Stop Chasing Your Cholesterol Number And Look At Your Arteries!
In a Nutshell
Cholesterol numbers are just proxies—they cannot reveal the actual disease: plaque in artery walls. Three direct imaging tests (CIMT for early soft plaque, calcium-score CT for calcified plaque, and CT angiogram for full plaque mapping) are required to see what cholesterol misses. Metabolic drivers like insulin resistance, not LDL targets, are the root cause; guidelines pushing ever-lower LDL with drugs overlook this and fail to reduce events.
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After receiving cholesterol panel results that appear good—possibly due to statin medication or naturally low levels—most people assume their arteries are also healthy. This belief stems from the common assumption that if the cholesterol number is in range, the arteries must be in range too.
The cholesterol number is not the disease. The actual disease is plaque sitting in the wall of the artery, which the cholesterol number cannot detect. The goal is to show what the cholesterol number misses and how to look inside the artery to see the plaque itself.
Three different approaches exist for examining arteries for plaque, one of which doctors typically do not mention to patients.
Dr. Ford Brewer spent his career in preventive medicine, running the preventive medicine program at Johns Hopkins. He now helps people avoid heart attacks, strokes, and early death. The show focuses on teaching how to think about preventive medicine rather than providing medical advice.
The cholesterol number is a proxy or bioindicator—a measurement standing in for something else that it cannot directly see. When someone has a heart attack, the lab report number is not what stopped their heart. The plaque in the artery wall that cracked open, threw the clot, and shut down blood flow is the actual disease.
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