For over half a century, Americans have been taught a simple explanation for the nation’s No. 1 killer: that saturated fat clogs our arteries, leading to heart failure.
This diet-heart hypothesis, first put forth in the 1960s by physiologist Ancel Keys, remains firmly lodged in popular consciousness. But unbeknownst to most, modern medical research now understands heart disease to be far more complex than a matter of meat and butter consumption alone.
Inflammatory Link Between Immune System and Heart Disease
Inflammation is a leading theory for explaining the root of heart disease, according to Dr. Barbara Roberts, director of the Women’s Cardiac Center at The Miriam Hospital in Providence, Rhode Island.
In a 2023 report published in BMC Cardiovascular Disorders, researchers made a scientific case for why inflammation may underlie heart disease, especially atherosclerotic heart disease—hardening of the arteries due to plaque buildup—which accounts for most cardiovascular events.
Just as the body mounts an immune response to infection or injury, a similar inflammatory reaction occurs in heart disease. The adaptive immune system has been shown to have an association with heart disease risk due to sustained chronic inflammation, according to the study.
“Although immune cells are integral key players of cardiac healing, an unbalanced or unresolved immune reaction after [myocardial infarction] aggravates tissue damage that triggers maladaptive remodeling and heart failure,” according to a 2021 European Heart Journal review.
In a 2022 Journal of Molecular Science report, researchers noted that atherosclerosis is a chronic inflammatory disease in which balancing inflammatory immune system agents determines disease progression or resolution.
LDL Quality–Not Just Quantity–Matters
Low-density lipoproteins (LDL) act as cholesterol transporters in the body, carrying it where needed to synthesize hormones. LDL also plays a supporting immune role, defending against pathogens and oxidative stress, according to research. However, poor lifestyle factors like diet, smoking, and inactivity can overwhelm the immune system, resulting in LDL oxidation.
Emerging evidence indicates oxidized LDL—not total LDL—is key in heart disease. When oxidized, LDL carriers break down into smaller particles unable to attach to liver receptors. These particles then float freely in the blood, damaging arterial walls.
Contrary to logic, smaller oxidized particles present a higher risk than larger LDL. “Even if you have low LDL cholesterol with high LDL particle count, you can have a greater chance of heart disease than someone with cholesterol that is through the roof but has a low LDL particle count,” Jonny Bowden, who holds a doctorate in holistic nutrition and is a board-certified nutritionist and author, told The Epoch Times.
A 2020 study spanning eight years published in the Journal of Atherosclerosis and Thrombosis showed that individuals with the highest levels of small-dense LDL particles had over a five times greater risk of developing heart disease than those with the lowest levels.
High LDL particle count doubled the risk of peripheral arterial disease—where narrowed blood vessels reduce blood flow to the limbs—while LDL level had no association, according to a 2018 study of almost 28,000 women 45 years old or older published in Circulation.
“A higher amount of omega-6 in the LDL makes it more susceptible to oxidation,” James DiNicolantonio, a cardiovascular research scientist and doctor of pharmacy at Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, told The Epoch Times. On the other hand, when LDL lacks antioxidants such as Coenzyme Q10 and carotenoids, and there is more inflammation in the body, LDL can also undergo oxidation, he added.
Insulin Resistance Emerges as Key Driver
Insulin facilitates glucose transportation and storage. Insulin resistance occurs when cells don’t respond to insulin and cannot easily store circulating glucose. While known as a Type 2 diabetes precursor, insulin resistance may also contribute to heart disease progression, indicates research.
A 2022 study of 110,000 adults published in Diabetes Care linked insulin resistance and heart disease risk. In prediabetic adults, only those with insulin resistance and obesity had higher cardiovascular risk versus those with normal glucose tolerance. In diabetic adults, cardiovascular risk persisted regardless of obesity.
A 2023 study in the Journal of International Medical Research explained that while the mechanisms connecting insulin resistance and heart disease remain unclear, the link has been established. Altered insulin responses result in cardiometabolic disorders like obesity, low-grade inflammation, and hypertension—all atherosclerosis and cardiovascular disease precursors. Lifestyle changes like proper dieting and avoiding sedentary behavior are essential to manage insulin resistance and minimize cardiovascular risk, the authors noted.
A 2019 review in Diabetes & Metabolic Syndrome: Clinical Research & Reviews also argued that insulin resistance is potentially the single most important cause of coronary artery disease.
Nutrient Deficiency
The introduction of processed foods such as refined sugar and seed oils is closely linked to worsened heart health. A lack of nutrients is also to blame for increased cardiovascular disease, according to Mr. DiNicolantonio. “A lack of any essential nutrient will speed/lead to the production of atherosclerosis,” he told The Epoch Times.
Key deficiencies closely tied to heart disease include magnesium and copper. Vitamin D deficiency is also associated with cardiovascular disease and hypertension. Antioxidant vitamins A, C, E, B6, and folate also support heart health.
Despite his certainty that nutrient deficiency contributes to heart disease, Mr. DiNicolantonio said no single cause explains heart disease. “There are too many mechanisms to try and guess what is the primary cause of heart disease,” he noted.
It starts with violations of his mantra, “Eat Well, Live Well, Think Well,” according to Dr. Jack Wolfson, a board-certified cardiologist. These violations prompt immune activation, inflammation, oxidative stress, nervous system dysfunction, and cell energy issues. “Ultimately, disease is the final outcome,” he added.
Triglycerides as an Independent Risk Factor
Triglycerides, the most abundant blood fat, have a well-documented role in heart disease. Elevated triglyceride levels from poor diet and inactivity disrupt lipid metabolism, increasing the risk of heart disease. High levels of circulating free fatty acids independently contribute to atherosclerosis.
A 2021 Journal of Lipid and Atherosclerosis study of over 1.8 million Korean adults reconfirmed triglycerides as an independent heart disease risk factor, reaffirming findings from studies beginning in the late 1980s showing triglycerides and associated lifestyle factors significantly contribute to heart disease development.
