
The Dr. Hyman Show Office Hours: Cholesterol and Heart Disease — What I’ve Changed My Mind About
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Feb 2, 2026 A deep dive into why cholesterol number alone is not the whole story. Discussion of particle quality like ApoB and lipoprotein(a) and which labs matter. Exploration of inflammation, insulin resistance, and how sugar and refined starches fuel dangerous lipids. Practical markers like triglyceride/HDL ratio, waist circumference, and imaging for real heart risk.
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Cholesterol Weight Misleads Risk
- Total cholesterol and standard LDL tests miss key drivers of heart disease like particle number and inflammation.
- Inflammation and particle quality matter more than LDL weight for most people.
Inflammation Triggers Plaque
- Inflammation, not cholesterol alone, drives plaque deposition according to seminal research.
- High cholesterol with low inflammation confers lower risk than high inflammation with normal cholesterol.
Metabolic Dysfunction Creates Risk
- Metabolic dysfunction and insulin resistance create atherogenic dyslipidemia with small dense LDL particles.
- This metabolic state fuels inflammation that oxidizes LDL and enables arterial deposition.





