5 Things to Keep Your Arteries Clean
Disclaimer: Not Medical Advice. Opinions are my own.
Was this newsletter forwarded to you? Subscribe here
In partnership with LMNT
Get Your Free Electrolyte Sample Pack.
Today's Newsletter at a Glance:
- What I Wish I Knew at 20
- What Penetrates the Artery Wall
- What Weakens the Artery Wall
- The Bottom Line
I wish I’d known this at 20.
I’ve spent my career operating on hearts. And at 55, I had my own cardiac event.
I’d seen thousands of diseased arteries. But I didn’t apply these principles to myself early enough.
If I could go back and tell my 20-year-old self anything, it would be what’s in this newsletter.
I share it because I don’t want you to end up where I was at 55.
When we talk about “keeping your arteries clean,” what we really mean is avoiding atherosclerotic cardiovascular disease, or ASCVD.
The process behind most heart attacks and strokes largely boils down to two things:
- What penetrates the artery wall. These are the ApoB-containing particles: LDL, IDL, VLDL, and Lp(a).
- Artery wall vulnerability. How healthy and resilient the inner lining of your blood vessel (the endothelium) is at keeping those particles out.
Your arteries are lined with a single layer of endothelial cells.
For a long time, we assumed cholesterol particles simply leaked through gaps between these cells.
We now know much of it happens through a process called transcytosis: the endothelial cell actively grabs ApoB particles on the blood side, carries them through its interior, and releases them into the artery wall on the other side. Receptors on the cell surface (such as SR-B1 and ALK1) help drive this process.
Once inside the wall, some of the ApoB particles bind to the surrounding tissue and get trapped. Your immune system tries to remove them; white blood cells engorge themselves with cholesterol, and inflammation sets in. That’s the beginning of plaque.
Over the years, plaque can take two forms:
- Soft plaque. Soft and inflamed, with a thin cap that can rupture, triggering a clot and a sudden heart attack or stroke.
- Hard plaque. More stable and calcified, slowly narrowing the artery and restricting blood flow.
Put simply, it’s an equation: how many particles are trying to get in, and how easily the wall lets them in.
Reduce both, and you dramatically reduce your risk.
What Penetrates the Artery Wall
Every atherogenic particle (LDL, IDL, VLDL, and Lp(a)) carries exactly one ApoB protein.
So measuring ApoB essentially counts the number of particles that can enter your artery wall.
The more particles there are, the greater the chance they can get in and get stuck.
That’s why I focus on ApoB rather than LDL-C alone.
Two people can have the same LDL number but very different particle counts, and different risk profiles.
The mainstream guidelines are catching up. The 2026 ACC/AHA dyslipidemia guideline, released this March, is built on the principle that cardiovascular risk depends on both the concentration and duration of exposure to ApoB-containing lipoproteins, and ApoB is introduced into the US guideline for the first time as a recommended measurement.
Know your numbers. Ask your doctor to order an ApoB test. My personal target for most people is under 80 mg/dL, and lower if you already have heart disease or major risk factors.
I recommend checking your Lp(a). It’s largely genetic, it’s a major risk factor, and many people have never had it checked.
Lowering ApoB with lifestyle:
- Swap saturated fat for unsaturated fat. Replace butter, fatty meats, and processed foods with olive oil, nuts, avocado, and fish.
- Eat more soluble fiber. Oats, beans, lentils, and psyllium bind cholesterol and bile acids in your gut and help lower LDL.
- Lose excess weight, especially visceral (belly) fat, which drives the liver to produce more ApoB particles.
- Cut back on refined carbs, sugar, and alcohol. These raise triglycerides and VLDL particles, which add to your ApoB count.
Lowering ApoB with medications:
For many people, especially those with genetic predispositions, lifestyle alone won’t reduce ApoB to target levels. That’s not a failure. It’s biology. We have excellent, well-studied tools:
The best plan is the one that gets your ApoB low and keeps it low for decades.
Talk to your doctor about which combination makes sense for you.
What Weakens the Artery Wall
Vascular vulnerability.
With the atherogenic particle count equal, a damaged endothelium offers more access. Protecting the lining of your arteries is the other half of the equation.
Never smoke: cigarettes, vapes, or marijuana.
