Note: This article was updated (April 22, 2024).
There is much new research on heart health and how we can mitigate the risk for heart disease. However, I often hear dated information about heart disease, some of which have even been debunked. Today, I’d like to shed light on the risk factors for heart disease to clear up some confusion. What are the most widespread myths about the cardiovascular disease that I hear?
1. Cardiovascular disease is genetic.
This is one that I was actually taught in medical school because that was the thinking at the time. We now know that 80% of heart disease is driven by diet and lifestyle alone, 50% of heart disease can be directly attributed to eating processed foods, and only about 5% is actually genetic. This huge paradigm shift in the last 20 years is taking too long to become common knowledge.
2. What I eat doesn’t really affect my risk of heart disease.
During medical school in the late ’90s, I was taught that diet didn’t matter that much; the thinking was that cardiovascular risk was purely a matter of family history. This is just not true. We know now that diet is a huge factor in your risk for cardiovascular disease and chronic illness in general. Because it’s so important, I’ll repeat this statistic again: 80% of heart disease can be prevented by diet and lifestyle alone. This comes from the Harvard School of Public Health.
3. Cholesterol is a major risk factor for heart disease.
The truth is that your cholesterol is not a major risk factor; it’s a very, very small factor in the big picture of cardiovascular health. Half of all people who show up at the emergency room with a first heart attack have normal cholesterol levels – that’s right, 50%. Batting 500 might be amazing in baseball, but in medicine, it’s called malpractice. If I were wrong half the time when I treat patients, my business would shut down quickly. However, in the realm of conventional heart disease prevention, being wrong half the time is considered the standard of care.
4. Taking cholesterol-lowering medication will significantly improve my risk for heart disease.
Nope. This is another common myth that is simply not statistically sound. For example, the original data on Zocor (aka simvastatin) was that the number needed to treat to prevent one event was 40. So this means that in a group of high-risk individuals, 40 people had to take cholesterol medication for five years to prevent one event. As a physician, this means that if I can get a group of 40 people with a high risk of cardiovascular disease to take a pill every day for five years, I can prevent one heart event. That’s a pretty poor statistic, especially when you realize that heart disease is the number one cause of death in our country. So over half of those 40 people – over 20 of them – will still die from heart disease. That’s not good enough.
5. Cholesterol medications are safe and cause no side effects.
I was also taught in medical school back in 1996 that the medications we use to treat high cholesterol are safe. Fast forward a few decades and we now know that if you’re a male and take cholesterol medication, it increases your risk for diabetes by about 5%. If you’re a postmenopausal female, cholesterol-lowering medication can increase your risk of developing diabetes by about 48%. Also, these medications are known to cause things like peripheral neuropathy, chronic fatigue, and fibromyalgia.
6. I’ve seen a cardiologist, who told me I was fine; I don’t need to think about cardiovascular disease.
A standard cardiac evaluation by a heart specialist typically only deals with late-stage heart disease. Tests such as stress test or coronary artery calcium score looks for actual heart disease. It takes anywhere from 20 to 40 years to go from a fatty streak to actual heart disease. The process of heart disease can begin, in some cases, as young as 16 years of age! So if you see your heart doctor in midlife and they say you’re OK, it is possible that they’re missing an earlier stage of heart disease. There are over 300 risk markers for heart disease, and the standard evaluation includes five. It’s important to consider a much broader perspective in order to address cardiovascular health.
7. I take cholesterol medication and my numbers have become normal; I’ve eliminated my risk for heart disease.
One of the things we’ve learned from the recent cholesterol studies over the last 20 years is that heart disease is caused by inflammation. So just reducing cholesterol numbers with medication does not significantly change outcomes. If you don’t deal with the root cause, the inflammation, you actually don’t lower your risk that much. That’s the reason that the “number needed to treat” (40 people) that I mentioned above, is such a poor statistic. What the studies have shown is that inflammatory markers like hsCRP are actually more closely associated with heart disease risk. Statins can actually lower these, but a lot of other things can as well. Just lowering your cholesterol number with cholesterol medication by itself does not eliminate your risk for heart disease. It does decrease your relative risk by about 25%, but if you look at the absolute numbers (the number needed to treat) they still are not amazing therapies. Drug companies like to use relative risk statistics because it frames their drugs as more effective. However, absolute numbers help us to get a clearer picture of the real benefit.
8. I’ve checked all my numbers and I don’t have any risk factors, so I’m not at risk for heart disease.
Actually, there are over 300 risk factors for heart disease. Our current healthcare system looks at five: obesity, smoking, blood pressure, cholesterol, and diabetes. What about the other 295? There are multiple advanced tests that are now available to assess risk factors for cardiovascular disease. Advanced testing while assessing additional risk factors like sleep apnea, diet, stress, inflammation, gut health, etc. are huge leverage points for lowering your risk for heart disease.
9. A low-fat diet lowers the risk for heart disease.
Actually, the exact opposite is true. Lots of healthy omega-3s from fish and clean sources, extra virgin olive oil, and other sources of omega-9s like nuts and seeds, actually reduce your risk for heart disease. Processed fats like seed oils (e.g. canola and soy), trans fats, hydrogenated fats, and rancid oils actually increase the risk for heart disease. Unfortunately, 80% of what many Americans eat is processed food. These processed foods include rancid hydrogenated oils. When it comes to fats in our diet, it’s critical to differentiate between healthy and toxic fats. Focus on clean, healthy fats like fish oil from good sources, well-sourced fish, extra virgin olive oil, healthy nuts, seeds, olives, and avocados. You can significantly lower your risk for heart disease with these healthy fats. For example, eating two tablespoons of
flaxseed a day by itself lowers your risk for heart disease by about 20 to 25%. Small changes make a big difference.
10. I’ve been tested and have the gene for heart disease; I can’t change my risk. I’m doomed to have a heart attack like my parents before me.
Again, there are genes associated with an increased risk of inflammation and heart disease like the APOE4 for gene or the MTHFR gene, for example. However, genes are not direct determinants of disease; they just increase the risk. The question is: Are the genes turned on or off? What does your diet look like? Is your environment turning them on or off? What things are you doing to help lower inflammation? if you have the APOE4 gene, actually lots of healthy fats, plasmalogens, and omega-3s can lower your risk back to that of someone that doesn’t have that gene. Just think about that for a minute. Diet by itself can eliminate the risk of the APOE4 gene.
Summary
As you can see, we have much control over our health. We can alter the trajectory of our health by making some very basic changes in our diet and eating real food, using stress reduction practices, improving the quality of our sleep, and removing environmental toxins and chemicals.
These are powerful tools. Your health is in your hands.
Are you interested in learning more about the functional medicine approach to cardiovascular disease? Check out the Cardiometabolic Food Plan on our website. This free resource is a great place to start in changing your heart health trajectory.
Take care and be well.
Since 2010, Richmond Integrative and Functional Medicine has been helping people to restore their health and hope with an integrative approach to conventional and alternative medicine that’s entirely science-backed. We at RIFM believe everyone is made for health. We offer a comprehensive, in-person patient membership program to ensure you get access to the care you need to thrive.
