A propensity for cardiovascular disease ran in Attia’s family. Attia lumps heart disease and stroke under atherosclerotic cardiovascular disease (ASCVD). ASCVD is the leading cause of global deaths.

Blood helps transport oxygen and nutrients to our tissues through the human vascular network. It also moves cholesterol molecules, which are essential to life. These molecules are moved around in particles called lipoproteins. Lipoproteins comprise lipids (or fats) on the inside and proteins on the outside. High-density lipoproteins (HDL) carry more protein compared to fat whereas the reverse is true for low-density lipoproteins (LDL). Both HDL and LDL are encased in apolipoprotein (apoA for the former and apoB for the latter).

While heart attacks seem sudden, “atherosclerosis is a slow-moving, sneaky disease” (119). While risks of ASCVD increase in middle age, the risks begin building early in life, perhaps even during our teenage years. Trouble begins when LDL particles get stuck in the arterial wall, which results in the lipids on LDL becoming oxidized. This process, in turn, results in more and more LDL/apoB accumulating along the arterial wall. Monocytes, which are large white blood cells, turn into macrophages and try to eat the accumulated LDL particles.