By Ross Walker

I received a very thoughtful and interesting question recently asking, “If 90% of heart disease is preventable, why are all forms of cardiovascular disease still our most common cause of death and disability?”

The commonest cause of heart disease is atherosclerosis, which is the progressive build-up of fat, inflammatory tissue and calcium in the walls of arteries over many decades. When these fatty plaques reach a critical mass, the plaques may rupture internally into the arterial channel and a subsequent clot forms, blocking the artery. If this occurs in the coronary arteries, it is highly likely that the person will suffer a heart attack. This is still the commonest cause of death around the world and certainly the most common manifestation of cardiovascular disease.

This is an explanation of what pathologically happens in the walls of arteries but does not explain what causes atherosclerosis in the first place. In our modern world, 70% of atherosclerosis and therefore heart attack (as I’ve stated the commonest manifestation of atherosclerosis) is directly related to the insulin resistance gene.

The insulin resistance gene is a survival advantage if you are a hunter-gatherer but a survival disadvantage if you live in modern society. The gene allows you to store fat around the belly after a big feed to tide you over until the next few days until this happens again. In the meantime, you are wandering around a jungle looking for more food but often go without a decent meal for a day or two. In modern society, we have breakfast, lunch and dinner and typically sit on our backsides all day in sedentary jobs. This gene is present in 30% of Caucasians, 50% of Asians and close to 100% of people with darker or olive skin. Thus, when anyone with this gene is exposed to modern living, it is very common to develop diabetes (or prediabetes), High blood pressure, specific cholesterol abnormalities which include high triglycerides and low HDL, along with abdominal obesity.

All of these factors combined or, even in isolation, predispose the individual to cardiovascular disease.

Two or more of these factors combined are known as the metabolic syndrome which is the commonest syndrome in the world and, as I’ve stated, accounts for 70% of heart attacks.

Another 20% of the cause of atherosclerosis comes from an elevated Lipoprotein(a). One in five people around the world have an excessive level of Lipoprotein(a) in the bloodstream which places them at a 70% higher risk for heart disease. Unfortunately, this simple test is not routinely performed by most doctors. It is purely genetic and is the typical reason why someone who practices healthy lifestyle principles still has a premature heart attack.

I have just given an explanation for 90% of heart disease with the remaining 10% being due to a variety of other factors which are clearly not as common. So, in most cases 20% of the causes of heart disease are being missed because people are not being screened for Lipoprotein(a).

In the remaining 70% of cases related to insulin resistance, many people continue to gain weight through excessive eating, are sedentary and are affected by the ever present stresses of the modern world, not to mention the use of a variety of substances such as cigarettes, excessive alcohol and illegal drugs.

A recent trial from Holland, known as the Morgen study, demonstrated clearly that if you followed the five keys to being healthy you reduce your risk for cardiovascular disease by 83%. If you then include appropriate genetic screening such as Lipoprotein(a) and take steps to control this issue, then we will see the rates of cardiovascular disease plummeting.

Over the years, there have been a number of studies demonstrating reversal of cardiovascular disease but this is not a passive process purely involving pharmaceutical therapy and medical procedures, it requires enormous responsibility on the part of the patient to completely rearrange their lifestyle, follow appropriate medical advice and take high quality supplements.

I have been practising medicine for over 40 years and have been a cardiologist for over thirty years and during this time I have seen numerous patients stabilise and often reverse the disease with this integrated approach to their care. It does require a lifelong commitment to being healthy and working with a trusted medical practitioner and unfortunately for many reasons, the majority of people can’t or won’t do so.

The Walker Rule Number One of Medicine is very straightforward, “the most important coronary arteries in this world are your own - if you’re not prepared to look after them, why should I bother to help you?