You may avoid eggs, shrimps, milk and other cholesterol-rich food to prevent the waxy type of fat from being deposited into your arteries. However, is it possible that what people blame for the incidence of coronary artery disease (CAD) is really not “the most” significance culprit?

“Cholesterol is a vitally important necessary molecule that’s needed for the immune system, memory, brain activity, overall functioning,” says nutritionist Jonny Bowden, Ph.D., CNS, co-author of The Great Cholesterol Myth,

Cholesterol is even needed in the production of some anabolic hormones like testosterone that are responsible for your muscle gains at the gym. However, as you already may be familiar, there are two types of cholesterol. The “hero” kind known as HDL, or good cholesterol, helps get rid of the “villain” LDL or bad cholesterol and stop them from clogging artery walls.

It used to be that high total cholesterol greatly increased your risk of a heart attack. Yet, experts have now pointed out these two types are separate and their ratio is perhaps more important to assess CAD risk than the total waxy substance levels.

But it is not that cut and dry. “High cholesterol is a lot of different things, but we don’t think it’s a terrible thing. We think its more complex than we’ve been told,” says Bowden.

According to Bowden, we know there are at least 5 different times when both HDL and LDL cholesterol vary greatly. “If you only look at LDL go up, you don’t actually see what kinds of LDLs are moving in,” he says. “Let’s say you call two of the kinds broadly LDL (a) and LDL (b). A is a large cotton ball-like, fuzzy molecule; it doesn’t contribute to heart disease at all. B is a very small, inflamed oxidized molecule that can get in the artery wall and cause some real mischief.”

Is Your Body Inflamed?

To renowned cholesterol expert, Barry Sears, Ph.D., creator of the Zone Diet,, and President of the Inflammation Research, the primary cause of high cholesterol is the stimulation of the enzyme HMG-CoA reductase in the liver—and the primary activator of this enzyme is insulin.

“The reason for the cause of CAD is inflammation. This is why aspirin is so effective in reducing heart disease,” he says. “This inflammation causes soft vulnerable plaques on the inside of the vessel wall to rupture like pimples that causes the blockage of the artery.”

Yet, the problem with this chronic body inflammation is that you do not feel it. “These are little inflammatory pockets and tears and disruptions in the arteries that can attract and cause substances like the bad LDL cholesterol and compounds made from sugar to get stuck in the pockets and tears,” says Bowden. “They then attract more of an inflammatory response, with more free radicals, until you’ve got a toxic waste dump that can turn into a plague. Cholesterol doesn’t cause any problems. Oxidative damage, free radicals do damage.”

It turns out that CAD is more complex than total cholesterol level and/or your individual LDL and HDL levels. Equally, insulin is not just linked to diabetes, but also to CAD.

So even though may not have high cholesterol, you can still be at high risk for CAD. For example, a diet heavy with processed sugar can spike insulin rapidly, and too much soybean oil, corn oil and other vegetable oils high in Omega 6 fatty acids relative to Omega-3 fatty acids, along with high stress and lack of sleep can increase cortisol and free radicals promoting a chronic inflammation state. Not physically active? This can promote more belly fat, which can spike pro-inflammatory substances while inactive muscles may impair glucose and insulin performance—all of which can lead to CAD.

The Real Fix

As tedious as it can sound, the truth is that heart disease is preventable. “The Nurses Health Study found that about 82 percent of cardiovascular episodes are caused by five different lifestyle factors. If we stop smoking, maintain a healthy weight, eat a Mediterranean diet—plenty of vegetables and fruits; mono-saturated fats and omega-3 fatty acids food rich like olive oil, nuts and fish; and some whole grain and legumes—consume a moderate amount of alcohol like red wine, and exercise we can wipe out most of the risk of heart disease,” says Bowden.

And get moving as much as possible. Sitting for prolonged periods of times may impair fat metabolism. “Also, don’t forget to make regular stops to smell the roses,” adds Sears. All these lifestyle changes balance hormones like insulin and cortisol, and power up antioxidants to decrease the effect of free radicals, and favor a healthy metabolism.

Ask Questions

The next time you visit your doctor, don’t be satisfied with a blood pressure and total cholesterol levels check, particularly if you are at a higher risk, such as heredity issues, current and past lifestyle factors, and increasing age. Make sure to engage your doctor in your current CAD risk and what you can do. Not sure what to ask? Follow this advice from Sears:

The best marker of CAD risk is the ratio of arachidonic acid (AA) to eicosapentaenoic acid (EPA) in the blood.  The ratio of these two fatty acids indicates the extent of inflammation in the soft vulnerable plaques. The AA/EPA ratio is between 1.5 and 3 for the Japanese population who traditionally have low incidences of CAD. For most Americans, it is greater than 15.

The size of the LDL particle is another marker of CAD with the smaller the particle (type A) the more likely you may have a coronary event. A good surrogate marker of the large and fluffy LDL particles (type B) is the triglycerides to HDL ratio—TG/HDL. The lower TG/HDL ratio, the better. The average American has a high TG/HDL ratio (3.5) indicating most of their LDL particles are the small, dense type A particles.

Ask to check out more than your glucose levels. Fasting glucose is not a marker of insulin resistance, as the pancreas will keeping pumping out more insulin stabilize blood glucose levels. Both the TG/HDL ratio and the fasting insulin are good surrogate markers for insulin resistance since the gold standard is a glucose clamp, which is only done in research applications. The levels of insulin (it causes the liver to make cholesterol) should be kept to less than 5 micro units/ml.