Cholesterol Optimization Protocol

LDL-C, the standard cholesterol number, is only part of the picture. ApoB (one per LDL particle) and LDL particle number capture how many particles are circulating, and you can have a normal LDL-C with a high particle count, or the reverse. Inflammation and oxidized LDL also drive plaque. The Mediterranean diet reduced heart attacks and strokes in PREDIMED even with little change in LDL, so overall diet quality matters. Soluble fiber, plant sterols, berberine and red yeast rice each lower LDL in trials. Omega-3 lowers triglycerides. Niacin raises HDL and lowers triglycerides and Lp(a), but adding it to a statin did not reduce heart events in AIM-HIGH or HPS2-THRIVE. Lp(a) is largely genetic, and few treatments lower it much. For high LDL or ApoB, keep saturated fat small and favor extra virgin olive oil and avocado oil. Many people can improve their lipids with lifestyle, and some need a statin or other medication as well (familial hypercholesterolemia, very high ApoB, established heart disease). Risk assessment should include inflammation, insulin resistance, advanced lipids and family history, not only LDL-C.