As a clinical lipidologist certified by the American Board of Clinical Lipidology, I provide evidence-based care without overselling interventions. With widespread misinformation about cardiovascular prevention and cholesterol’s role in atherosclerosis, it’s crucial to rely on trusted, scientifically supported recommendations. I share the knowledge and guidance I would offer to my own family.

Understanding Your Cardiovascular Risk
Cardiovascular disease is the leading cause of death in America. My approach focuses on reducing your risk of atherosclerotic cardiovascular disease (ASCVD) to help you live a long, healthy life. Cardiovascular disease is an alligator that will approach your boat at some point, given its prevalence. This makes prevention essential for everyone, regardless of current risk levels.

Maximizing the Impact of Intervention
While those who have already experienced a cardiovascular event—such as a heart attack or stroke—derive the greatest clinical benefit from treatments like lipid-lowering therapies, it’s important to recognize that ASCVD poses a significant lifetime risk for everyone. Because of its prevalence, even individuals without prior events will benefit from early, preventive interventions. The goal is to act before the disease manifests, significantly reducing the likelihood of future events and keeping that alligator from getting too close.

Key Factors Contributing to Cardiovascular Risk

• Elevated LDL Cholesterol (LDL-C): High LDL-C levels contribute to plaque buildup in arteries. Lowering LDL-C is critical for reducing cardiovascular risk. My belief, widely shared by the National Lipid Association and preventive cardiologists, is that lower is better for preventing atherosclerosis.
• Endothelial Dysfunction: Systemic inflammation, hypertension, and insulin resistance stress blood vessels, increasing the risk of atherosclerosis.
• Smoking: Smoking damages blood vessels and significantly raises heart disease risk.
• Physical Inactivity: A sedentary lifestyle negatively affects lipid profiles and overall heart health.
• Genetic Factors: Variations in LDL-C clearance, particularly in those with heterozygous familial hypercholesterolemia (FH), increase cardiovascular risk. Elevated lipoprotein(a) [Lp(a)] also raises ASCVD risk and is not easily modifiable by lifestyle changes. Screening for FH and Lp(a) is crucial, as untreated conditions lead to significantly higher risks of early heart disease.

The Cumulative Impact of Risk Factors
Atherosclerosis develops over time due to cumulative exposure to atherogenic particles like LDL-C. Both the presence of risk factors and the duration of exposure are critical, underscoring the importance of early intervention and sustained management. Factors such as systemic inflammation, obesity, a poor diet, chronic stress, and conditions like pre-eclampsia or inflammatory diseases further increase cardiovascular risk. By addressing these modifiable factors or accounting for non-modifiable ones, we can craft personalized strategies to reduce your long-term risk.

Understanding Your Risk
Evaluating both your 10-year and lifetime cardiovascular risk provides essential insights. While short-term risk calculators may suggest low immediate risk, younger individuals with significant risk factors—such as a family history of early ASCVD or elevated Lp(a)—have substantial lifetime exposure. This long-term risk requires thoughtful, proactive management.

The Power of Coronary Artery Calcium (CAC) Scoring
CAC scoring is a valuable, low-cost tool for detecting calcified plaque in the coronary arteries. Even in younger individuals, any calcium presence indicates subclinical atherosclerosis. CAC scores can guide early interventions and treatment strategies, even for those considered low-risk by conventional calculators. For higher-risk individuals, coronary CTA may offer additional insights, detecting soft plaques that are not visible on non-contrast CT scans, providing a more comprehensive view of atherosclerosis.

Personalized Strategies Beyond Guidelines
While clinical guidelines provide a solid foundation, each individual’s needs are unique. Together, we can explore evidence-informed strategies to tailor an approach that fills gaps where guidelines may not apply.

Navigating Information Overload
With the overwhelming amount of information available online and from podcasts, it can be hard to know what to trust. As your physician, I can help you navigate this landscape, ensuring that we focus on evidence-based practices and expert recommendations that will have a meaningful impact on your health.