Eliminating 90% of Heart Disease Risk

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How to Eliminate 90 Percent of Heart Disease Risk

Medical myths and dogmas die hard. Researchers creating a new body of knowledge for prevention and control of heart disease had to disprove a bunch of doozies. For example, we used to think that heart disease, high cholesterol, and high blood pressure were just inevitable consequences of aging. All these are now bygone notions, refuted by massive data. Other long-standing myths and dogmas about our number one killer epidemic persist, however. For example, many still think that major risk factors, like cholesterol, account for a minority of risk, and that many people have heart attacks with no risk factors at all.

There are rare genetic conditions that give people high cholesterol no matter what they eat, but such genetic defects occur in no more than 1 in 200 people. As you can see in my video, Eliminating 90% of Heart Disease Risk, this means that most people with atherosclerosis acquire it by what they put in their mouth.

One study showed that for men and women, old and young, and in all areas of the world, nine potentially modifiable factors like diet, exercise, and smoking, accounted for over 90 percent of the proportion of the risk of having a heart attack. This has also been confirmed in prospective studies such as the Harvard Health Professionals Follow-Up, which showed that making healthy lifestyle choices are associated with a 90 percent drop in risk in men followed over time. This is true for women as well, who had a 92 percent drop in risk.

The same goes for diabetes—91 percent of cases could be attributed to bad habits and behaviors. And the same healthy lifestyle, which includes not smoking, eating a healthy diet, exercising and maintaining an optimal body weight, may reduce the risk of multiple chronic diseases such as stroke. Up to 80 percent of strokes are avoidable with simple lifestyle changes.

How does this all compare to drugs? Why change our diet, lose weight, and start exercising if we can just pop some pills? Pharmacological therapies, including cholesterol lowering statin drugs and blood pressure pills, typically only reduce cardiovascular disease risk by 20 percent to 30 percent, not 90 percent like lifestyle changes. So, even on drugs, 70 to 80 percent of heart attacks still occur.

One of the great things about the Harvard Health Professionals Follow-Up is that they also looked at the effect of lifestyle changes on people already on medications. Even those on cholesterol and blood pressure lowering drugs may be able to get a further 78 percent drop in risk by eating and living healthfully. So, the choice isn’t diet or drugs. Cardiovascular medications “should be used as an adjunct to, not just a replacement for, healthy lifestyle practices.”

It takes time for new science to trickle down into mainstream medical practice. The practice of cardiology and medicine in general may correspond, on average, to what was being published 10 or 20 years before. So, it’s important to know if your doctor is still stuck practicing 20th century medicine.

Chronic disease, then—the leading cause of death and disability—may be a choice. See for example, Cavities and Coronaries: Our Choice. What do you choose?

Why reduce a preventable disease just 90%? How about 99.9%? See One in a Thousand: Ending the Heart Disease Epidemic

More from the field of lifestyle medicine:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

32 responses to “How to Eliminate 90 Percent of Heart Disease Risk

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      1. So the choice isn’t diet or drugs. Cardiovascular medications “should be used as an adjunct to, not just a replacement for, healthy lifestyle practices

        1. I think Dr Greger meant to say that you don’t just take medication (when absolutely needed) and then continue to eat hamburger everyday, put it in simple term :)

          1. Yup, but why take them at all? and if we are told to take them when “necessary” what exactly is necessary? A non-vegan doc who still abides to the medical myths and dogmas will tell me when?

            1. I don’t speak for Dr Greger but he cannot go against your own doctor without seeing you personally. So personally, I go against my own doctor several times (with respect of course). I will try my lifestyle change first to prove it to him that I can improve before having to take medication. But that’s me against my own doctor. As an adult, you can decide what you want to do with your health. Dr Greger and even your own personal doctor only give recommendation.

              1. All I’m saying is if Dr. Greger really believes some should take statins he should state under which circumstances they are to be taken and not give a general and confusing term such as high cholesterol or the like…

                1. People with rare genetic disorders presenting with uncontrolled,
                  unbalanced (not merely high) cholesterol need help…lifestyle changes don’t work for them and they are at high risk so statins may be a lifesaver. They can also make healthy diet changes and mitigate the toxicity of the drug. Most of us can work with our biology and make fluffy LDL or high HDL through lifestyle choices.

    1. Statins are OK to give you a jump start on getting your LDL levels down. Dr. Dean Ornish, and Dr. Esselstyn prescribe statin drugs to initially help people to get their cholesterol down quickly, and then once they achieve a good cholesterol level, especially LDL, then they go OFF of the statin drugs. According to many vegan doctors like Esselstyn the key is to get your total cholesterol down to 150 or below and your LDL down to around 60. Dr. Joel Fuhrman says that your body will not start dissolving the plaque in your arteries until you get your total cholesterol down to 150. And then Esselstyn says that once you are down below 150 you have made yourself “heart attack proof”.

      1. John Axsom: Thank you for your post. I’ll also note that Dr. Greger has a video around somewhere that talks about the importance of getting total cholesterol below 150. I believe he also suggests aiming for LDL below 70. Even lower is great, but I think his cut-off number is 70.

