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According to William C. Roberts, editor in chief of the American Journal of Cardiology, the only critical risk factor for atherosclerotic plaque buildup is cholesterol, specifically elevated LDL cholesterol in our blood. Indeed, LDL is called “bad” cholesterol because it’s the vehicle by which cholesterol is deposited into our arteries. Autopsies of thousands of young accident victims have shown that blood cholesterol levels were closely correlated with the amount of atherosclerosis in their arteries. To drastically reduce LDL cholesterol levels, we need to drastically reduce our intake of trans fat, which comes from processed foods and naturally from meat and dairy; saturated fat, found mainly in animal products and junk foods; and dietary cholesterol, found exclusively in animal-derived foods, especially eggs.

The optimal LDL cholesterol level is probably 50 or 70 mg/dL, and apparently, the lower, the better. That’s where we start out at birth, that’s the level seen in populations largely free of heart disease, and that’s the level at which the progression of atherosclerosis appears to stop in cholesterol-lowering trials. An LDL around 70 mg/dL corresponds to a total cholesterol reading of about 150, the level below which no deaths from coronary heart disease were reported in the famous Framingham Heart Study, a generations-long project to identify risk factors for heart disease. The population target should therefore be a total cholesterol level under 150 mg/dL.

To become virtually heart-attack proof, we need to get our LDL cholesterol at least under 70 mg/dL. Plant-based diets have been shown to lower cholesterol just as effectively as first-line statin drugs, but without the risks. In fact, the “side effects” of healthy eating tend to be good—less cancer and diabetes risk and protection of the liver and brain.

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