How do I lower my risk of cardiovascular disease?

Our read is that lowering cardiovascular disease risk involves addressing factors beyond just cholesterol levels, with an emphasis on diet and exercise.

Abolishing atherosclerosis could increase lifespan by approximately 3%, and plaque rupture is a significant cause of fatal heart attacks.

However, experts disagree on the primary drivers of heart disease, with some questioning the long-standing focus on LDL cholesterol and saturated fats.

• 01Peter Attia states that abolishing atherosclerosis alone would increase lifespan by approximately 3%.
• 02Peter Attia notes that plaque rupture can lead to heart attack, which is fatal about 50% of the time on first occurrence.
• 03Paul Saladino indicates that elevated 2-hour postprandial glucose levels above 83-100 mg/dL are linearly related to cardiovascular disease death.
• 04Peter Attia highlights that individuals with congenital forms of severe insulin resistance, including lipodystrophy, have extremely high coronary artery disease risk.
• 05Rhonda Patrick suggests that high-intensity exercise is more effective than low-intensity exercise for endothelial adaptations due to shear stress.
• 06Rhonda Patrick also finds that higher amounts of VILPA, such as around nine minutes a day, are associated with reductions in mortality.
• 07Andrew Huberman reports that consumption of ultra-processed foods is associated with worse physical and mental health outcomes.
• 08Peter Attia mentions that people with type 1 diabetes are at risk for the same complications as people with type 2 diabetes, including cardiovascular disease, kidney disease, diabetic retinopathy, blindness, and limb amputations.
• 09Paul Saladino explains that LDL cholesterol functions as a transport mechanism for substances from the liver throughout the body, acting as a repair agent, antioxidant, and supporter of bodily processes including the immune system.
• 10Peter Attia states that high cholesterol levels detected in adulthood do not necessitate immediate cardiac artery evaluation.

Experts disagree on the primary drivers of cardiovascular disease. Paul Saladino and Peter Attia contend that atherosclerosis is a disease of the tissue, not just plasma lipid levels. Paul Saladino argues that recommendations to consume vegetable oils because they lower LDL are suspect and potentially harmful, given that LDL is not the primary villain in heart disease, and that seed oils are a major driver of chronic disease in humans. He also suggests that the physical dimensions of LDL particles make it improbable for them to directly penetrate the endothelium without causing damage. Peter Attia posits that carbohydrates, not dietary fats, may drive chronic diseases. Rhonda Patrick notes that the combination of high fat and high carbohydrate intake is the worst scenario for adverse health outcomes, including negative changes in lipoprotein profiles. Bryan Johnson warns that frequent short international trips are akin to shift work and increase the risk of diabetes, cardiovascular disease, dementia, and death by 2-2.5 times. Peter Attia also points out that Guinness World Records banned sleep deprivation attempts due to significant health risks including mental health issues, cancer, cardiovascular disease, metabolic syndrome, and suicide.

The verdict could change with a clearer understanding of the exact reasons why arteries retain LDL and veins do not, or if a readily apparent intervention is found to quickly reverse fatty liver disease. Improved prediction of fatal myocardial infarctions would also be a significant development.