        FYI: Moderator Katie recently made me aware of an Esselstyn FAQ page. That page has a section on LDL. On that page, he suggests people aim for 80 or 85 or below, though the lower the better. http://www.dresselstyn.com/site/faq/ Here is the full quote on the matter:

        “LDL is the bad cholesterol. The closer it can be to 80-85 or lower, the better. However, if one is unable to take statin drugs and eating plant-based nutrition, and the LDL won’t go lower than 95-105, it would appear that they will still be fine. The lesson we learned from the Tarahumara Indians, who never have cardiovascular disease, is that the most key protective element is not so much the pure LDL number as is knowing that nothing ever is eaten which is a building block of vascular disease or can injure endothelium.”

    2. Read the important parts again:

      “How does this all compare to drugs? Why change our diet, lose weight and start exercising if we can just pop some pills? Pharmacological therapies, including cholesterol lowering statin drugs and blood pressure pills, typically only reduce cardiovascular disease risk by 20 percent to 30 percent, not 90 percent like lifestyle changes. So even on drugs, 70 to 80 percent of heart attacks still occur.

      One of the great things about the Harvard Health Professional’s Follow-up is that they also looked at the effect of lifestyle changes on people already on medications. Even those on cholesterol and blood pressure lowering drugs may be able to get a further 78 percent drop in risk by eating and living healthfully”

      In short, drugs a 20% to 30% reducing in risk. Lifestyle changes much higher reduction in risk. Those on statins, 3/4 heart attacks still occur.

      Clearly a statement that statins are not the way to go as they don’t do enough as simply eating right and moving more.

    1. Statin has many side effects, so my take is if your cholesterol is high then try diet and exercise as much as you can to see how low you can get. There is a complex HDL, LDL, Triglycerides ratio that you can follow before you consider statin, so if your LDL may be high but your HDL is also high then you are still OK (not desirable but OK but stay away from statin as much as possible).


      To calculate your cholesterol ratio, divide your high-density lipoprotein (HDL, or “good”) cholesterol number into your total cholesterol number. An optimal ratio is less than 3.5-to-1. A higher ratio means a higher risk of heart disease.



    2. The risk associated with blood cholesterol is fairly linear for given age brackets over a wide range.

      From Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55 000 vascular deaths

      The trendlines continue downwards in populations with remarkably low (by Western standards) cholesterol.

      From Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations

      Mendelian randomization studies provide the strongest evidence to date that elevated LDL is causal, and the association isn’t some artifact of other lifestyle confounders. See Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: a Mendelian randomization analysis

      There’s no known threshold at which lower LDL cholesterol isn’t better for CVD outcomes. Many cardiologists advocate high-dose statins to reduce LDL to the levels seen among low-fat strict vegetarians and our primate cousins. The main limitation is the incidence of side-effects like myopathies and possibly dementia.

      1. At the risk of invoking a libel suit, I want to tell you, Darryl, that I have evidence of some hanky panky with that 2014 Chowdhury meta-analysis that led people to the Let Us Eat Bacon mentality. I’m scratching my head as to what to do with this bit of gossip.

      1. Is the iron in sea salt that appears as “rust” in salts such as redmonds sea salt and other “health food store” pure sea salts actually unbound iron? These pinkish/copper flakes I assume are, in a way, the shavings of rocks. In theory at least. I might be wrong but still have to wonder. I do not see how we humans could absorb or even digest these particles of iron in salt.

        1. I bought sea salt from Costco once and it looks pinkish. I would not worry about too much iron in sea salt or any food or otherwise there should be some warning. Excess iron is mainly inherited (genetic or blood transfusion from someone who has it) or due to someone taking a lot of iron supplement. My take is to never take iron supplement but get it from foods unless it is due to some kind of genetic problem that causes one to not be able to absorb iron and become iron deficient.

          I know that a lot of foods are fortified with iron but I don’t eat those foods anymore.


          Iron overload can be inherited (genetic) or acquired by receiving numerous blood transfusions, getting iron shots or injections, or consuming high levels of supplemental iron.

          1. Yes, I am not referring to iron overload, I am more curious how the human body would be able to absorb a nutrient from, essentially, a piece of “rock”? That’s what these specks are. We absorb nutrients from food, but how would the body break down such particles like this? I’d think they’d get pooped out at best, at worst they might get imbedded in our blood vessels, joints, and other places.

            1. The correct answer is beyond my IQ but I think the body cannot absorb any nutrients from a rock but only from plants and meat (if you’re a meat eater). Long time ago (I no longer do), I shop for calcium supplement and I read that you have to buy an organic type that can be absorbed by the body while all synthetic ones are like a piece of rock that not only do not get absorbed by the body but get deposited in the wrong places like liver and kidney. And then I read that some supplements are OK as synthetic such as VIT B12, magnesium, zinc, etc. I always try to get an organic source but when I can’t then I have to consider synthetic.

              1. I wonder if that is true about the calcium. Very interesting and concerning, as this would present a big time health issue for long term consumers of mineral water. Some of the calcium in mineral waters occurs in high concentrations, and in waters heavily marketed and sold in US organic markets. So, essentially all the minerals in mineral water and salt are just rock. At least that is what it seems like.

