Coronary Artery Disease (CAD)
An Overview
 Background information about CAD

There was no category for CAD by insurance companies or government agencies before 1930, because it was so rare. All forms of heart disease (congenital, rheumatic, syphilitic, hypertensive, pulmonary, and coronary) were grouped together for reporting purposes. Reference 1   In Heart Disease, a medical textbook of more than 900 pages, copyright 1931, Paul Dudley White, a famous research cardiologist, wrote: 

"… it may be stated as probable that close to two percent of the population of the northern part of the United States have heart disease of a degree sufficient to produce symptoms or signs."  In the 1943 edition of the book, he said:  "…when I graduated from medical school in 1911, I had never heard of coronary thrombosis, which is one of the chief threats to life in the United States and Canada today…. There can be no doubt but that coronary heart disease has reached epidemic proportions in the United States, where it is now responsible for more than 50 per cent of all deaths…."  CAD, the breakdown or degeneration of the coronary arteries, though it did not have that name, had been identified by 1910 during autopsy of elderly people. It was seldom seen in those younger than 65. Due to the striking nature of a sudden heart attack, and the prevalence of autopsy to define cause of death, it would not have been overlooked had it been happening widely.

The old question, "Which came first, the chicken or the egg?" is a moot point for poultry farmers, but it is of the utmost concern in determining the cause of human ailments.

Applying common sense to CAD issues

I. Theory: Dietary cholesterol causes heart attack.

A.  By 1942 CAD had become the #1 killer of men in the US.
B. At that time it was about the #8 killer of women.
C. Women eat the same foods as their husbands or fathers.
D. In the 1890’s people ate meat, eggs, salt pork, and lard regularly, but CAD was not a problem.
CONCLUSION: Dietary cholesterol is not the cause of CAD.

II. Theory: Cholesterol harms arteries

A. Cholesterol is manufactured in the liver, and is higher in those with CAD. 
B. It does not block arteries in the arms and hands. It does not block small vessels in the fingers causing the fingernails to fall off. 
C. It does not plug capillaries, which are only wide enough for one blood cell at a time to pass. 
CONCLUSION: High cholesterol is a marker for arterial damage, but it does not do the damage.

III. Theory: Other factors claimed to cause CAD.

A. Infection of the artery: Why didn’t heart arteries get infected before the 30’s? Arteries in the arms do not develop the problem. A cut or blister may become infected. The infection does not cause the cut or the blister. Infection is a marker for damage. 
B. Inflammation: Why didn’t heart arteries get inflamed before the 30’s? All tissue damage results in inflammation. Inflammation does not come first, then the tissue damage. Inflammation is a marker for damage. 
C. High blood pressure: It does contribute to damage as the higher pressure strains the arteries. But, many people have high blood pressure without suffering heart attacks. And many others have high blood pressure without developing CAD.
D. Smoking causes CAD. Did people not start smoking until the 30’s? Many people smoke and do not get CAD. Smoking may aggravate the problem by destroying Vitamin C, a necessary component in arterial tissue.
CONCLUSION: Inflammation and infection are markers for ulcerated arteries, not the cause.

IV. Fact: Nutrition is a factor in CAD.

A.  CAD is reversed in people on the Atkins diet (high protein, low sugar and starches).Reference 3, 4
B. CAD is reversed in people on the Dean Ornish diet (low fat, low sugar, leaning toward vegetarian). Reference 2, 4
C. A diet high in sugar leads to high blood sugar. High blood sugar is known to damage arteries. 
D. A diet high in sugar leads to high blood sugar. High blood sugar is known to damage arteries. 
CONCLUSION: Low levels of Vitamin C and high levels of blood sugar damage blood vessels.

V. Fact: Emotion impacts the body and its health.

A. People who are customarily angry and hostile have increased blood pressure, increased blood sugar, and have other biochemical markers for fight-or-flight which promote CAD.
B. When the body is in fight-or-flight mode because of perceived threat, it suppresses immune system behavior and tissue repair in favor of reacting to immediate threat.
C. Consumption of moderate amounts of alcohol has been shown to prevent CAD. This may be because of the stress relief, which is a by-product. Lately, it appears Prozac is lowering CAD.
D. Personalities who do not customarily express or suppress hostility do not get CAD even if they smoke and are over-weight.  Reference 5, 6, 7
E. Personalities who resolve their hostility have their arteries heal. Reference 5, 6, 7
CONCLUSION: Some types of habitual emotion damage the body, and others support healing.

VI. Theory: Heredity dictates who gets CAD.

A. CAD was not a significant problem as late as 1930.
B. It was a major problem for men by 1940.
C. CAD did not become the #1 killer of women until 1984.
D. Food preferences and emotional response are learned from parents at an early age and so could explain the "runs in the family" observation.
CONCLUSION: Genetic changes did not (and cannot) occur for men in the course of 10 or 20 years; and it does not occur at a different rate for men and women. 


A diet low in sugar and starches and high in Vitamin C supports longevity. High fat intake, smoking, infection, and inflammation are not significant factors unless there is already damage to the arteries. 

The significant change that may have caused the increase in heart disease in men in the early part of the twentieth century was the end of World War I. The farm boys who went to war did not return to the farm, but went into the cities. There, the nutrition would not have included as much fresh fruit and vegetables and the community was not so supportive. The industrial and mercantile world was more dog-eat-dog. And then the Depression came along.

Women did not see the great increase in CAD until the 70’s, when women went into the work place in large numbers, and so were exposed to the same workplace stresses as their husbands. If anger from workplace stress damages men’s health, we should expect it to affect women similarly.

What to do about CAD

Take steps to repair damage and to limit new damage. The way to accelerate repair is to consume ample amounts of fruits and vegetables, and perhaps take supplemental anti-oxidant vitamins A, C, and E. This would apply even if the damage is occurring from emotional issues.

Preventing more damage would include limiting the intake of sugar, grains, and potatoes. Starches are quickly and directly converted to sugar in the digestion process. Resolving underlying emotional issues may be the best treatment and the best preventive for CAD. This usually means clearing up the causes of anger and hostility. In people below age 60, the emotional issues seem the most important factor.


Do not change the dosages of your prescription medications without consulting your doctor.

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1. Heart Disease, Paul Dudley White, 1931, pp295-305
2. Lancet, July, 1990, Vol. 336, pp129-133.
3. New England Journal of Medicine, May 22, 2003 Vol. 348(21):2082-2090
4. Mayo Clin Proc 2003;78:1331-1336.
5. Type A behavior and Your Heart. Friedman & Rosenman, MDs,, 1974 
6. Am J Epidemiol. 2002 Dec 15;156(12):1092-9.
7. WebMD Medical News  Nov 2002