Most heart attacks are a clot forming on a damaged plaque. Three things set your risk: what your blood particles carry, how your blood vessels behave, and how easily your blood clots. Food and training move all three.
Plaque forms when apoB particles (LDL and its relatives) get stuck in the artery wall and the fats they carry oxidise there. Blood pressure and stiff vessels injure the wall and speed that up. What actually kills is a clot forming on a plaque that cracks. The statins paper builds this model in full. Here is the short version, with each habit placed where it acts.
ApoB particles carry fats into the artery wall. Linoleic acid in them is what oxidises there and starts the damage.
Nitric oxide relaxes the vessel wall. A relaxed, flexible artery runs at lower pressure and takes less damage.
A fibrin mesh traps red cells on a cracked plaque and blocks the artery. Fibrinogen predicts heart attacks on its own.
The terms multiply. Fewer particles, less to oxidise, calmer vessels or less clotting each lowers the total.
In the CERT trial, 60 people with coronary stents did supervised 4×4 intervals twice a week for six months. Ultrasound inside their coronary arteries showed the plaque shrank, while the control group's grew. Nobody was targeting cholesterol. Training also lowers fibrinogen and resting pressure, raises VO2max and makes muscle a bigger sink for blood sugar, so it acts on all three panels above.
It was one small trial, and both groups were mostly on statins, so it shows intervals working on top of a statin, not instead of one. The intensity matters too: CERT used 85–95% of max heart rate, not easy Zone 2.
Read more: Exercise: HIIT · Statins paper VII.3: exercise moves the plaque
↑ back to the short listHigh insulin is upstream of most heart markers. It raises triglycerides, lowers HDL, shifts LDL toward small dense particles, makes the kidneys hold sodium and stiffens arteries. Fix insulin sensitivity and those all improve together. A cholesterol drug, by contrast, moves one number.
Insulin sensitivity is built mostly in muscle and lost mostly in belly fat. Lifting gives glucose somewhere to go. Refined starch and sugar on top of a seed-oil diet are the fastest way to lose it. Sleep counts too.
Read more: Metabolic Health · Statins paper VII.2 · Exercise: lifting
↑ back to the short listAn LDL particle only does damage once its fats oxidise in the artery wall, and linoleic acid, the main fat in soybean, corn, sunflower and canola oil, is the one that oxidises. The fats you eat end up in your LDL. In feeding studies, swapping linoleic acid for oleic acid made LDL measurably harder to oxidise.
Lowering the fuel is better than adding antioxidants. The vitamin C, E and beta-carotene trials all failed, and beta-carotene did harm. The weak link is that no trial has cut linoleic acid and counted heart attacks. The best old test of the opposite advice, the Minnesota Coronary Experiment, swapped saturated fat for corn oil. Cholesterol fell and deaths did not.
Read more: Linoleic Acid paper · Statins paper VII.1 · Stearic acid
↑ back to the short listPotassium helps the kidneys clear sodium and relaxes the smooth muscle in artery walls. Across 22 trials, raising it lowered pressure in people with high blood pressure, and not in people whose pressure was already normal. Your sodium-to-potassium ratio predicts heart outcomes better than sodium alone. Most people eat well under the 2,600–3,400 mg target.
Read more: Potassium · Orange juice · Statins paper VII.5
↑ back to the short listNitrate from arugula and beets is absorbed, concentrated in saliva, turned into nitrite by bacteria on your tongue, and turned into nitric oxide in the body. This route skips the eNOS enzyme, which stops working well in metabolic disease, so it still delivers nitric oxide when the vessel lining can't make enough itself. The trials are consistent: lower blood pressure and better blood flow, with bigger effects in people who start high.
The bacteria are the catch. Antibacterial mouthwash wipes them out and the effect goes with them.
Read more: Beets · Statins paper VII.4: two juices, two mechanisms · Pomegranate
↑ back to the short listMagnesium blocks calcium from entering vessel muscle, which lets the wall relax. It also keeps the heart's rhythm steady and helps insulin work. Across 34 trials the effect on pressure was small but steady, and it was larger in people who were insulin resistant or low to begin with. That's the same pattern as everything else on this page: it helps most where the terrain is worst.
Read more: Magnesium
↑ back to the short listEPA and DHA lower triglycerides reliably, go into heart-cell membranes, where they steady the rhythm, and calm inflammation. Eating fish tracks with fewer heart deaths in cohort studies. Capsule trials are mixed: high-dose purified EPA helped, and most fish-oil trials found little. Whole fish also brings vitamin D, selenium and protein, which may be why it does better than capsules.
Wild is worth paying for. Farmed fish raised on grain and soy feed carry more omega-6 and less omega-3. Nuts are no substitute. Their omega-3 is ALA, which the body converts poorly, and most come loaded with linoleic acid.
Read more: Wild Fish, Oysters & Venison
↑ back to the short listSkin stores nitric oxide compounds, and UVA light releases them into the blood. That relaxes vessels within minutes, and vitamin D has nothing to do with it. A Swedish cohort of 29,518 women found that sun-seekers had fewer heart deaths than sun-avoiders. That study can't separate sunlight from an outdoor lifestyle, but the nitric oxide release itself has been measured in humans.
Read more: Sunlight & Metabolic Health · Vitamin D
↑ back to the short listMost sodium comes from processed and restaurant food, so people who cook from scratch usually eat less than they think. Cutting sodium hard raises renin, aldosterone and adrenaline, and large cohorts find a J-curve: heart risk climbs at low intakes as well as very high ones. The real lever is the sodium-to-potassium ratio, and you fix that by eating more potassium, not by eating less salt.
It's contested for a reason. Salt-sensitive people, often older or Black or with kidney disease, do see their pressure rise with salt, and the low-intake cohorts include sick people who eat little. The claim that sodium has no effect on pressure at all overshoots too.
Read more: Sodium · Statins paper VII.5: correcting a popular overcorrection
↑ back to the short listWhat a high LDL-C means depends on the rest of this list. The statins paper, Part III, explains why the same number means different things in different bodies.
This is a quick guide. The evidence and references live on the linked pages. Not medical advice.