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Inflammation Worsens Danger of Heart Disease


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A recent study published in the American Journal of Pathology adds to the already considerable body of evidence which suggests that inflammation is a primary cause of heart attacks and strokes.

In an article I wrote last year, Preventing Heart Disease Without Drugs, I reviewed the current scientific understanding of what causes heart disease. If you’ve been following this blog, you know that inflammation and oxidative damage – not saturated fat and cholesterol – are the primary causes of heart disease.

I wrote:

Inflammation is the body’s response to noxious substances. Those substances can be foreign, like bacteria, or found within our body, as in autoimmune diseases like rheumatoid arthritis. In the case of heart disease, inflammatory reactions within atherosclerotic plaques can induce clot formation.

When the lining of the artery is damaged, white blood cells flock to the site, resulting in inflammation. Inflammation not only further damages the artery walls, leaving them stiffer and more prone to plaque buildup, but it also makes any plaque that’s already there more fragile and more likely to burst.

Oxidative damage is a natural process of energy production and storage in the body. Oxidation produces free radicals, which are molecules missing an electron in their outer shell. Highly unstable and reactive, these molecules “attack” other molecules attempting to “steal” electrons from their outer shells in order to gain stability. Free radicals damage other cells and DNA, creating more free radicals in the process and a chain reaction of oxidative damage.

Normally oxidation is kept in check, but when oxidative stress is high or the body’s level of antioxidants is low, oxidative damage occurs. Oxidative damage is strongly correlated to heart disease. Studies have shown that oxidated LDL cholesterol is 8x greater stronger a risk factor for heart disease than normal LDL.

The data from this study provide further support for the “oxidative response to inflammation” hypothesis described above. The researchers found that inflammation leads to a reduction of mature collagen in atherosclerotic plaques, leading to thinner caps that are more likely to rupture. This is important because other studies have shown that it is not atherosclerosis alone, but the rupture of the atherosclerotic plaques, that causes heart attacks and strokes.

It follows, then, that if we want to prevent heart disease we need to do everything we can to minimize inflammation and oxidative damage.

Top four causes of oxidative damage & inflammation

  1. Stress
  2. Smoking
  3. Poor nutrition
  4. Physical inactivity

By focusing on reducing or completely eliminating, when possible, the factors in our life that contribute to oxidative stress and inflammation, we can drastically lower our risk for heart disease.

For more in-depth information about each of these factors and how to minimize your risk of heart disease without drugs, please refer to Preventing Heart Disease Without Drugs.

To read more about heart disease and cholesterol, check out the special report page.

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Join the conversation

  1. Could the animal products in the diet partially be causing the inflammation? What about avoiding processed food, sugar, vegetable oil, AND animal products?

  2. Hi Chris,
    Love your exploration of all of this. As a physician greatly interested in the simplest most accurate (and inexpensive) recommendation for everything : ) it is quite amazing and bewildering to witness the intensity of the argument over food.
    Since you check the research in such detail, could please point me to the best basic science research that is super-clear in proving the inflammatory action of sugars. It is easy to say things about diet, but as you know, repeating aphorisms is a poor basis for truth in this regard, so I really want to find the true physiological facts backing up the common statements about sugar’s inflammatory role. I recently saw a study that demonstrated mitochondrial damage from over revving the Kreb cycle (vroom vroom), and I imagine you have seen much more in this regard. In particular is there any research showing direct endothelial inflammation from sugar intake that is not inferred or based on presumed causal relationships?
    Much appreciated

  3. Hello David,

    You mention vegetables oils as being an inflammatory cause. Im 28 years old and have high cholesterol since I was 19. My weight has always fluctuated between 120-140 pounds, I’ve never been overweight and my diet is OK. I usually consume organic foods only and I try to eat a variety of foods. My problem is not knowing which oils (if any) are safe to cook with. Most of my family ends up having heart attack or stroke and we are eastern european. They grew up on farms where there is an abundance of raw milk, cheeses, meats and vegetables and fruits. Lack of exercise perhaps?? I don’t quite know what caues it… My grandmother had her first stroke at 34. Her daughter had hers in her 40s so I dont want to go down the same path. I would love advice on oils and if you have ideas on cookbooks because I can’t really start making changes unless I have some kind of direction on how to cook and what to cook?

