[cthalupa]

The National Lipid Association and American Heart Association have both been advocating that lower cholesterol numbers are better, e.g. https://www.lipidjournal.com/article/S1933-2874(25)00317-4/f...

Research science in this area has been in agreement for a long time now that ApoB is a more informative indicator than just LDL-C, because there are a variety of different atherogenic particles, not all LDL particles are created the same, etc.

His ApoB numbers are quite readily and apparently out of range. Hell, even his LDL is out of range for the two largest lab providers in the US - Labcorp and Quest both have <100 for their reference range. But the science shows that plaque progression is still generally occurring at levels above 70 LDL-C even with low Lp(a) and other atherogenic particles - the reference ranges are likely to get moved lower and lower as practice catches up with research.

His numbers are well within the range of concern based on pretty universal consensus across the research in this area over the past couple of decades. Preventative cardiologists and lipidologists would almost certainly agree with this concierge doctor.

[safety1st]

Thanks for the astute and informed comment. So re-reading that portion of the article, it seems to me the answer to my question is not that any general or consensus guidelines are wrong, but that a company called Forward Health is doing lipid panels and providing an incorrect interpretation of the results.

OP's LDL-C was 116 and this is on the very top end of what Forward Health's report says is OK, their report is wrong, this number is bad.

All the stuff about needing to measure ApoB, needing a high end concierge doctor, and the very long article about measuring 10-20 different numbers and doing more exercise than the guidelines and being at risk of heart attack if you don't do amounts of exercise that the author consider unreasonable etc., some of this may have value, but this all seems to be a lot of very lengthy personal opinion by the techbro author of the post. The key insight is simply that your LDL-C becomes a cause for concern over 100, perhaps even over 70, and he was not as healthy as some tech company told him he was. No surprise there, I will talk to actual doctors instead of using services from "tech forward" startups any day of the week.

[cthalupa]

I would agree that this article overstates a lot of things.

ApoB is still a reasonable thing to check though, at least once - Lp(a) is the primary cause of atherogenic particle counts being high when LDL-C isn't the culprit, and it's usually a genetic factor. Having a high Lp(a) will bounce your ApoB up and give you a better understanding of the total atherogenic particle load. You could have fine LDL-C or Lp(a) on their own but the total amount could be enough to be worrisome.

Lp(a) being problematic is definitely less common than it being more or less fine, but it's certainly not incredibly rare, either.

[safety1st]

Really great context, thanks!