By Andrew Rudin, MD
Heart disease remains the leading cause of death in this country, and atherosclerosis – the gradual narrowing of arteries by plaque – is the process behind much of it. The word “clogged” makes it sound like a plumbing problem, and partly it is. But what actually drives it is closer to a slow fire: inflammation in the vessel wall, fed over years by the choices that surround us.
It starts earlier and quieter than most people think
Plaque does not appear overnight. It builds across decades, which is both the bad news and the opportunity – because the same span of time is what gives prevention its power. The habits you keep in your forties are writing the story of your arteries in your sixties.
The fundamentals still win
A diet built around whole foods, vegetables, and healthy fats; regular movement; not smoking; and keeping blood pressure and blood sugar in range – these are not exciting, but they are what the evidence supports again and again. Most of the marginal, heavily marketed interventions cannot touch the impact of getting these right.
Inflammation is the through-line
This is where my thinking has shifted over the years. When sleep runs short, stress stays high, blood sugar runs off course, and the diet is heavy in processed foods, inflammation becomes the baseline – and inflammation is central to how plaque forms and destabilizes. Much of “heart-healthy living” is really inflammation management by another name.
The gut may be part of the picture
Emerging research points to the microbiome’s role here too. Certain gut bacteria produce a compound called TMAO when they break down nutrients found in red meat and some other foods, and higher TMAO levels have been associated in studies with greater cardiovascular risk. It is early science, not a verdict – but it fits the larger truth that what happens in the gut does not stay in the gut.
The reassuring part is that none of the core prevention requires anything exotic. It asks for consistency, which is harder than intensity but far more powerful. Work the fundamentals, track your numbers with your physician, and give the process the years it rewards.
This article is for general education and is not medical advice. Talk with your physician about your individual health.
About the author
Andrew Rudin, MD, is a cardiologist and board-certified cardiac electrophysiologist with more than 20 years of experience and the founder of TargetBiome. He writes about heart health, prevention, and the emerging gut-heart connection. Dr. Rudin has been cited as an expert in Medscape and Men’s Journal. Learn more at andrewrudin.com.