Many people, and their doctors, believe that a diet high in saturated fats is the primary cause of coronary heart disease (CHD). However, this belief is misguided, according to the authors of an editorial who reviewed data from past clinical trials.

“The emphasis on knowing your cholesterol is really misguided, and takes the focus away from things that are really good for people,” Rita Redberg, co-author on the paper, told TheDoctor.

In their review and analysis of observational studies they found no relationship between saturated fat consumption and ischemic stroke, type 2 diabetes, death from all causes, CHD or death from CHD. They believe the findings of previous studies suggesting the so-called “plumbing theory,” or opening clogged arteries by inserting a metal stent, does not prevent future heart attacks or reduce the risk of death.

A measure of high total cholesterol to high-density lipoprotein (HDL or ‘good’ cholesterol) ratio in the blood, rather than low density lipoprotein (LDL or ‘bad’ cholesterol) levels, is the best predictor of CHD risk, the authors maintain.

You can make dramatic improvements in your health with even small changes in the way you eat and how much you walk every day.

The public heath message about the prevention and treatment of CHD should shift from measuring cholesterol levels in the blood and reducing dietary saturated fat to living an overall healthy lifestyle, the researchers said. “CHD is a chronic inflammatory disease and it can be reduced effectively by walking for 22 minutes a day and eating real food.”

Chronic inflammation of the arteries is the result of a diet high in sugar, refined carbohydrates and omega-6 fatty acids, as well as other lifestyle factors such as smoking and lack of exercise. This inflammation responds well to a Mediterranean diet rich in foods that contain polyphenols, alpha linoleic acids and omega-3 fatty acids that reduce inflammation — such as nuts, extra virgin olive oil, vegetables and oily fish.

Lifestyle is the first step in minimizing heart disease risk, said Redberg, who is a professor of medicine at the University of California, San Francisco. You can make dramatic improvements in your health with even small changes in the way you eat and how much you walk every day. Minimize the amount of processed food (from boxes and cans) you eat and try to eat fresh fruits and vegetables, nuts and fish as often as possible.

You should talk to your doctor about the benefits and risks of taking LDL-lowering medications called statins, and then make the decision. “Many people have an inflated idea of the protective benefits of statins, so I think it’s a good idea for people to understand the risks and benefits,” Redberg added.

Most people who take statins are not getting any benefit in terms of reduction of CHD risk, said Redberg. She suggested consulting an online decision aid, such as one offered by the Mayo Clinic, before talking with your doctor about taking statins.

The editorial is published in the British Journal of Sports Medicine.