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Doc's Opinion is a a website containing articles and blog about health, nutrition, healthy lifestyle and disease prevention.

21/09/2025

Six episodes are now out!

I’m writing a series called Inside the Artery: 13 Steps of Atherosclerosis. Step by step, it tells the story of how atherosclerosis develops inside the artery wall — from the very first changes in the endothelium to advanced plaque.

The first six episodes are now published, covering the journey from the earliest triggers through foam cell formation.

A new series on how heart disease really happens — and how to stop it before it starts

18/09/2025

For most of the twentieth century, medicine wasn’t a conversation — it was a command.
Doctors spoke, patients obeyed, and trust was the silent air between them.

That order has collapsed.

This is the story of how medicine lost its authority — and what it means to practice in an age where trust must be earned, one conversation at a time.

Public trust in doctors has collapsed. From scandals to COVID, here’s how medicine lost its authority—and how trust might be rebuilt.

15/09/2025

As a child, I pressed my nose against the window of an old clock shop in Reykjavík, convinced the ticking machines were whispering the secrets of time.
Medicine later taught me that our bodies have clocks of their own — circadian rhythms, telomeres, even molecular timers of aging. What happens when they fall out of sync?

Read my latest Letter from Reykjavik

How our inner clocks shape health, aging, and meaning.

11/09/2025

We can now silence hunger.
The question is — what happens when appetite itself becomes a condition to medicate?

From miracle drug to moral dilemma? The hidden costs of silencing hunger with GLP-1s like Wegovy and Ozempic.

08/09/2025

For centuries in Iceland, fish was survival. Daily food, not fashion.
Now the modern diet has shifted — but the question remains: does fish still protect the heart as our ancestors believed?

The sea still offers health — but do we take it?

04/09/2025

He kept JFK upright
He signed his death certificate.
He handled the missing autopsy materials.
He kept Johnson’s angina hidden from the public.

George Burkley — the White House doctor who knew too much.

For the first time in The Heart of Power, the story isn’t about a president, but the physician who stood behind them — and carried their secrets to the grave.

Discover the hidden role of George Burkley, the White House doctor who kept JFK’s autopsy secrets and Johnson’s heart troubles from the public.

01/09/2025

Atherosclerosis doesn’t begin when cholesterol crosses the artery wall. It begins when it gets stuck there. — Step 3 in the series is live.

Stuck Where It Shouldn’t Be

28/08/2025

Is brain fog real—or just life in 2025?

We blame stress. Aging. Screens. Long COVID. But what if something deeper is going on?

In my latest article, I explore the strange, rising tide of mental misfires—through science, personal stories, and a few sharp conversations (including one in a hot tub).

Why we can’t focus, what the science says—and what the mist over Mt. Esja might be trying to tell us.

👉 Read: “Brain Fog Nation”

Brain fog isn’t just in your head. Learn how distraction, dopamine, and digital life may be rewiring our focus—and why it matters more than ever.

25/08/2025

The gate has cracked open.

In Step 1, we saw how the artery’s delicate lining can falter.
Now comes Step 2: what slips through that breach — tiny ApoB-bearing lipoproteins, silent couriers that start the slow work of plaque.

It doesn’t begin with a flood. It begins with a trickle.

👉 Read the new chapter in my atherosclerosis series:

When the Gate Opens

20/08/2025

👉 Your LDL might look “fine,” but hidden particles could still be fueling heart disease.
In my latest article, I explain why VLDL and remnant cholesterol — not just LDL — are the forgotten drivers of atherosclerosis.

LDL isn’t the whole story. Learn how VLDL and remnant cholesterol drive heart disease risk, even when LDL levels look “normal.”

18/08/2025

This is the first in a 13-part series exploring the biology of atherosclerosis — from the earliest changes in the artery wall to the moment a heart attack strikes. Each step will connect cutting-edge science to real-world prevention.

How a Fragile Cellular Layer Sets the Stage for Atherosclerosis

16/08/2025

Inside the Artery: The 13 Steps of Atherosclerosis
Most people think a heart attack begins when the chest pain starts. It doesn’t.

By then, the real story is decades old — written silently inside the artery walls.

I’m starting a new miniseries on Substack that follows the step-by-step journey of atherosclerosis, from the very first microscopic changes to the moment an artery closes. Along the way, we’ll uncover where prevention really works — and why it so often fails.

👉 First post: Endothelial Dysfunction — The Trouble Begins is coming soon.

A new series on how heart disease really happens — and how to stop it before it starts

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About Doc’s Opinin

Doc’s Opinion is written and edited by Axel F. Sigurdsson MD, Ph.D., FACC.

Dr. Sigurdsson is a cardiologist at the Department of Cardiology at The Landspitali University Hospital in Reykjavik Iceland. He also practices cardiology at Hjartamidstodin (The Heart Center) which is a private heart clinic in the Reykjavik area. He is a Fellow of the American College of Cardiology (ACC), The Icelandic Society of Cardiology and the Swedish Society of Cardiology. He is a past president of the Icelandic Cardiac Society.

Dr. Sigurdsson is also a licensed aeromedical examiner. He has held the position of Medical Director of Icelandair since 2005.