    • What about keeping the vegetables/fruits, adding raw nuts/seeds, getting rid of the meats/milk/cheese, and using less oil?

  4. Chris,

    I’m not touting the benefits of smoking, just pointing out that there are major gaps in correlation studies.  Anyone who touts the benefits of smoking is probably smoking something indeed.

    But I think people have the wrong enemy here, or at least do not understand the whole picture.  The bottom line is that smoking is overhyped as the villain.  It is shocking to me that people will chastise smokers as the biggest idiots on the face of the planet, looking at them as if they are committing suicide…

    Then they turn around and make cupcakes for a school function for their kids and feed them chicken nuggets, Cokes, and mac n’ f”n cheese.  It would be far better if kids were allowed to smoke Camel’s all day if packaged junk food and soft drinks were banished from the food supply.  Doting, loving, and caring soccer moms are harming our nation’s citizens just as much or more than the tobacco industry. 

    Cessation of smoking certainly shouldn’t be on a top 4 list, nor should avoiding physical inactivity (when the opposite of that is presumed to be jogging, hitting the stairmaster, and doing various other no pain, no gain exercises).  Stress avoidance on the top 4?  Not a chance.   

    My top 4 would be…

    1) Don’t diet – meaning restrict any natural food category, component, or perform overall calorie restriction.
    2) Avoid all refined sugars, especially HFCS and crystalline fructose, except on the very rarest of occasions.
    3) Do not consume foods that come in packages unless it can be verified that absolutely no additive ingredients are included.
    4) Limit the consumption of highly-oxidized, vitamin E depleted polyunsaturated vegetable oils. 

    Do that, and one can, like a French or Japanese person, smoke cigarettes, drink alcohol, drink coffee, avoid the gym, stay up late, eat tons of refined grains, live a stressful, fast-paced life, and have vastly superior health in comparison to the general American public. 

    Of course, most Americans are unhealthy beyond the point of being able to do any of the above things without paying a dear price for it.  That I’ll give you.    

  5. As a fellow mainstream health challenger, I must admit, this post has some shortcomings.  For one, the recommendations to not smoke, reduce stress, eat healthy, and get exercise ARE the pillars health and longevity espoused by the mainstream.  You’ve offered little challenge. 

    Challenging dogma would go something more like this…

    -Smoking has decreased in the United States while heart disease and lung cancer have seen a corresponding increase.
    -Smoking reduces stress, so why not smoke to reduce stress and oxidative damage, or at least consider that they might cancel each other out?
    -Countries who smoke more cigarettes than Americans, such as France and Japan, have a tremendously higher levels of health and much lower rates of heart disease.
    -Exercise causes much more inflammation than rest.  This is common sense, and most people take exercise too far.  Like Broda Barnes once said, who did happen to be the most successful doctor in history at reducing heart disease incidence (over 90%):

    “As one grows older it is prudent to gradually reduce one’s work as well as exercise.  If playing a strenuous game of tennis appeals to you, that is your privilege; however you should give it up when you are made weary by it unless you want to do some heart damage.  One should exercise for pleasure, but dismiss the idea that it will prolong life… Stress is the greatest accelerator of atherosclerosis, have respect for it.” 
    People are stressed out, not because life is stressful but because they have a poor stress response due to phsyiological problems.  In other words, put two people in the same stressful situation and one finds it to be stressful while the other does not.  To think that stress has something to do with a modern epidemic when stress is as natural as breathing, seems pretty silly.  “If we are adapted to anything in this world, we are certainly adapted to stress.”

    Can’t argue with the healthy diet part though.  No one will ever get around that.  However, based on the typical assumptions of what consitutes a healthy diet, it’s better advice to tell people to eat “as unhealthy as possible,” trying to eat lots of fats, carbohydates, animal protein, and calories with vegetables and fruits making great side dishes. 

