Cardiovascular disease is the most common cause of death for all Americans, accounting for one in four deaths per year. (12) It’s important to understand how this “silent killer” develops and what you can do to prevent it.

What is atherosclerosis?

Long before most heart attacks occur, a disease is developing in the arteries called atherosclerosis. Atherosclerosis is a common condition in which plaque builds up in the arteries, reducing blood flow and starving the body of oxygen and other essential nutrients. The arteries become stiff and blood pressure rises. In some cases, the plaque breaks off, forming a clot and leading to a sudden heart attack or stroke. (17)

Did you know? Even in those without cardiovascular risk factors, almost 50% of individuals have been found to have subclinical atherosclerosis or increased plaque and blockages. (17)

What is coronary artery disease?

Coronary artery disease is the term used when plaque is located in the arteries leading to the heart. Not surprisingly, this is an especially dangerous situation.

Over 18 million (6.7%) of the US population suffers from diagnosed coronary artery disease (CAD). (12) CAD significantly increases the risk of heart attack, stroke, and other cardiovascular conditions. While CAD can affect anyone, it is more common in people with certain conditions, such as chronic obstructive pulmonary disease (COPD) and diabetes. (31)(41) Coronary artery disease risk factors are wide-ranging and include genetic (e.g., family history of CAD), lifestyle (e.g., physical inactivity, poor diet), and environmental factors (e.g., secondhand smoke exposure). (11)

Coronary artery disease may present with certain symptoms, including:

  • Angina (chest pain) (27)
  • Shortness of breath (43)
  • Heartburn, nausea, or vomiting (14)

However, many patients with CAD don’t feel any symptoms at all, and the disease is only detected by tests conducted by a healthcare practitioner. (13) That’s why it’s essential to get regular medical checkups.


healthcare worker feeling an elder woman's heart
Although invisible from the outside, the narrowing of the arteries due to atherosclerosis can lead to coronary artery disease.


Fortunately, it takes time for coronary artery disease to develop. Long before the arteries narrow and stiffen, changes can be detected by the advanced diagnostic techniques.

The role of the endothelial glycocalyx

In recent years, scientists have discovered a thin yet essential lining of the arteries and blood vessels. This lining, called the endothelial glycocalyx, provides natural protection against the development of coronary artery disease. (21)

The glycocalyx lines your blood vessels and protects and regulates your entire vascular system. That means it’s essential for your heart as well as every organ and system in your body. (21)(25)

The glycocalyx is a “smart barrier”, meaning it allows certain substances to pass from your blood through the artery wall, while keeping others out. (6)(21) Researchers have called the endothelial glycocalyx the “front-line for atherosclerosis.” (26) When it’s in good condition, your glycocalyx can prevent plaque buildup and the development of coronary artery disease. (21)(25)

Factors that affect the endothelial glycocalyx

The endothelial glycocalyx is very fragile; it can be damaged quickly—in as little as a few hours—by many factors, which are summarized below. (34)

Lifestyle factors:

  • High-sugar diet (28)(40)
  • High-fat diet (9)
  • Physical inactivity (24)(33)
  • Psychological or physical stress, which cause inflammation (21)
  • Smoking (8)

Environmental factors:

  • Aging (19)
  • Systemic inflammation (34)
  • Trauma (34)

Health conditions: (42)

  • Atherosclerosis
  • Cardiovascular disease
  • Chronic kidney disease
  • High blood pressure
  • Stroke
  • Type 2 diabetes

The good news is that the glycocalyx is quite resilient. Given the right support, it can rebuild itself quickly. Animal and laboratory studies demonstrate that the endothelial glycocalyx repairs itself rapidly even after profound damage. With supportive treatments or changes in lifestyle, improvements can be seen in hours and continue over days and weeks. (10)(34)(37)


men running outdoors with headphones
Exercise can help with both stress management and vascular function, especially when immersed in nature.


How to prevent coronary artery disease

With that in mind, how can you protect your glycocalyx and reduce your risk of coronary artery disease? The following tips can help benefit your overall health and may prevent CAD.

Address modifiable lifestyle factors

Eat healthy foods and focus on a fruit and vegetable-rich, low-sodium, and low-glycemic index diet. Additionally, reduce stress when possible, quit smoking, and exercise regularly. (20)

Support vascular health

Take steps to keep your blood pressure and cholesterol levels optimal, and communicate with your healthcare provider. For example, reduce or eliminate alcohol and trans fats in your diet. (18)(30) And don’t forget to exercise, especially if you have high blood pressure! (15)

Consider supplements

Although research is ongoing, certain evidence-based dietary supplements may help reduce the risk and address atherosclerosis and coronary artery disease.

The plaque buildup that is the major coronary artery disease risk factor is worsened by inflammation. (7) There are many strategies to reduce inflammation in the blood vessels, including certain supplement ingredients. As with most supplements, finding out if you have nutrient deficiencies is a critical step. Deficiencies of magnesium and vitamin D have been identified as coronary artery disease risk factors. (22)(23)


Magnesium is essential to maintaining the proper functioning of every cell in the body and plays an important role in managing and reducing inflammation. Magnesium deficiency is common and often correlated with poor cardiovascular health, (22) including an increased risk for CAD in long-term studies. (32)(35)(39)

Vitamin D

Vitamin D deficiency is extremely common. In one study of over 700 individuals, only 20% of healthy controls and about 4% of those with CAD had sufficient levels of vitamin D. (29) High levels of vitamin D may be protective against coronary artery diseases, whereas low levels are correlated with an increased risk. (23) According to a 2020 review study, the form of vitamin D3 known as calcitriol may be particularly beneficial for CAD and atherosclerosis. (2)(5)(23)(36)

Omega-3 fatty acids

Omega-3 fatty acids, often derived from fish, squid, and krill, are often recommended for individuals with elevated cardiovascular risk. (1)(36) Intake of omega-3s has been shown to reduce unhealthy triglyceride and low-density lipoprotein (LDL) levels in the blood, which has beneficial anti-inflammatory effects for the cardiovascular system. (3)(4) There has been conflicting research regarding the effectiveness of omega-3 supplements; however, high-quality supplements at a relatively high dose may be responsible for the positive effects seen in many studies. (16)

The bottom line

Research indicates that supporting a healthy endothelial glycocalyx, the protector of your entire vascular system, is essential for preventing coronary artery disease and promoting healthy cardiovascular function. Minimize your risk of CAD by eating a healthy diet, exercising regularly, managing stress, reducing your exposure to environmental pollutants, and supplementing with certain dietary supplements (e.g., magnesium, vitamin D, omega-3s) when recommended by your practitioner.

If you’re a patient, speak to your integrative healthcare provider about your options for improving cardiovascular health and reducing your risk of CAD.

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Disclosure: This article was written in partnership with Arterosil. All supplier partnerships have been approved by doctors on our Integrative Medical Advisory team, and this content adheres to all guidelines outlined in our content philosophy. Fullscript has not been compensated financially for the publication of this article.

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