#316 - What Should You Actually Do About High Cholesterol? | Dr. Seth Martin & Mike Haney

Heart disease is the leading cause of death, but it’s also one of the most preventable. Decades of research have established a strong causal role for LDL and other ApoB-containing particles in atherosclerosis, and we now have multiple proven ways to lower them. The harder question is how to turn that evidence into a decision for an individual person.

Mike Haney talks with Johns Hopkins cardiologist Dr. Seth Martin, a co-author of the new 2026 dyslipidemia guidelines, about what the latest evidence says we should actually measure and act on. The throughline is pragmatic: lower exposure to atherogenic particles earlier and for longer, use additional tests when they can change a decision, and distinguish interesting new measurements from ones that have actually been shown to improve outcomes.

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What We Cover:

• Why the evidence that LDL and ApoB-containing particles cause atherosclerosis is so strong
• What “lower for longer” means and how the new LDL and ApoB goals change with cardiovascular risk
• When ApoB adds useful information beyond a standard lipid panel
• Why the guidelines recommend against routine LDL particle-size testing
• How PREVENT risk scores and coronary calcium scans can help decide when treatment makes sense
• What decades of statin research tell us about benefits, muscle symptoms, and diabetes risk
• How much lifestyle changes typically move cholesterol, and when non-statin drugs enter the picture
• Why common heart-health supplements don’t have the evidence behind proven lipid-lowering therapies

🎙️ About the Guest:

Dr. Seth Martin is a professor of medicine and preventive cardiologist at Johns Hopkins, where he directs the Advanced Lipid Disorders Program and Digital Health and AI Lab at the Ciccarone Center for the Prevention of Cardiovascular Disease. He is a co-developer of the widely used Martin-Hopkins LDL cholesterol equation and served on the writing committee for the 2026 ACC/AHA dyslipidemia guideline.

📍What Dr. Seth Martin & Mike Haney discussed:

• 00:04 - LDL and ApoB are causal. Lower for longer
• 07:10 - Guidelines set the standard. Not your doctor
• 11:40 - 2026 shift: earlier treatment, PREVENT, lower goals
• 17:01 - LDL near zero does not eliminate cholesterol
• 19:59 - Hard numbers are back, and lower
• 23:05 - ApoB if a high result changes treatment
• 27:42 - No trial says treat particle size instead of LDL
• 34:51 - PREVENT is for people not already high risk
• 38:52 - Calcium 300 can push the goals. Zero can mean lifestyle first
• 44:29 - The 3% statin line, and the choice just under it
• 51:22 - Muscle symptoms uncommon. Statin can move prediabetes diagnosis earlier
• 56:21 - Lifestyle often lowers LDL about 10%, not the whole benefit
• 59:05 - Other proven drugs when a statin is not enough
• 1:05:31 - Statin beat the supplements. Fish oil can raise AFib risk

🔗 Helpful Links:

• 2026 Guideline on the Management of Dyslipidemia: ⁠Read the guideline and supporting materials⁠
• The New Cholesterol Guideline: What to Know — Johns Hopkins: Read the Johns Hopkins summary
• PREVENT-ASCVD Calculator.: ⁠Use the PREVENT calculator⁠
• Martin-Hopkins LDL Equation: Learn about the Martin-Hopkins method
• SPORT Trial — JACC (2022): Read the SPORT trial

Watch the conversation: https://youtu.be/vRfhof5dOZw

Find us on YouTube: ⁠https://youtube.com/levelshealth?sub_confirmation=1⁠

👋 Who we are:

Levels helps you understand your metabolic health with personalized data, expert guidance, and tools that connect your daily choices to measurable changes in your body. Our goal is to help you make better decisions about food, exercise, sleep, and long-term health.

Look for new shows every month on A Whole New Level, where we have in-depth conversations with thought leaders about metabolic health.