It’s far more complex than that. Atherosclerosis begins in the teen years with fatty plaque deposits already in the aorta and major turbulence points of large arteries. The most prevalent first warning sign of atherosclerotic heart disease (blocked arteries and heart attacks) before preventive medicine and longer life expectancy, has long been.....sudden death. That is, the first sign was often death, and that occurs in the 6th decade of life (50’s). When the life expectancy doesn’t let people live long enough to develop symptoms, when most children don’t live through the first two years of life because of infectious pneumonia, when the average person doesn’t get regular checkups and preventive medicines and other therapies to control elevated lipids, glucose, and blood pressure and to manage stress, diet, and inactivity, when inadequate caloric and nutrient intake are the norm, and when there are dangerous working conditions and frequent generational wars, then you see the early deaths, small populations, and young populations that dogged mankind for thousands of years, including Americans in the 18th and 19th centuries.
No question that untreated diabetes, rheumatic heart disease, warfare and untreatable infectious diseases limited life expectancies ( and were in themselves a form of natural selection). However from an evolutionary perspective, humans never developed capacity to deal with chronic high, blood carbon monoxide levels. Those levels rose dramatically in the population when cigarette smoking became popular. Heretofore such levels were never seen. Cigarette smoking is the solitary worst thing you can do to your health and has been catostrophic for many otherwise healthy people especially men.
Given a choice would prefer an elevated cholesterol to having chronic elevated carbon monoxide levels. Much more research on carbon monoxide is necessary