensive Use of Pharmacology
When absolutely needed after optimizing other factors we can provide you detailed guidance on evidence-based uses of cholesterol medication, optimal dosing, avoiding side effects, and monitoring effectiveness with advanced testing.
This work is shifting the paradigm in how we evaluate and mitigate heart disease risk through multimodal assessments, personalized interventions focused on root causes, and responsible integration of drug therapies. With heart disease projected to afflict over 800 million people globally by 2030, this innovative approach has immense potential to help reduce the burden of the world’s leading killer.