Whatstack

Guide

Cholesterol.

What plaque is, how to test it properly (ApoB, Lp(a), calcium score, Cleerly), both sides of the statin debate, PCSK9 and what’s coming — and every lever to lower it, diet to drugs.

Contents

  1. 01What arterial plaque actually isAtherosclerosis isn't 'pipes furring up from the inside' — it's a disease of the artery…
  2. 02The cause: ApoB particlesOne fact anchors this whole guide, and it's about as settled as anything in medicine: the…
  3. 03It's reversible: shrinking & stabilising plaqueFor decades atherosclerosis was assumed to be a one-way street. The imaging trials proved…
  4. 04The standard lipid panelThe basic panel gives you five numbers — and two more for free. The trap is that the…
  5. 05The super-tests: ApoB & Lp(a)Two 'beyond standard cholesterol' tests do more than the whole basic panel for many people…
  6. 06Advanced markers & what's worth itBeyond ApoB and Lp(a) there's a long menu of 'advanced' cardiac markers — a couple worth…
  7. 07Risk scores & their limitsBefore anyone scans your arteries, guidelines run your numbers through a risk calculator…
  8. 08The coronary calcium score (CAC)A fast, cheap, low-radiation CT that counts calcified plaque in your heart's arteries. It's…
  9. 09CT angiography & CleerlyIf the calcium score's blind spot is soft plaque, the CT angiogram is the fix: it sees the…
  10. 10Statins: how they work & the evidenceStatins are the most-studied drugs in cardiovascular medicine. For someone who has already…
  11. 11Statins: risks, nocebo & the overtreatment debateHere is where informed, well-meaning experts genuinely disagree — so you deserve both sides…
  12. 12Beyond statins: ezetimibe & bempedoic acidIf a statin isn't enough, isn't tolerated, or you'd rather go lower without a bigger statin…
  13. 13PCSK9 inhibitors & inclisiranYou asked specifically about PCSK9's wins — so here they are: the most powerful…
  14. 14The Lp(a) frontierLp(a) is cardiology's big unmet need: common, causal, genetic — and until now untreatable…
  15. 15New treatments coming soonBeyond Lp(a), the next few years bring an oral PCSK9 pill, a resurrected drug class that…
  16. 16Diet: what actually lowers ApoBDiet is a real lever on cholesterol, but the effect sizes are honest — moderate, not…
  17. 17Weight, exercise, smoking & sleepThe non-diet levers matter as much for plaque as for cholesterol — some by moving the…
  18. 18Supplements & peptidesA handful of supplements genuinely lower LDL; most do less than the label implies; and the…
  19. 19Putting it togetherThe whole guide in one arc: know your real risk, measure the right things, look at your…
  20. 20Sources & how to read the evidenceThis guide was built from the primary literature — clinical guidelines, randomised trials…
Educational reference — not medical advice. This summarises published research and clinical guidance. Doses and thresholds are typical figures from the literature, not instructions. Never start, stop, or change a statin or any drug — and never self-source — on your own; decide anything here with a qualified clinician using your own numbers.