I am not a statin skeptic--or rather, I don't want to be a statin skeptic. I've done the research and it makes sense to me, but I still feel some social and psychological pressures to reject statins.

When I see that it is widely accepted that ApoB is better to measure than LDL-C, but the industry continues to measure LDL-C, but not ApoB, I wonder why. It makes me skeptical.

When I see that the purpose of statins is to reduce plaque buildup in the arteries, and that we have the ability to measure these plaque buildups with scans, but the scans are rarely done, I wonder why. Like, we will see a high LDL-C number (which, again, we should be looking at ApoB instead), and so we get worried about arterial plaque, and we have the ability to directly measure arterial plaque, but we don't, and instead just prescribe a statin. We're worried about X, and have the ability to measure X, but we don't measure X, and instead just prescribe a pill based on proxy indicator Y. It makes me skeptical.

In the end statins reduce the chance of heart attack by like 30% I think. Not bad, but if you have a heart attack without statins, you probably (70%) would have had a heart attack with statins too. That's what a 30% risk reduction means, right?

As you can see, I'm worried about cholesterol and statins.

I'd argue that even the CT scan is unnecessary for a lot of people who want to start a preventative regimen to tackle heart disease. Especially if you're in your 20s or 30s with no family history of heart disease and no absurdly high ApoB results combined with really high lp(a).

    Key Takeaway: Get a CT or CTA scan, and if you can afford it go for the CTA with Cleerly.

There's something I deeply don't understand about this.

> I shared these results with a leading lipidologist who proclaimed: “Not sure if the lab or the primary care doc said an LDL-C of 116 mg/dL was fine but that concentration is the 50th percentile population cut point in the MESA study and should never ever be considered as normal.

> It’s also important to note that, according to a lipidologist friend, an ApoB of 96 is at a totally unacceptable 50th percentile population cutpoint from Framingham Offspring Study.

So... the exact median value is "totally unacceptable" and "should never ever be considered as normal"? I'm open to the possibility that the US population is so deeply unhealthy that this is true, but then that needs to be argued for or at least mentioned. Like, you can't say "you're exactly average in this respect" and expect your and that's terrible to be taken seriously without any followup.

Or if I'm misunderstanding what's meant by "50th percentile population cut point" then again, I think this jargon should be explained, as it's plainly not the usual meaning of "50th percentile".

I’m sensing a potentially significant misallocation of resources. My mental model is that there’s a hypothetical quantification of not just your time and money, but your anxiety, attention bandwidth, mental energy, etc.

I think, in some ways, the trick is being able to short circuit the entire journey represented by this website in favour of some form of, “I’m 40. I should be more mindful of heart disease. I should add a 30 min walk to my mornings.” And then move on with your life.

I think many cultures, but especially American healthcare culture, foment a growing background noise of constant anxieties and stressors. Life is sufficiently complex but there’s always a peddler eager to throw you a new ball to juggle (and pay for).

Long story short care about your health. If you don't do already, maybe now is a good time to start.

What you put into your body: no processed food, cook yourself, lots of variety of veggies and fruits, little meat, little alcohol.

What you do with your body: regular exercise, low stress, enough sleep.

What you do with your mind: good social environment, good relationships.

And an apple a day keeps the doctor away!

You can run a full blood panel on your whoop by clicking a button and showing up at a quest diagnostics

Going deep on biomarkers, blood tests, and debates about optimal levels is okay for some people who derive motivation from obsessing over topics, but I’m starting to notice a trend where people obsess about these things for a couple years before burning out and moving on to the next topic.

The best thing you can do for yourself is to establish healthy diet and lifestyle habits that are sustainable. A lot of people who jump from obsession to obsession do a great job at optimizing for something for a few years, but when their life changes they drop it completely and fall back to forgetting about it.

Fad diets are the original example of this: They work while the person is doing it, but they’re hard to maintain for years or decades. CrossFit and other exercise trends have the same problem where some people get extremely excited about fitness for a couple years before falling off completely because it’s unsustainable for them. Some people are able to continue these things for decades, but most people do it for a short while and then stop.

I’m now seeing the same pattern with biomarker obsessives: They go a few years obsessing over charts and trying things for a few months at time, but when the interest subsides or they get busy with life most of it disappears.

The most successful people over a lifetime are those who establish healthy habits that are easy to sustain: Eating well enough, reducing bad habits like frequent alcohol or fast food consumption, some light physical activity every day, and other common sense things.

The most important factor is making it something easy to comply with. The $300 biomarker panels are interesting, but most people don’t want to pay $300 every year or more to get snapshots that depend largely on what they did the past week. Some people even get into self-deceiving habits where they eat well for a week before their blood tests because the blood test itself has become the game.