                1. Well that’s why I said that I am not an expert on this subject. I think from a layman’s point of view that calcium in water is already broken down in molecules that can be absorbed, but you cannot eat a rock and get the calcium. Now if some supplement maker take a piece of rock and grind it and market as calcium then it does contain the right amount of calcium by law but it is not absorbable. This is why I don’t want to buy any food that is fortified with anything because I cannot control what I eat but I will get the nutrients first from foods, then supplement if necessary but pick and choose what supplement to use. And I had to pay a higher price for such supplement but either I do that or I end up poisoning myself. Quick answer for calcium: I did the math on the foods I eat and I can get enough calcium easily so I don’t need supplementation.

                  A quick google search on this subject reveals the following info – apparently it is more complicated than synthetic vs. organic and synthetic calcium seems to be OK:



  1. I recall when an uncle of mine had a heart attack in his mid 40’s and was advised to take an aspirin each day since he had about a 60% blockage in his arteries. He was sensitive to aspirin and had to quit due to stomach issues with it. His doc also strongly advised him to change his habits which he did, he quit smoking and chewing tobacco, he quit fast food and that helped a great deal. Other than his work he did no exercise, but he was a house painter which is strenuous at times. He showed me a book about vitamin E , he is now deceased and I do not recall the title of the book, it was back in the early 80’s. Anyway he hated taking pills so he got his vitamin E from buckwheat and his vitamin C from fruit. He ate buckwheat each day and consumed 1 apple, 1 carrot, and 1 grapefruit each day and within a year and a half his arteries were confirmed by exam to be clear. He stayed in good health for many years. I have searched for the book but have failed to find it even on amazon.

    1. I just looked it up, buckwheat does not have vitamin E, best sources are sunflowers and almonds. spinach and other greens my be better due to lower calories.

  2. I had my cholesterol tested at 113 overall. Testosterone was low for my age too and I have brain fog that prompted the blood panel. Here is my question: is what I am reading about low hdl (being a risk factor for Altzheimers) true? How should one treat hypocholesterolimia? Need help.

    1. Hi Danny :)

      What is your current diet and lifestyle and age?

      It’s hard to give black and white advise without data from your primary care physician.

      For most healthy people cholesterol cannot be too low- it’s regulated by the liver. However there are conditions that affect hormone and cholesterol from functioning normally.

      How low fat is your diet? You could try adding in a DHA/EPA supplement from algae, and increasing nuts/seeds/avocados etc…

      In addition address other lifestyle factors such as sleep, physical activity, and have a full investigation into hormone levels.

      Hope this helps!

  3. I didn’t see it really addressed here is advice for the people who legitimately DO have that rare genetic disorder. I have been genetically tested and been formally diagnosed with the mutation that causes familial hypercholesterolemia. I don’t suffer as badly as some of my family (I have family with LDLs in the 300’s, while mine remains stubbornly in the mid-200’s, no matter what I do). I’ve learned the hard way through my own experimentation with diet and exercise that plant-based may “help” my situation, but it doesn’t fix it or eliminate my risk for heart disease like it does others. It’s pretty discouraging. :/ I WISH Dr. Greger would post a video aimed at those of us who food WON’T help entirely. What is the responsible medical recommendation to treat those of us who legitimately DO have genetic disorders?

    1. Hi Tiffany :) I recently worked with Dr Michael Klaper, who would be one you could consider consulting for advice on this. I observed him treat a few patients in a similar situation to yourself, that is cholesterol still above the ‘150’ number despite genuine strict adherence to a SOS-free WFPB diet. So my assumption is that you have been following a salt/oil/sugar free wholefood plant-based diet, with regular exercise, good sleep habits and stress reduction techniques? Then the summary was this- for you, it’s less likely the cholesterol level PER SE, it’s the health of your arteries! In those consuming animal products and toxins from alcohol, caffeine, environments, smoking, additives/preservatives/chemicals etc… they cause a pro-inflammatory environment and make the cholesterol oxidise, which generates free radicals, which then damages the arteries and causes the associated issues with high cholesterol (heart disease et al). Provided you minimise these toxins and maximise your exposure to anti-oxidants through lots of fruits and vegetables and plant-based foods, these side-effects are much less likely to occur. Some people’s livers/genes/enzymes simply produce higher levels of cholesterol for optimal cell membrane function and hormone production and provided you are not oxidising the cholesterol through your lifestyle, it’s a much less greater risk than your typical SAD eater smoking, drinking and eating fast food. To help ease your mind, you can examine this more scientifically by testing your HS-CRP in your blood (a high sensitivity marker of arterial inflammation), ENDO-Pat test to assess arterial function and a carotid +/- abdominal aorta ultrasound to look for atherosclerosis. These will be more accurate tests in your case than cholesterol numbers. You could also consider possible other influences, such as thyroid, iodine levels, B12/MMA/ homocysteine tests and an EFA profile. If you would like, feel free to write out your exact food consumption and lifestyle and I can make suggestions if there is any thing you may have overlooked! Hope this helps! Remember as per Neal Barnard- ‘Many genes make suggestions, but lifestyle pulls the trigger!’ :)

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