If “bad” LDL cholesterol and trans fats aren’t causing heart disease, what is? Here are a few of the theories that have been put forward in recent years:

It’s inflammation: Adding natural antiinflammatories to the diet—such as tomatoes, spinach and kale, fatty fish, and berries—could reduce your risk of heart disease. Researchers monitored more than 10,000 heart patients, and those whose inflammation levels were lowered pharmaceutically were also less likely to suffer a second heart attack. Their risk dropped by up to 17 percent, researchers at Brigham and Women’s Hospital in Boston found.1

It’s refined sugar: People who get a quarter or more of their daily calories from refined sugar triple their risk of dying from cardiovascular disease (CVD). The US Centers for Disease Control and Prevention (CDC) discovered the risk when they analyzed the diets of thousands of Americans. Consuming processed food and drinks also makes you overweight and raises the risk of diabetes, which further increase the likelihood of CVD.2

It’s stress: People who feel they aren’t in control of a situation, such as at work or home, are twice as likely to die from heart disease. A study in Finland tracked the lives of 800 people working for an engineering company. While high workloads and tight deadlines didn’t increase CVD risk, it was the stress—including negative psychological factors such as feeling trapped or powerless—that did the damage.3

It’s air pollution: Cigarettes, car exhaust, and industrial pollution are the real cause of CVD, several studies claim. CVD risk has nearly doubled in Chinese cities that have recently industrialized, a CDC report found, while people living near busy roads are also more likely to suffer from heart disease.