I cannot judge the science in most of the article since I'm not a medical doctor.

But since I have a PhD in computer science in a relevant subdomain, I can certainly judge the part where he recommends the following:

> What should you do with your test results? Throw them into ChatGPT, of course!

Do not count on anything coming out of ChatGPT for medical advice. Period.

I was planning to start getting scans ordered for specific risks like aneurysm or heart attack but what holds me back is the idea the scans will harm me worse than those things.

It is very difficult to have any level of confidence with the medical industry so my current approach has been to eat as healthy as possible while staying as fit as I can without undue extreme stress.

Fabulous information, but lacking information isn’t the issue. The behavioral changes are obvious and well evangelized : lose weight, regular activity (walking), and if necessary, take meds. (Yes I know your marathon runner cousin who died suddenly of a heart attack, but these are still your best odds)

Telling people what to do rarely fixes anything. People need dozens of impressions for those changes to sink in. Friends, family, social outings, commercials, movies, songs all promoting overindulgence won’t be overcome with a helpful pamphlet or nagging.

> Sticking to a Mediterranean diet that is light on carbohydrates and saturated fats is almost always the safest bet. Almost every health diet is some permutation of this.

A permutation that's currently making the rounds in the press (even though the original research is from 20 years ago) is the "portfolio diet":

https://jamanetwork.com/journals/jama/fullarticle/196970

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.0...

Some press mentions:

https://www.health.harvard.edu/heart-health/the-portfolio-di...

https://www.nytimes.com/2025/11/04/well/eat/health-benefits-...

https://www.cnbc.com/2025/11/05/the-portfolio-diet-what-it-i...

Great post but quite surprised there is no mention of cutting red meat. There is a lot of evidence that especially the American diet is dangerously high in red meat to the point of elevating Heart Disease risk.

I'm not sure that non-medically indicated CT scans are a great idea, as you're at least doubling your yearly dose of radiation in the year of the CT scan. Perhaps it's warranted, but the article doesn't seem to balance that at all against doing a CT scan "every 1-5 years".

I might just be tired, but this seems highly repetitive. The author mentions friends in the field and concierge doctors multiple times in as much as I read.

Feels like the whole thing could be shortened to just say "here's the tests you run, the drugs you might take, the lifestyle changes you should consider".

Very interesting, but do the numerous mentions of taking action in your 20s, 30s and 40s mean it's too late for someone in their 50s?

Nitpick: he mentions LDL-C but the test results don't mention that at all. Only later do I see that is "LDL Cholesterol".

The primary thing I did was ask a cardiovascular surgeon in my network to send the lab requisition form to a lab. This is the gate for much of this stuff, even if you pay out of pocket. If someone knows a simple “pay and play” testing service that would be fantastic.

Most doctors recommend against these and against the full body MRI one can get because they believe you’ll always find things you don’t expect and that will make you indulge in interventions that have weak support, resulting in deleterious iatrogenic effects.

I found that I had no such impulse with the data I had. But a friend of mine, supplied with evidence of a little arrhythmia went through a battery of tests and experimentation. He was in line for getting a cardiac ablation when he finally quit his job and stopped having the problem. So I get why they say that. There’s people like that.

Anyway, if you’re curious what you can get for $800 email me and I’ll post here. I’d do it proactively but I’m traveling so it will take a little work.

yeah, always the usual: eat better and do physical activity

unfortunately, depression cripples my motivation to do physical activity

I still do some, but it's never enough

Was this written via LLM? There’s a link early on to some ai search tool which kinda made me question the validity of everything mentioned.

The "be an advocate" thing is both true but also incredibly selfish and egotistical.

If everyone did that, the whole system would grind to a halt. Doctors aren't in a rush because they enjoy so, they are because they're already overworked. 1 out of every 25 patients (their family) demanding extra attention is possible although still a burden. 21 out of every 25 is not possible.

I was a bit distracted by the capitalization of the word "Advocate". Both when used as a noun and a verb. Peculiar.

But a great article with really great suggestions. Too bad there's not better medical care by default but good to hear that we can take control.

If you dig into research and follow the low-risk experiments that people do online to reduce their Lp(a), you can find techniques and evidence to do so. It doesn't have to be an impossible-to-fix issue.

I like this list of experiments by Greg Muschen: https://x.com/gregmushen/status/1924676651268653474

For what it's worth, this article by the doctors at Barbell Medicine has been my go to recommendation for what to prioritize for health and longevity: https://www.barbellmedicine.com/blog/where-should-my-priorit...

