 No matter where we live, how old we are, what we look like, health researchers have discovered that 90% of having a first heart attack can be attributed to nine modifiable risk factors. The nine factors that are threatening our lives include smoking, too much bed cholesterol, high blood pressure, diabetes, abdominal obesity, stress, a lack of daily fruit and vegetable consumption, as well as a lack of daily exercise. But Dr. William Clifford Roberts, executive director of the Baylor Heart and Vascular Institute, and longtime editor-in-chief of the American Journal of Cardiology, is convinced that atherosclerosis has a single cause, namely the cholesterol, and that the other so-called atherosclerotic risk factors are only contributory at most. In other words, we can be stressed over weight-smoking diabetic couch potatoes, but if our cholesterol is low enough, there may be just not enough cholesterol in our bloodstream to infiltrate our artery walls and trigger the disease, suggesting only absolute prerequisite for a fatal or non-fatal atherosclerotic event like a heart attack is an elevated cholesterol level. It was not appreciated until recently that the average blood cholesterol level in the United States, the so-called normal level, was actually abnormal, accelerating the blockages in our arteries and putting a large fraction of the normal population at risk. It's our number one killer. That's cited as one of the reasons that cholesterol controversy lasted for so long. An unwillingness to accept the notion that a very large fraction of our population actually has an unhealthily high cholesterol level. Normal cholesterol levels may be terminal cholesterol levels. The optimal cholesterol level, the optimal bad cholesterol LDL level, is 50 to 70. Accumulating data from multiple lines of evidence consistently demonstrate that that's where a physiologically normal LDL level would be. That appears to be the threshold above which atherosclerosis and heart attacks develop. That's what we start out at birth with. That's what our fellow primates have. That's the level seen in populations free of the heart disease epidemic. But we can also look at all the big randomized controlled cholesterol lowering trials. This is graphing the progression of atherosclerosis versus LDL cholesterol. More cholesterol, more atherosclerosis. But if you draw a line down through the points, you can estimate that the LDL level at which there is zero progression is down around an LDL cholesterol of 70. You can do the same with studies preventing heart attacks in the first place. Zero coronary heart disease events might be reached down around 55, and those who've already had a heart attack in trying to prevent a second one might need to push their LDL levels even lower. Atherosclerosis is endemic in our population in part, because the average person's LDL cholesterol is up around 130, approximately twice the normal physiologic level. The reason the federal government doesn't recommend everyone shoot for at least even just under 100 is that despite the lower risk accompanying more optimal cholesterol levels, the intensity of clinical intervention required to achieve such levels for everyone in the population would financially overload the healthcare system. Drug usage would rise enormously, but they're assuming drugs are the only way to get our LDL that low. But those eating really plant-based diets may hit the optimal cholesterol target without even trying, just naturally nailing under 70. The reason given by the federal government for not advocating what the science shows is best was that it might frustrate the public, who would have difficulty maintaining a lower level. But maybe the public's greatest frustration would come from not being informed of the optimal diet for health.