Putting it together

The whole guide in one arc: know your real risk, measure the right things, look at your arteries if it's borderline, then pull the levers in order of proven power. Nothing here is a prescription — it's a way to have a much better conversation with your clinician.

The measurement ladder

Know these numbers: Start with a standard panel (which hands you non-HDL and remnant cholesterol free), add one ApoB, a one-time Lp(a), hs-CRP, and glucose/HbA1c. If your calculated risk lands in the intermediate zone, add a calcium score — and consider a CT angiogram (± Cleerly) if you're young with a strong family history or a high Lp(a), where a zero calcium score can falsely reassure. Most people have never seen their ApoB or Lp(a); those two are the highest-value gap to close.

The treatment ladder (most-proven first)

In order: 1. Lifestyle foundation — don't smoke, swap saturated for unsaturated fat, add fibre, exercise, lose visceral fat, sleep. Always, for everyone. 2. LDL/ApoB-lowering drugs matched to risk — statin first (cheap, proven), then ezetimibe, then bempedoic acid or a PCSK9 inhibitor for those who need more or can't tolerate a statin. 3. Treat the neighbours — blood pressure and glucose. 4. If Lp(a) is high, drive everything else harder and watch the pipeline. The single rule: match intensity to your actual risk.

The mindset

What to hold onto: Plaque is partly reversible and largely preventable. ApoB is the number. Lower-for-longer beats a late scramble. And the goal isn't a perfect lab result — it's fewer heart attacks and strokes. Decide everything here, especially any medication, with a clinician using your real numbers.

The order that matters

Measure (ApoB + a one-time Lp(a)) → look if borderline (a calcium score, ± CT angiogram) → lifestyle always → drugs matched to risk. Simple, proven, and personalised to you rather than to a population average.

The Cholesterol Guide