Smoke directly injures the endothelium, increases inflammation, and makes blood more likely to clot. Cigarette smokers have roughly 2 to 4 times the risk of coronary heart disease. Vaping impairs blood vessel function too. And marijuana isn’t the harmless exception many assume: a 2024 survey-based study of more than 434,000 U.S. adults found that daily use of cannabis, predominantly through smoking, was associated with a 25% increased likelihood of heart attack and a 42% increased likelihood of stroke when compared with non-use. Even among people who had never used tobacco, daily cannabis use was associated with myocardial infarction and stroke.
Control your blood pressure, and measure it at home.
High blood pressure pushes against your artery walls with every heartbeat, injuring the endothelium and allowing more particles into the wall. A blood pressure reading at your yearly physical is not enough. "White coat hypertension" can raise blood pressure due to nerves.
The 2025 AHA/ACC guideline places home blood pressure monitoring as the diagnostic gold standard and sets a universal treatment goal of under 130/80 mm Hg for all adults. Use a validated upper-arm cuff, since cuffless devices like smartwatches are discouraged due to accuracy concerns.
A reasonable goal is around 120/80. In the SPRINT trial, targeting a systolic pressure under 120 in high-risk adults reduced major cardiovascular events by about 25%.
Keep glucose and insulin managed.
This is why your diet matters beyond cholesterol. Chronically elevated glucose damages the endothelium directly.
It creates oxidative stress, forms sticky compounds called advanced glycation end products (AGEs), and reduces the production of nitric oxide, the molecule that keeps vessels relaxed and healthy. High insulin levels from insulin resistance add to the problem, shifting the endothelium toward constriction, inflammation, and dysfunction long before blood sugar reaches the diabetic range.
Build your diet around vegetables, fruits, nuts, legumes, and lean protein, rich in fiber and micronutrients, and limit ultra-processed foods. The evidence is strong: in the PREDIMED trial, a Mediterranean-style diet with extra-virgin olive oil or nuts reduced major cardiovascular events by roughly 30%.
Ask your doctor to check your fasting glucose, HbA1c, and fasting insulin, not just your fasting glucose.
Exercise regularly.
Aim for at least 150 minutes per week of moderate activity or 75 minutes of vigorous activity. When blood flows faster during exercise, it signals your endothelium to produce more nitric oxide. Over time, that keeps arteries flexible, lowers blood pressure, improves insulin sensitivity, and strengthens the very barrier that keeps ApoB particles out.
The Bottom Line
ASCVD comes down to two forces: the ApoB particles trying to get into your artery wall, and how vulnerable that wall is to letting them in.
- Lower the particles: know your ApoB (aim for under 80 mg/dL), check your Lp(a), and use lifestyle and, when needed, medication to keep ApoB low.
- Strengthen the wall: never smoke anything, keep your blood pressure around 120/80 using a home cuff, keep glucose and insulin in check, and move your body every week.
ASCVD is a time-of-exposure disease.
Every year of high ApoB, high blood pressure, smoking, or poor metabolic health adds to the plaque your arteries are quietly building.
Genetic studies show that people with lifelong lower LDL have dramatically lower rates of heart disease.
The sooner you start, the bigger an impact you can have.
I learned this the hard way at 55. You don’t have to.
Start today.
Stay Hydrated. Replace What You Lose.
Hydration isn’t just about drinking more water — it’s about replacing what you lose.
When you sweat (from workouts, sauna sessions, or just daily life activities), you’re not just losing water — you’re losing electrolytes like sodium, potassium, and magnesium.
That's why I drink LMNT as my electrolyte replacement.
LMNT uses a science-backed electrolyte ratio of sodium, potassium, and magnesium.
LMNT tastes great and helps me replenish my electrolytes after an extended hard workout or a sauna session. Since they launched their 12 oz skinny cans, Pineapple Salt has been my favorite flavor.
If you are active, sweat often, and want to try LMNT for yourself, click here to receive a FREE sample pack of all 8 flavors with any purchase, plus a No-Questions-Asked Refund Policy.
I want to hear from you!
Did you learn from this newsletter?
What resonated or surprised you?
(Respond directly to this email. I read all responses)
Only the best,
Jeremy London, MD
P.S. Don't forget to follow my podcast for free on Spotify or Apple Podcasts
Featured in Today's Newsletter:
|
Before you go...
Want to read past Newsletters? Click Here
|
* Disclaimer: This blog is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user’s own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay seeking medical advice for any medical condition they may have and should consult their healthcare professionals for any such conditions.
Stay connected on all my platforms:
