Ivor Cummins interviews Dr. Vladimir Subbotin, who argues for a fundamental shift in the way we think about the origins of heart disease. Here, Subbotin draws on his research and knowledge of arterial physiology to suggest the initial defect in heart disease is not high cholesterol inside the arteries but deterioration in the artery walls and the small veins that feed them (vasa vasorum). His hypothesis, if correct, implies many core assumptions related to the cause, prevention, and treatment of heart disease could be wrong.