Debunking Common Cardiac Myths

Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health.

This week I had the pleasure of sitting down with independent cardiologist Dr. Dan O’Roark to tackle some of the most common, and often misunderstood, ideas around heart disease. With nearly four decades of experience, Dr. O’Roark brings a wealth of knowledge and a willingness to question the “groupthink” we sometimes see in medicine. We started with cholesterol and the long-held belief that high cholesterol alone is a direct cause of heart disease. Looking at the Framingham data and what he has seen throughout his own practice, Dr. O’Roark explained that unless cholesterol is extremely elevated, it may not be the independent risk factor many people have been led to believe. Instead, we talked about the important roles inflammation and insulin resistance can play in cardiovascular disease. It was another good reminder that we have to look at the whole patient, not just follow a formula or check a box.

Our conversation went well beyond cholesterol. We talked about the problems that can come with overtreating blood pressure, the misunderstood role of salt, and why the low-fat diet advice so many of us grew up hearing may have done more harm than good. Over the years, some of these recommendations (based on outdated research and sometimes influenced by outside interests) have contributed to the growing problems of obesity, type 2 diabetes, and heart disease. We also discussed anti-inflammatory treatments like colchicine and supplements such as nattokinase and where they may fit for certain patients. What I appreciated most about this conversation was Dr. O’Roark’s willingness to keep asking questions. Good medicine requires us to stay open to new information, rethink what we thought we knew when the evidence changes, and most importantly, treat the person sitting in front of us—not just the numbers on a lab report.

PODCAST NOTES

• The longstanding notion that high cholesterol is the fundamental cause of heart disease is far too simplistic and, in many cases, misleading. As Dr. O'Roark illustrated with the Framingham data and decades of personal clinical experience, most patients with cholesterol levels under 300 simply do not show a direct, independent correlation with heart attack or cardiac mortality. Even more striking, I’ve seen firsthand and heard from Dr. O'Roark about patients with “perfect” cholesterol suffering severe atherosclerosis, and others with very high numbers exhibiting spotless arteries. The reality is that numbers alone don’t define your risk, and we need to stop using cholesterol as a blanket scapegoat for heart disease.

• Insulin resistance and chronic inflammation have emerged as the real culprits driving cardiovascular disease, eclipsing simple cholesterol readings in terms of both clinical relevance and research support. Our dietary shift over decades towards high sugar, refined carbohydrates, and processed foods has laid the groundwork for epidemic levels of insulin dysregulation and low-level inflammation. I strongly believe—and the discussion reinforced—that markers of inflammation and insulin health are far better predictors of heart outcomes than cholesterol panels, and every patient deserves evaluation and treatment tailored to these modern realities.

• The “LDL paradox” reveals just how hazardous it can be to chase ever-lower cholesterol numbers, regardless of context. In practice and supported by robust studies, we now see that when LDL cholesterol plummets below about 100, all-cause mortality begins to climb. It’s not just about heart attacks; extremely low cholesterol disrupts hormone production, cell walls, and overall vitality. Lower and lower numbers are not always better. The body needs cholesterol to function properly. I constantly remind myself (and my patients) that good health cannot be measured by one number, and that excessive medication can do more harm than good.

• Statin drugs, prescribed widely and often reflexively, simply do not deliver major long-term benefits for most of my patients without existing heart disease—and their side effects are anything but trivial. Time after time, I hear from patients whose energy, muscle strength, and overall well-being plummet on statins. When we look at the best evidence, any improvement in life expectancy for these patients is measured in mere days over five years—and often at the cost of muscle aches, liver irritation, and drops in key nutrients like CoQ10. My philosophy, echoed by Dr.  O'Roark, is to use statins with great caution, at the lowest effective dose if truly needed, and only after the full picture of risks and benefits is considered.

• Overly strict blood pressure control is another area where old standards have shifted without adequate justification from strong evidence. When I entered medicine, 140/90 was normal; now, we’re told to medicate people down to 120/80 or even lower. For older adults, those targets often result in dizziness, fatigue, and dangerous drops in blood flow. Dr. O'Roark and I discussed how these aggressive interventions not only lack proven benefit for most, but actually may harm quality of life and even survival in certain populations. Individualized targets—respecting age, comorbidities, and function—should guide therapy, not across-the-board mandates.

• The common advice to reduce salt as much as possible is simply not appropriate for the vast majority of people. In my practice, I see patients—especially healthy, active individuals and older adults—who struggle with low energy, dizziness, and even fainting because they aren’t getting enough sodium. Dr. O'Roark pointed out that only a small fraction of people are genuinely salt-sensitive. For most of us, our kidneys and homeostatic mechanisms are more than capable of maintaining optimal sodium levels, even with intakes well above current “limits.” Advanced heart or kidney disease are the exceptions. Everyone else likely benefits from more moderate and flexible sodium consumption.

• The legacy of the “low-fat, high-carb” era has been disastrous for public health, resulting in rising rates of obesity, metabolic syndrome, and type 2 diabetes. Our shift from natural, nutrient-dense fats (like butter, lard, and fatty cuts of meat) to refined carbohydrates and industrial seed oils (high in pro-inflammatory omega-6s) has upended metabolic health. I’ve witnessed patients’ health improve when they swap processed, starchy foods for whole foods with balanced healthy fats. There is real wisdom in how our grandparents ate—meals centered around real foods, moderate natural carbs, and no processed junk—that we’re only now rediscovering.

• No drug or supplement can provide the foundation of health that a balanced lifestyle does. I’m more convinced than ever that daily exercise, restorative sleep, effective management of stress, regular review and support of hormonal health, and whole, unprocessed foods are the keys to prevention and longevity. The newer options like colchicine (for inflammation) and nattokinase (for mild blood thinning and plaque stabilization) offer additional support for those at risk, but they must always be adjuncts, not replacements, for lifestyle change. The secret to good heart health is in the everyday choices we make—not in a pill bottle.

I encourage you to question one-size-fits-all advice—especially recommendations rooted in outdated research or driven more by insurance metrics than individual patient care. The evidence continues to evolve. What matters most for your heart—and your overall health—is not always the latest drug or the lowest possible number, but how you eat, move, sleep, and manage stress. Make small, meaningful changes and seek out clinicians who will take the time to listen, explain the evidence, and build a care plan that is right for you. Hold us as providers to the highest standards.

Stay educated. Stay healthy.

Till next week.