The title of the article says "don't die of heart disease", but given that we all have to die at some point, if you could choose what natural cause to die of, wouldn't you pick heart disease? It is the best way to die. The worst is stroke. So once you cross a certain age, say 60, don't worry about heart disease, worry instead about stroke.

> To help manage inflammation, there are new medications like colchicine that are normally only used in very high-risk patients.

Clarification: Colchicine has been used by humans for over 3000 years. What's new is its use for cardiovascular disorders.

> It's not sexy, and as a result an overwhelming majority of the population is unaware about how to avoid succumbing to it

When I started building an ECG Holter in my early 20s, I tried to get some friends to use it and kept hearing "yeah, but it’s not exactly sexy to wear that thing." That’s when it hit me how little people care about prevention until something goes wrong. We still have a huge awareness gap to close.

The value of the biomarkers are they applicable for all age range? What if someone already had a heart attack, then what should be the normal values post incident?

Triglyceride-to-HDL Ratio (TG/HDL)

Interpretation: • < 2.0: Insulin sensitive • 2.0–3.9: Moderate insulin resistance risk • ≥ 4.0: High likelihood of insulin resistance

Your ratio = 5.0 → Suggests likely insulin resistance.

There are some points on this post that confuse me.

> In early 2023 during a routine skin check at my dermatologist [...]

Are routine skin checks a thing?

> [...] I’ve spoken with several of the world’s leading cardiologists and lipidologists [...]

How come?

I love this sort of documentation-style guide to medical issues. Reminds me of https://www.fourmilab.ch/hackdiet/e4/

Curious about how accessible these tests are in Europe. Living in a country (NL) that doesn't value annual checkups makes me assume detailed, preventative blood testing like this is hard, let alone possible to get in non-extreme situations.

I recently did a comprehensive panel of my own volition with Quest Labs and was pleasantly surprised by the entire process. It was super easy to schedule, affordable, and their online platform is surprisingly sleek.

There doesn't seem to be any mention of hypertension on that page.

It is a long read and I want to make time for it. Quick search check and calc (for calcify etc.) and diet appear alot in the article which is not surprising based on other things I have watched on the subject.

What if heart disease saves me from dementia? I'm not just being contrarian. I think about this a lot of the time. I'm already 40. I'm being healthy now, but whatever damage has already been done is baked in. (plus whatever is in my genetics) A quick death at 65-70 might be much more preferable to a slow terrible decade-long decline.

Stop drinking. Replace cheese and butter with olive oil in copious amounts. Only eat fish meats. Don’t smoke or vape. Eat salads and other prebiotics. Get some cardio - even walking your dog is great. Your brain fog will lift, your skin will clear, your mood will improve and your doctor will gasp at how clear your carotids are next time they’re ultrasounded.

A key takeaway is: don't be afraid of taking statins if you need them. I fell for the "statins are bad" BS for years and have paid the price.

This is all very interesting, but far too detailed and technical for 99% of people. The TLDR should include an easy to understand summary without jargon like "VO2" and "a set of HIIT at Zone 4".

Love the chart at the bottom--it really puts on display media bias and lack of integrity and using fear to push idiotic policies which area really just a way to put everyone in the pocket of government and keep them there permanently with zero real improvement to public health. Fear get eyeballs. the Covid mass hysteria proves that, too.

As far as heart disease goes, yes, it's the big killer and it's time people started waking up from the media haze, but to do that, you have to admit you were wrong, and for many, that is far too tall a hill to climb.

Tl;dr be affluent enough to be able to afford great medical care and have enough free time for preventative actions

I don't like this kind of content. The author might have a personal motivation for it, but for the general public, it's just more mental load.

We are all going to die one day.

When I was younger, I would fret over this kind of article. Great, one more thing I have to worry about. Now I just mostly ignore it. It's impossible otherwise. If I dedicate hours and days and months to all the heart best practices, what about when the liver, esophagus, kidney, bladder, brain articles come out?

We all know the good practices. Don't be a dumbass. Don't drink too much, exercise and so on. Besides that, I'm very much going to be reactive, as the article cautions against. I just don't have time or mental energy to do otherwise.

> Don’t Die!

Why the f* not.

My in-laws are over 95. They refuse to go to an elderly home and as a result make everyone miserable, starting with themselves and inflicting infinite suffering on their children who each have a family of their own, and need to take care of them all of the time.

I don't want to do that to my own children. I don't want to not die. I don't esp. want to die but I'm not really afraid of it, it's just a normal part of life.

Preventing heart disease is probably a good thing, but if one prevents every ailment conceivable then how does this work eventually?