Have We Been Misled About Heart Disease?

For decades, we've been told that high cholesterol is the cause of heart disease and that lowering LDL cholesterol—whether through diet or medication—is the key to protecting our hearts.

Yet despite widespread statin use and decades of low-fat dietary recommendations, heart disease remains the leading cause of death worldwide. More concerning, half of all heart attack victims have “normal” cholesterol levels.

So if cholesterol isn’t the root problem, what is?

Emerging research suggests that heart disease isn’t caused by cholesterol alone but by chronic inflammation, insulin resistance, and metabolic dysfunction.

In this blog, we’ll break down:

• Why cholesterol has been unfairly blamed for heart disease

• The real causes of arterial plaque build-up (hint: it’s not just fat)

• The hidden role of insulin resistance and inflammation in cardiovascular disease

• What actually matters when assessing heart health

Is Cholesterol the Firefighter or the Fire?

Imagine this: You see a house on fire, and every time, firefighters are at the scene. Would you assume that firefighters caused the fire?

Of course not.

Yet this is exactly how cholesterol works in your body. It is present at the site of arterial damage not because it caused the problem, but because it is part of the repair process.

Since cholesterol is a critical building block of every cell, it naturally shows up where damage has occurred. But blaming cholesterol for heart disease is like blaming firefighters for fires—it ignores the underlying cause of the damage.

The real question is: What is causing the damage to the arteries in the first place?

Does High Cholesterol Really Cause Heart Disease?

For decades, medical advice has centred on LDL cholesterol ("bad cholesterol") as the primary culprit behind heart disease.

The theory suggests that LDL cholesterol builds up in arteries, forming plaques that block blood flow and lead to heart attacks.

But here’s why this explanation is overly simplistic:

• Cholesterol is essential for life—every cell in your body needs it to function.

• Fifty percent of heart attack victims have “normal” cholesterol levels.

• Lowering cholesterol with statins does not significantly reduce heart attack risk in people without prior heart disease.

Key Insight: Cholesterol does not cause heart disease on its own. Its what is sent to the 'scene of the crime' to repair the damage. The real issue is what is damaging the arteries in the first place.

Cholesterol: Villain or Vital Nutrient?

Cholesterol is not just important—it is essential. Without it, the body cannot function properly.

• Cholesterol is a primary component of every cell – It provides structure and integrity to cell membranes.

• It is essential for brain function – Cholesterol supports neurotransmitters and cognitive function.

• It is the building block of hormones – Cholesterol is necessary for testosterone, oestrogen, cortisol, and vitamin D production.

• It plays a crucial role in digestion – The liver uses cholesterol to produce bile, which aids in fat digestion.

Key Insight: The idea that we should aim for the lowest cholesterol possible ignores the fact that cholesterol is a vital nutrient required for life.

The Real Culprit: Inflammation and Insulin Resistance

If cholesterol is not the problem, what is?

The latest research shows that chronic inflammation and insulin resistance are the real drivers of heart disease.

Chronic Inflammation:

• Damages blood vessel walls, making them more vulnerable to plaque build-up

• Triggers the immune system to create unstable, rupture-prone plaques

• Increases the risk of blood clots

Insulin Resistance and High Blood Sugar:

• Excess sugar and carbohydrates damage arteries and fuel inflammation

• Chronically high insulin levels increase plaque formation

• Up to 88% of American adults exhibit signs of metabolic dysfunction, with insulin resistance playing a central role. Unfortunately, the UK is now facing a strikingly similar metabolic crisis, mirroring trends seen across the Atlantic.

Key Insight: Cholesterol only becomes problematic when combined with inflammation, insulin resistance, and oxidative stress.

Why Oxidised LDL is the Real Problem

LDL itself is not inherently harmful—it plays an essential role in delivering nutrients and cholesterol to cells. The issue arises when LDL particles become oxidised (damaged) due to chronic inflammation, high blood sugar, and oxidative stress, making them more likely to trigger plaque build-up and arterial disease.

🛑Why Oxidised LDL is Problematic:

• Triggers an immune response – The body treats oxidised LDL as “damaged” and sends white blood cells (macrophages) to remove it, leading to plaque build-up.

• Increases inflammation – This immune response worsens arterial inflammation, narrowing blood vessels and increasing clot risk.

• Is more likely to become small, dense LDL – These particles penetrate artery walls more easily than large, fluffy LDL, increasing plaque formation.

In short, oxidised LDL fuels inflammation, promotes plaque build-up, and increases the risk of dangerous artery-clogging clots—significantly raising your risk of heart disease.

Why the Standard Cholesterol Test is Misleading

Most doctors still rely on total LDL cholesterol as the primary indicator of heart disease risk. However, as we have discussed, LDL alone does not provide the full picture—what really matters is whether your LDL is oxidised.

The real question is: Is your LDL oxidised? The difference between ‘normal’ LDL and oxidised LDL can dramatically change your heart disease risk. High LDL alone isn't the issue—it’s about context. Oxidised LDL is only dangerous in the presence of inflammation and metabolic dysfunction—which is why insulin resistance plays a critical role in heart disease risk. Chronically high insulin levels increase oxidative stress, making LDL more likely to become oxidised, raising heart disease risk.

We go into full detail inside the Mindful Metabolism Program, where we break down how to assess your risk properly, including LDL particle size, triglyceride-to-HDL ratios, and what your numbers really mean.

Final Thoughts: Rethinking Heart Disease Prevention

Blaming cholesterol for heart disease is an oversimplification. The latest research shows that cholesterol is part of the body’s repair process—not the cause of arterial damage.

The real question should be: What is causing the inflammation that damages arteries in the first place and how do I reduce it?

Instead of focusing on lowering cholesterol, the priority should be:

• Reducing sugar and processed foods

• Eliminating inflammatory seed oils

• Improving insulin sensitivity

• Supporting the body with the right nutrients

• Consume Heart-Healthy Fats

• Manage Stress and Sleep

The good news? Heart disease is largely preventable with the right approach to metabolic health.

Want to Take Charge of Your Metabolic Health?

The Mindful Metabolism Programme is a 16-week metabolic reset designed to:

• Reduce chronic inflammation and repair metabolic dysfunction

• Optimise insulin sensitivity for long-term health

• Provide the tools, education, and support needed to take control of health and longevity

Join a community of individuals taking proactive steps to improve their heart health and overall well-being.

Click below to learn more and start your metabolic reset today.

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Disclaimer: This blog is for educational purposes only and is not intended as a substitute for medical advice.