William Roberts is a leading cardiovascular pathologist. He is the current editor (at 2018) of the American Journal of Cardiology— a position he has held since 1982. He has published over 1,500 articles. Roberts served as the first head of the pathology service at the National Heart, Lung, and Blood Institute at the National Institutes of Health from 1964 to 1993. He has been located at Baylor Heart and Vascular Institute and Baylor University Medical Center in Dallas, Texas since 1993.

He wrote:

Risk Factors

Roberts notes that most physicians believe that the following are risk factors for heart disease but only high cholesterol is the cause.

1. smoking
2. diabetes mellitus
3. high blood pressure
4. family history
5. obesity
6. stress
7. inactivity
8. inflammation
9. high cholesterol

He states that if cholesterol is less than 150 mg/dL (3.9mmol/L) then you will not have a heart attack irrespective of the other 8 risk factors. He also states that HDL cholesterol is largely irrelevant despite the importance placed on it by many health organisations.

The Cause of Atherosclerosis

Roberts states four reasons why cholesterol is indeed the cause – and only cause – of heart disease.[4] It is important to note that the other factors are important in regard to our health – they are simply not implicated in heart disease.

Animal trials

It is easy to produce plaques in animals by feeding high cholesterol or high saturated fat diets. It is not possible to produce plaques in carnivores (rats, dogs, cats) unless the thyroid function in disabled as carnivores convert cholesterol into bile salts which are excreted.

Despite frequent claims that heart disease is an inflammatory disease, inflammation is “infrequent in plaques of coronary arteries.” Inflammation can result from a multitude of illnesses and injuries.

Cholesterol is present in plaques

Cholesterol is present in plaques along with white blood cells (that have engulfed oxidised cholesterol), other lipids and calcium deposits.

Populations with high cholesterol have high levels of heart disease

Many studies including the Seven Countries Study, Seven-day Adventist studies and Framingham studies have shown that higher levels of serum cholesterol is associated with higher levels of cardiac events.

Lowering cholesterol results in a decrease of atherosclerotic events

Lowering serum total cholesterol and low-density lipoprotein (LDL) cholesterol levels decreases the number of cardiac events and plaque size is decreased.[5]

1. Roberts, W. C. (2008) The Cause of Atherosclerosis. Nutrition in Clinical Practice. 23 (5), 464–467.
2. Roberts, W. C. (2010) It’s the cholesterol, stupid! American Journal of Cardiology. 106 (9), 57–73.
3. Roberts, W. C. (2016) 10 Questions on Atherosclerosis [online]. Available from: http://education.ajconline.org/video.php?event_id=1320&stage_id=5&vcs=1 (Accessed 28 January 2017).
4. Roberts, W. C. (2008) The Cause of Atherosclerosis. Nutrition in Clinical Practice. 23 (5), 464–467.
   
5. Esselstyn, C. B. (2001) Resolving the Coronary Artery Disease Epidemic Through Plant-Based Nutrition. Preventive Cardiology 4 (4). 4171–177.