Chronic low-grade inflammation is now recognised as the primary trigger of arterial damage — responsible for initiating the cascade that leads to plaque formation, vessel stiffening, and cardiovascular events in an estimated 50% of heart attack cases where cholesterol levels appeared completely normal.

*Ridker PM et al. Inflammation, aspirin, and the risk of cardiovascular disease. New England Journal of Medicine, 1997.

Endothelial dysfunction — the gradual loss of your vessel lining's ability to produce nitric oxide naturally — is now considered the earliest measurable stage of cardiovascular disease, typically developing silently for 10 to 15 years before blood pressure or cholesterol readings show any abnormality.

*Bonetti PO, Lerman LO, Lerman A. Endothelial dysfunction: a marker of atherosclerotic risk. Arteriosclerosis, Thrombosis, and Vascular Biology, 2003.

72% of hypertension patients who discontinue medication see their blood pressure return to elevated levels within 6 months — because blood pressure medication compensates for the output of endothelial dysfunction without ever addressing the vessel lining dysfunction causing it.

*Whelton PK et al. Journal of the American College of Cardiology, 2018.

By the time standard cholesterol blood tests show abnormalities, arterial plaque has typically been accumulating for 10 to 20 years — and a statin that lowers the cholesterol number does not repair the damaged endothelium that allowed cholesterol to penetrate the arterial wall in the first place.

*Libby P et al. Nature Reviews Disease Primers, 2019.