Heart Attack Risk Factors: Beyond Cholesterol

When it comes to preventing heart attacks, there's a wealth of contradictory information. Most doctors focus almost exclusively on reducing LDL cholesterol, but according to Dr. Ken Berry, a family physician with over 22 years of clinical experience, this perspective is incomplete and potentially misguided. A recent scientific analysis published in the British Medical Journal Open Heart reveals surprising data about the true risk factors for heart disease.

The main risk factors (and their relative risk values)

A study published by Professor Noakes in the British Medical Journal Open Heart in 2021 presents an enlightening graph that organizes cardiovascular risk factors according to their "hazard ratio." This measure indicates how dangerous each factor is for developing coronary disease.

Clinical factors (from highest to lowest risk):

1. Type 2 diabetes: Hazard ratio of 10.71
2. Metabolic syndrome: Hazard ratio of 5.99
3. High blood pressure: Hazard ratio of 4.25
4. Obesity: Hazard ratio of 3.01
5. Smoking: Hazard ratio of 1.87
6. Family history of premature coronary disease: Hazard ratio of 1.50

Biochemical markers (from highest to lowest risk):

1. Insulin resistance/hyperinsulinemia: Hazard ratio of 2.83
2. Elevated triglycerides: Hazard ratio of 2.14
3. Elevated apolipoprotein B: Hazard ratio of 1.89
4. Elevated non-HDL cholesterol: Hazard ratio of 1.67
5. Elevated LDL cholesterol: Hazard ratio of 1.38
6. Inflammatory markers (like hs-CRP): Hazard ratio of 1.33

The real enemy: type 2 diabetes and metabolic syndrome

The data reveals a shocking fact: type 2 diabetes has a hazard ratio of 10.71, similar to the relationship between smoking and lung cancer. This means type 2 diabetes is approximately 10 times more dangerous for your heart than having elevated LDL cholesterol (hazard ratio of only 1.38).

Equally alarming is metabolic syndrome, characterized by:

• Elevated triglycerides
• High blood pressure
• Increased waist circumference
• Glucose metabolism alterations

This syndrome has a hazard ratio of 5.99, placing it as the second most dangerous factor for developing coronary disease, well above elevated LDL cholesterol.

Inverted priorities in conventional medical care

Dr. Berry expresses his frustration with common medical practice that focuses almost exclusively on reducing LDL cholesterol through statins, while ignoring or minimizing much more significant risk factors:

• A patient with poorly controlled type 2 diabetes (A1c of 6.5-7.0) has extremely high cardiovascular risk
• Many doctors consider these A1c levels as "pretty good" and focus on prescribing statins
• This approach prioritizes a minor risk factor (LDL) over the most important factor (blood glucose)

The solution: proper nutrition to reverse the main risk factors

According to Dr. Berry, the good news is that the four main risk factors can be reversed through dietary changes:

1. Reversing type 2 diabetes

A very low-carbohydrate diet (ketogenic or carnivore) has shown to normalize blood glucose levels in many patients, potentially eliminating the greatest cardiovascular risk factor.

2. Eliminating metabolic syndrome

These same eating patterns can normalize triglycerides, blood pressure, and reduce abdominal fat, completely reversing metabolic syndrome.

3. Controlling hypertension

Many people who adopt low-carbohydrate diets experience blood pressure normalization, frequently reducing or eliminating the need for antihypertensive medications.

4. Reducing obesity

Ketogenic and carnivore diets are recognized for their effectiveness in reducing body weight and fat percentage, addressing another critical risk factor.

Strategic approach to reduce your cardiovascular risk

Dr. Berry recommends concentrating your efforts on the factors that have the greatest impact:

1. Prioritize blood glucose normalization if you have type 2 diabetes or prediabetes
2. Address metabolic syndrome through appropriate dietary changes
3. Control your blood pressure naturally when possible
4. Reduce your body fat percentage to healthy levels
5. Stop smoking if you're a smoker

Only after addressing these main factors would it make sense to worry about lower-impact markers like LDL cholesterol.

The complete perspective on cardiovascular risk

The main message is clear: to truly protect your heart, you must look beyond LDL cholesterol and focus on the factors with the greatest impact on your actual cardiovascular risk.

Adopting a diet appropriate for humans —whether ketogenic, ketovore (keto with emphasis on animal products), or carnivore— can potentially eliminate the four main cardiovascular risk factors, offering significantly greater protection than simply reducing LDL cholesterol through medications.

This approach based on current scientific evidence could radically transform heart disease prevention, focusing resources and efforts where they truly matter: on the factors that genuinely determine our cardiovascular risk.