Axel F. Sigurdsson MD, PhD

I studied medicine at the University of Iceland between 1978-1984. Upon receiving my medical license, I went to Sweden at the beginning of 1988 for further education and training.

I spent the next eight years at the Sahlgrenska/Östra University Hospital in Gothenburg, Sweden, specializing in internal medicine and cardiology.

In October 1993, I defended my doctoral thesis at the University of Gothenburg, termed “Neurohormonal Activation in Patients with Acute Myocardial Infarction or Chronic Congestive Heart Failure – With Special Reference to Treatment with Angiotensin Converting Enzyme Inhibitors”

In 1995-1996 I was a clinical fellow at the Royal Jubilee Hospital in Victoria BC, Canada. The primary purpose of my fellowship was training in interventional cardiology, mainly coronary angiography and percutaneous coronary interventions (PCI’s).

I have published more than 100 scientific abstracts, articles, and book chapters in international journals and textbooks.

Since 1996 I have worked as a clinical cardiologist at the Landspitali University Hospitalin Reykjavik Iceland as well as practicing internal medicine and cardiology at Hjartamidstodin (The Heart Center) in Kopavogur, Iceland.📷

I was born in Vestmannaeyjar, a volcanic island close to the south coast of Iceland on August 21, 1959.

Doc’s Opinion

I started writing Doc’s Opinion in the spring of 2012.

My aim is to write informative high quality articles based on medical science. Evidence based medicine is at the core of my writing.

My goal has always been to write articles that can be read and appreciated by health professionals as well as the general public. Of course, this is a difficult challenge because the gap between the medical literature and what ordinary people can read and understand may sometimes be difficult to overpass.

The main purpose of this website is to provide up to date information on preventive medicine, healthy lifestyle, and nutrition, and to provide reliable and practical information about different medical conditions. Although heart disease plays a central role, I also focus on many other areas of medicine.

A List of Some of my Published Scientific Papers

Evidence, Not Evangelism, for Dietary Recommendations

Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: A secondary analysis from the CANTOS randomised controlled trial

Effect of interleukin-1β inhibition with canakinumab on incident lung cancer in patients with atherosclerosis: Exploratory results from a randomised, double-blind, placebo-controlled trial

The cardiovascular risk reduction benefits of a low-carbohydrate diet outweigh the potential increase in LDL-cholesterol

Outcome of myocardial revascularisation in patients fifty years old and younger.

Angiotensin Receptor Neprilysin Inhibition Compared With Enalapril on the Risk of Clinical Progression in Surviving Patients With Heart Failure.

Benefits of Statins in Healthy Elderly Subjects What Is the Number Needed to Treat?

Comparison of 30-Day and 5-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients Aged

Prevalence of Abnormal Electrocardiographic Patterns in Icelandic Soccer Players and Relationship with Echocardiographic Findings.

Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality

Screening for risk factors of sudden cardiac death in young athletes

Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population

A comparison of all coronary angiographies (CA) performed in 2008 in Iceland and Sweden

Angiographic in-stent restenosis is not related to the inflammatory markers hs-CRP and MPO

Diagnostic accuracy of 64-MSCT for detection of in-stent restenosis

Clinical In-Stent Restenosis is related to stent length and diameter but not to diabetes in an unselected cohort

The effect of physical training in chronic heart failure

Effects of a 5-Lipoxygenase–Activating Protein Inhibitor on Biomarkers Associated With Risk of Myocardial Infarction: A Randomized Trial

Early neurohormonal effects of trandolapril in patients with left ventricular dysfunction and a recent acute myocardial infarction: A double-blind, randomized, placebo-controlled multicentre study

Effects of 3 analgesic regimens on the perception of pain after removal of femoral artery sheaths

Results of percutaneous coronary interventions in Iceland during 1987-1998.

In-hospital heart failure – epidemiology, prognosis and treatment

The role of neurohormonal activation in chronic HF and postmyocardial infarction

Neurohormonal activation and congestive heart failure: today’s experience with ACE inhibitors and rationale for their use

Prevention of Congestive Heart Failure by ACE Inhibition in Patients with Acute Myocardial Infarction

ACE inhibitors in patients with minimal or asymptomatic left ventricular dysfunction

Neurohormonal activation in patients with mild or moderately severe congestive heart failure and effects of ramipril. The Ramipril Trial Study Group

Is neurohumoral activation a major determinant of the response to ACE inhibition in left ventricular dysfunction and heart failure?

Left Ventricular Remodelling, Neurohormonal Activation and Early Treatment with Enalapril (CONSENSUS II) Following Myocardial Infarction

Response of plasma neuropeptide Y and noradrenaline to dynamic exercise and ramipril treatment in patients with congestive heart failure

Effects of ramipril on the neurohormonal response to exercise in patients with mild or moderate congestive heart failure

Short- and long-term neurohormonal activation following myocardial infarction

Neurohormonal effects of early treatment with enalapril after acute myocardial infarction and the impact on left ventricular remodelling

Enalaprilat in acute myocardial infarction: Tolerability and effects on the reninangiotensin system

Anti-arrhythmia agents after myocardial infarction should be used with caution

The Etiology of Bacterial Cellulitis as Determined by Fine-Needle Aspiration