“Alternative Facts” to the Cause of Heart Disease

Proposing alternative facts is quite common in many areas of medicine. There are scientists who debate on how to interpret research results as they develop.

Given February is Heart and Stroke Month, I wanted to share my life journey lessons with you on the cause(s) of heart disease.

In 1986, as a second year medical student at the University of Toronto, we completed our studies in Cardiology. We had great teachers, many of whom, I would put my life in their hands. The conventional wisdom was that cholesterol was the huge perpetrator of atherosclerotic disease (plaque formation). If we could just lower it, then we would reduce the incidence of heart attacks and stroke.

Cholesterol lowering medications began to appear in the market. Then ‘statin’ medications began to dominate the market; one blockbuster drug after another. I began to prescribe it as THE heart treatment, and for some doctors statins became the anti-aging solution when prescribed at four times the dose!

What is equally alarming is that we got rid of all fats and turned to a high carbohydrate diet, which still dominates the market place today. Such a diet creates obesity and will soon affect 50% of our country. We have replaced heart disease with diabetes as our society’s biggest growing health issue as a result of this ill-informed generational diet imbalance experiment.

The risk of developing heart disease has traditionally been assessed by measuring LDL-C (low-density lipoprotein cholesterol; the carrier of “bad” cholesterol) and HDL-C (high-density lipoprotein cholesterol; the carrier of “good” cholesterol).

Studies, as far back as 2008, have demonstrated that approximately 50% of heart attacks and strokes occur in patients with ‘normal’ cholesterol levels. (1) Therefore, routine cholesterol testing will fail to fully identify individuals at risk.

In 1976, Dr. Russell Ross, a world-renowned vascular biologist, wrote about his “Response to Injury Hypothesis” (2). I would argue at that time he was an ‘alternative’ voice.

Briefly, he believed cardiovascular disease begins with higher cholesterol levels and a subsequent key requirement of oxidation (think browning of a slice of apple exposed to the air). This leads to injury of the artery wall. The body responds to any injury with an inflammatory response designed to remove cholesterol from the artery wall. This process becomes poorly regulated and ultimately accelerates the cholesterol deposit and vulnerable plaque formation, placing an individual at increased risk of plaque rupture and subsequent heart attack or stroke.

Fast forward to 2017, I would assure you that all cardiologists will tell you that ‘cholesterol’ is not necessarily the culprit. Rather, it is the artery lining damage from inflammation and deposit of ‘oxidized cholesterol’ that are key to those who develop heart disease or not. We have the ability to measure the oxidation and inflammatory risk factors in our blood, but it is ‘costly’ to the system. Whether we can afford to test or not to test for them is for political debate.

With respect to the story of how heart disease and stroke develops, for now, the alternative facts turn out to be ‘true’.


  1. Ridker PM et al. N Engl J Med. 2008; 359: 2195-2207.
  2. Ross R and Glomset JA. N Engl J Med. 1976; 295: 369-377.

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