  6. Hello David,

    While I certainly agree with Dr. Esselstyn that inflammation is one of the major drivers of heart disease (along with oxidative damage), I couldn’t disagree more on his dietary recommendations.

    Cholesterol isn’t the cause of heart disease. Inflammation is. So why the focus on reducing cholesterol levels? Why not instead focus instead on reducing inflammation and oxidative damage, which are the true causes of heart disease?

    The only form of LDL that is dangerous is oxidated LDL. And what causes LDL to oxidize? Not cholesterol, which is hidden deep within the core of LDL, and not saturated fat, which is highly protected against oxidative damage. Instead, it is the polyunsaturated fat (PUFA) within the LDL particle that oxidizes first. Therefore, a key strategy in preventing heart disease is dramatically reducing intake of PUFA – primarily, vegetable oil.

    Please see my page on cholesterol for more information. In particular, please read Cholesterol Doesn’t Cause Heart Disease, and How to Increase Your Risk of Heart Disease.


  7. Chris,

    I just attended a talk by Dr. Esselstyn, and he gave the same explanation about the cascade leading to plaque formation and heart disease. He further talked about new research about nitric oxide, produced by the endothelial cells that causes our arteries to expand to allow for more blood flow. He quoted a study (don’t have the name) where they measured the arteries ability to expand in a person who just consumed greasy fast food vs a control group. I’m sure you can guess that the fast foods eaters nitric oxide function was impaired for several hours. He further stated that they now believe that the sharp cholesterol crystals under the formed plaque cap actually puncture the cap and lead to clot formation!

    Dr. Esselstyn’s own study included maintaining ones cholesterol below 4.2mmol (canadian) and recommends a wholely plant based diet, exercise, decreased stress, etc.

    My understanding is that our bodies create enough cholesterol for our body to function.

    In your opinion, are his deitary recommendations too extreme, or is this new evidence enough to charge cholesterol with the crime?

  8. Chris,

    Thank you for your informative insights; I really enjoy your blog.
    I am wondering what your thoughts are on the results of the China study, a well researched push for a plant based, whole foods diet?

  9. Thanks for your comment, Bryan.  I agree with you completely.  PUFA and excess sugar (including refined flour and simple carbohydrates that break down into sugar) are the most destructive aspects of the Standard American/Australian Diet to our health.  As you point out, there’s more to health than avoiding heart disease, and although it may be possible to do that with a low-fat, whole-foods diet, most people will not thrive eating that way.  That’s why very few people can stay on that kind of diet for any significant length of time.

  10. Chris,

    In contemplating poor nutrition, I’m thinking excess sugar and linoleic acid are major players.  It’s interesting that both an Ornish style low-fat diet emphasizing grains and vegetables as well as a high-fat diet emphasizing meat and dairy could minimize both of these factors.  But to me the bottom line is not necessarily heart disease, but life-span and quality of life.  To have a long and healthy life, we obviously have to avoid heart disease, but also cancer, and we have to be well enough to handle stress properly to minimize it’s effects.  I feel better on a diet that emphasizes meat and raw dairy.  Vegetables are not very appealing to me unless smothered in butter or cheese.   My guess is that many people have problems with excess consumption of natural plant pesticides like salicylates, isoflavones, lectins, polyphenols, and glycoalkaloids, as well as anti-nutrients like phytates and enzyme inhibitors.  These people will likely have a tough time eating enough vegetables to get good nutrition.  On the other hand, the nutrients in animal foods are well absorbed and most people don’t react to animal foods.  So while some people may be able to tolerate a low-fat high vegetable diet, I think most people will do better long-term on diets based on animal foods with minimal sugar and linloleic acid.

  11. Hi 
    Compliments on your well researched articles – a great resource for people who want to take controll of their health. It is good to see the mounting evidence that improving our chemical, physical and emotional balance lead us to homeostasis and health – it is so simple. Check out Dean Ornish on youtube with his research on the effects of lifestyle change on heart disease and cancer. http://se.youtube.com/watch?v=CbVflDOWCbU