For decades, doctors have concentrated on the “big five” causes of heart disease: elevated cholesterol, high blood pressure, diabetes, obesity, and smoking. But that is only part of the whole picture. Here are eight important things about heart disease you need to know right now


Ideally, your arteries should be flexible, with a smooth, undamaged endothelium, a single layer of cells that line the inner surface of your arteries. When healthy, your arteries allow the oxygen and nutrient-rich blood to flow freely.

But over time, the effects of heredity, unhealthy habits, and simply growing older can damage arteries. When arteries become damaged— a condition called arteriosclerosis—blood flow can eventually be hindered or even completely blocked. Calcification can also cause damage to your arteries.

If you’re over the age of 60, you likely have deposits of calcium in your major arteries. As the calcium builds up, it can harden and reduce blood flow. Studies have found that arterial calcification may set you up for other cardiovascular problems, including high blood pressure, aortic stenosis (where the heart’s aortic valve narrows), cardiac hypertrophy (thickening of the heart muscle), and congestive heart failure.


The main culprit in heart disease is inflammation—it’s thought to be the root cause. Slight injuries to the vascular wall become inflamed, trapping oxidized cholesterol particles and other nasty compounds.

Free radicals create more damage, and inflammatory chemicals create more inflammation. Eventually, connections between cells in the artery walls loosen, making it easier for foreign substances to get stuck there.

Before you know it, you’ve got a “toxic brew” that can form into plaque. In fact, many health professionals now believe that any benefit that statin drugs may have is because they slightly lower inflammation, not because they lower cholesterol. And speaking of inflammation …


ENEMY NO. 1 Sugar is a far greater danger to your heart than fat.

Sugar directly contributes to inflammation in the artery walls, and  foods that convert quickly to sugar in the body, such as cereals, breads, pasta, rice, and potatoes—drive up insulin, which tells your body to store fat and raises blood pressure.

High-carb, high-sugar diets also raise triglycerides, a fat found in the bloodstream that’s a serious risk factor for heart disease. “When sugar consumption rises, HDL decreases, and triglycerides increase,” says Mark Houston, MD, author of What Your Doctor May Not Tell You About Heart Disease. The most heart-healthy diets contain very little sugar.


Sleep is essential for cardiovascular health. Studies show that the risk of a heart attack goes up significantly in those logging fewer than six hours—or, interestingly, more than nine hours—a night. The sweet spot? Seven to eight hours of shut-eye each and every night.


Seriously. Emotional stress produces hormones and biochemical activity that contributes to inflammation. In some cases, stress can precipitate a heart attack or cause sudden death, even in the absence of any clear risk factors and in the presence of relatively healthy arteries.

Stress weakens the immune system while raising blood pressure and heart rate. “The mind and body are not separate entities, but rather different aspects of a single unit,” says Houston.


Omega-3s are your heart’s best friend. They’re the “parent molecules” for many of the anti-inflammatory chemicals your body makes, while omega-6s (vegetable oils) are the parent molecules for our inflammatory chemicals. These anti- and pro-inflammatory chemicals are called thromboxanes, leukotrienes, and prostaglandins. We actually need both omega-3s and omega-6s, but we need them to be in balance.

A 1:1 ratio is ideal, but typical American diets are stacked 16:1 in favor of pro-inflammatory omega-6s, meaning that we’re Omega-3s are found in a variety of foods. The best sources include fish, grass-fed meat, flaxseeds/flaxseed oil, walnuts, seaweed, hemp seeds, chia seeds, and soybeans. Studies show that people who eat fish at least twice a week have a 30 percent lower risk of cardiovascular disease than those who rarely eat fish.

Look for low-mercury varieties such as wildcaught or Pacific salmon, sardines, anchovies, rainbow trout, and haddock. To find a list of sustainable seafood where you live, visit—they have a great “Consumer Guides” section, which includes information on the best/worst seafood choices.


Get the right tests. Besides the cholesterol particle test, several other tests can give you useful information about your risk for heart

disease. Chief among them is the HS-CRP test (high sensitivity C-reactive protein), a measure of inflammation in the body. CRP is a potent predictor of future cardiovascular health—high levels are associated with infections, high blood sugar, and excess weight.

Houston likes to see a CRP reading of under 2, while The Great Cholesterol Myth coauthor, Stephen Sinatra, MD, goes even further.

He likes to see a CRP reading of 1.0 or less. The point is, the lower the better. homocysteine causes your body to lay down sticky platelets in blood vessels. Some homocysteine is normal, but an excess can affect cardiovascular health. Homocysteine contributes to atherosclerosis (accumulation of plaque in arteries), reduces the flexibility of blood vessels, and slows blood flow.

“Too much homocysteine alters the environment inside the arteries and sets the stage for arterial disease,” says Houston. Homocysteine should ideally be under 10 and should not go above 12.

Other tests that give valuable information about artery health include interleukin-6 (an inflammatory

compound that stimulates the liver to produce CRP), and a carotid intima medial thickness test (CIMT), which uses ultrasound to measure the thickness of the

carotid arteries. “Thickening of the carotid arteries has been shown to be a strong indicator of cardiovascular disease and atherosclerosis,” says Houston.