Prevent “The Big One”—Ischemic Heart Disease

Heart disease is the leading cause of death in the United States both for men and women, killing 25% of Americans, and heart disease deaths are most often due to ischemic heart disease (e.g., heart attack).1 These facts are well known among doctors, nurses, and other health professionals. However, did you know that virtually all “heart attacks” are preventable by diet and lifestyle? If you have never heard this, you are not alone. In my opinion, our education as health professionals tends to focus on the treatment of disease, using drugs, surgery, and other technological advances, and unfortunately, generally underemphasizes relatively inexpensive preventive techniques, including healthy dietary and lifestyle changes. Furthermore, doctors and nurses are trained to pay close attention to disease trends within families and to remind patients of their family histories. As a result, patients often leave doctors’ offices and hospitals with a misconception that if certain diseases, such as heart attacks, are common in their family, they will also likely die from the same disease. I have encountered many people who feel that their fate with regard to disease is sealed in their genes. In actuality, I strongly believe that heart attacks (and most other common chronic diseases that impact Americans) have more to do with families eating the same fatty, salty, sugary, high calorie, processed, animal based, low nutrient foods and sharing the same couch than having similar DNA.As deliverers of health care, we have the opportunity to empower ourselves and our patients as we become more familiar with the current research on preventive health, and as we personally embrace healthier diets and lifestyles.

Let’s consider heart attacks in more detail. Plaques develop as a consequence of damage to the endothelial cells that line our coronary arteries. Only about 12% of heart attacks are actually related to coronary arteries closing off due to large old plaques. The remaining 88% of heart attacks are due to rupture of relatively young, fatty coronary artery plaques.2 Subsequently, clot forms in an attempt to heal this injury, but often occludes the vessel, so that not enough oxygen rich blood reaches the heart muscle. This death of heart muscle (myocardial infarction) is often referred to as a heart attack. There is credible and comprehensive research that this cascade of events, which is often fatal, is directly related to a typically Western diet.

Nearly all heart attacks are preventable based upon my review of the current research. For example, beginning in 1985, Dr. Caldwell Esselstyn studied a group of patients who had severe coronary artery disease.4,5 The 18 patients that remained in the study (5 patients dropped out) had suffered 49 coronary events in the eight years leading up to the study, including angina, bypass surgery, heart attacks, strokes, and angioplasty. During the study, they were to eat a plant based, whole food diet, avoiding oils, meat, fish, fowl, and dairy products, except for skim milk and non-fat yogurt. Only a very low dose of a cholesterol lowering statin drug was used. During the course of the study, the average cholesterol dropped from 246 mg/dL to 132 mg/dL. LDL levels also dropped dramatically. In the following 11 years, there was only 1 coronary event, which occurred in a patient who strayed from the diet. Seventy percent of Dr. Esselstyn’s patients experienced opening of their clogged arteries. Furthermore, it is compelling that Dr. Esselstyn and two other prominent heart researchers, Dr. Bill Castelli (longtime director of the Framington Heart Study) and Dr. Bill Roberts (longtime editor of the prestigious medical journal, Cardiology), each indicated that they had never seen a heart disease fatality among their patients who had blood cholesterol levels below 150 mg/dL.6

It is also noteworthy that the rate of heart attack deaths in the United States is among the highest in the world, with rates over the years typically 10-15 times greater than some other countries.7 In fact, there are some countries where heart disease is rare.8 Please note that Japanese men who live in Hawaii or California have a much higher total cholesterol and incidence of coronary artery disease than Japanese men living in Japan.9,10 These data are not explainable by genes, but rather by diet and lifestyle.

We know that 35% of heart attacks strike Americans with cholesterol levels between 150 and 200 mg/dL.11 Why then do we set our goals for a total cholesterol of under 200, when, actually, a truly safe cholesterol has been shown to be under 150 mg/dL?  I believe that cultural bias plays a role here, impacting governmental legislation and medical education. After learning this valuable information about heart attack prevention, several years ago, I decided to personally strive for a total cholesterol of below 150 mg/dL. By adopting a whole food, plant based diet, I was able to achieve a sub 150 cholesterol within a few months and have maintained it. In the words of Dr. Esselstyn, I have now been “heart attack proof” for 4 years. I have no intention of returning to the Standard American Diet (SAD), because since adopting this healthy diet and lifestyle, I have also “cured” my pre-diabetes without meds and lost more than 50 pounds, which is a typical response to a plant based, whole foods diet and regular exercise. My dietary caloric intake is about 95% plant food and 5% animal based food (generally fish). I virtually never eat red meat and only occasionally eat skinless grilled chicken (typically on a salad).

It is most important that we seek the truth. The truth is that heart attacks are preventable in nearly all cases, and once informed, we all have the option of protecting ourselves (through our diet and lifestyle) from coronary artery disease. In my opinion, we also have an obligation to pass this information along to our families, patients, and friends. It is my experience that many people will make healthy dietary and lifestyle changes, when they fully understand the benefits of doing so, as well as the potential consequences of not making such changes. As doctors and nurses, let’s take the lead by personally embracing healthier diets and lifestyles to prevent and reverse chronic disease, becoming role models whose behavior our patients can emulate.  In doing so, we can also rest assured that we will not succumb to “the big one“!


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  9. Kagan A, Harris BR, Winkelstein W Jr, et al. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California: demographic, physical, dietary and biochemical characteristics. J. Chronic Dis. 1974 Sep;27(7-8):345-64.
  10. Kato H, Tillotson J, Nichaman MZ, Rhoads GG, Hamilton HB. Epidemiologic Studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California: serum lipids and diet. Am. J. Epidemiol. 1973;97(6):372-385.
  11. Castelli W. Take this letter to your doctor. Prevention. 1966;48:61-64.