Most people think “bad cholesterol” (LDL) is the only number that matters.

It’s not wrong—but it’s incomplete.

Especially if you have Type 2 diabetes.

Here’s the cholesterol metric that captures what LDL misses (and why it’s a better predictor of heart disease): 🧵⤵️ What is Non-HDL cholesterol?

It’s a simple calculation from your standard lipid panel:

Total Cholesterol - HDL = Non-HDL Cholesterol

No extra test.

No fasting required. It’s already on your lab report—just not highlighted.

If you’ve had a heart attack or stent, and you’re seeing tweets saying “low cholesterol is dangerous” this thread is for you.

I’m an interventional cardiologist. I see what happens when patients stop their cholesterol meds.

Here’s the science they’re not telling you.

https://twitter.com/mangan150/status/1982180079170957746

This study the TRT guy is talking about included HEALTHY people without heart disease

No prior heart attacks, no stents, no bypass surgery.

You can eat clean, exercise daily, and never smoke—and still have a heart attack at 50. The culprit? A particle called Lp(a) that 20% of people carry. Most find out too late.

Let me explain what it is and why it matters. Lp(a) is a modified version of LDL cholesterol—and it's worse in every way.
LDL particles are small (less than 70 nanometers). That size lets them slip through the lining of your arteries and get stuck inside the artery wall. Over time, that buildup becomes plaque.
Lp(a) is the same size as LDL. But it has an additional protein—Apo(a)—attached to its surface.
That protein makes Lp(a):

➡️Stickier (gets trapped in arteries more easily)
➡️Inflammatory (damages artery walls)
➡️Pro-clotting (increases risk of heart attacks and strokes)

So even if your regular LDL cholesterol is perfect, high Lp(a) can still clog your arteries—and make those clogs more likely to kill you

80% of people quit lifestyle changes right before results start showing.

Here's how long it actually takes to see improvements in blood sugar, cholesterol, and blood pressure — and why week 2 is where most give up. Blood sugar improves the fastest.

Within 1 week, continuous glucose monitoring shows measurable improvements in time-in-range and glucose management.

But HbA1c (the marker your doctor checks) takes 8 weeks to drop 0.6-0.7%.

You're improving. Your bloodwork just hasn't caught up yet.

25% of heart attacks in diabetics happen before age 40. I just treated another one yesterday.

If you have diabetes and think 'I'm too young to worry,' read this:⤵️ Diabetes increases your lifetime cardiovascular disease risk by 2-4 times compared to non-diabetics - even if you eventually control your blood sugar.

95% of post-stent patients never get their ApoB checked.
Yet it's the #1 blood test to predict your next heart attack.

Here's why it matters: Your lipid panel measures cholesterol mass.

But atherosclerosis isn't caused by cholesterol mass—it's caused by particles carrying cholesterol.
ApoB solves this.

It is a protein found on every atherogenic particle (ie plaque producing particle) = LDL, VLDL, remnants

1 particle = 1 ApoB protein
Measure ApoB = count particles directly.

> 50% of stroke and heart attack patients I see had uncontrolled BP for years.

Most of them said they ‘do everything right’ but their BP won’t budge.

Here are 5 reasons why your BP is uncontrolled despite doing everything

Here are the 5 reasons they didn’t fix it sooner: Most patients have zero idea what their average BP actually is.

The reason? They’re not measuring at home.
22-59% of hypertensive patients never use home BP monitors.

They depend entirely on clinic visits—maybe once every 3-6 months.

Meanwhile, office measurements fail to detect 15-25% of hypertension cases.

No home data = no real control.

Your cholesterol isn't high because of genetics.
It's high because you eat like shit, don't move, and pretend you'll 'start Monday.'

Here are 3 changes that actually work: Lose 10 kg if you're obese. That's an 8 mg/dL LDL drop.
But here's what matters more: weight loss amplifies everything else.

Many people believe statins are a product of marketing.

In reality - its neither a miracle, nor marketing, its "medicine."

here is a detailed explanation for people who are miisinformed, a good read for doctors who havent properly read the studies.
read on⤵️ 1️⃣ Not all statin trials are the same
The tweet lumps together very different studies.

REVERSAL enrolled just 502 patients with coronary artery disease and measured change in atheroma volume by intravascular ultrasound.

A high‑dose atorvastatin regimen halted plaque growth whereas pravastatin allowed plaque progression.

This was a mechanistic study with a morphological end‑point, not a huge trial with multiple chances to “spin” results.

KEY MESSAGE:
Among patients with symptomatic CAD and elevated LDL, use of an aggressive lipid-lowering strategy through treatment with 80 mg atorvastatin was associated with a reduction in the primary endpoint of percent change in atheroma volume compared with a more moderate lipid-lowering strategy through treatment with 40 mg pravastatin.
acc.org/Latest-in-Card…

As far as heart disease and it’s risk factors are concerned, NOTHING has sparked as much debate and research as the role of saturated fats.

Does saturated fat increase heart disease?
Or
Does it fix everything like low-carbers say
Let's dive in. A 🧵
(A longish thread - but bear with me on this - this will answer all the questions you have regarding saturated fat and heart health) The story begins in the mid-20th century when coronary heart disease (CHD) rates skyrocketed. Researchers in Oxford documented a 70-fold increase in coronary deaths over just 35 years.

This alarming trend set the scientific community on a quest to uncover the culprit for coronary artery disease.

You have a silent killer in your bloodstream.
No! It’s not LDL cholesterol. But, it's just as deadly.
What is lipoprotein-a and what should you care? A 🧵
(It’s quite possible that you might have never heard of it!)

🚨 Bookmark this thread to learn how to protect yourself and your loved ones from high Lp-a. 1. What is lipoprotein(a)?

Lipoprotein(a) is a unique particle in blood. It consists of an LDL-like core and apolipoprotein(a) protein. Unlike other lipoproteins, its levels are genetically determined. It promotes atherosclerosis and thrombosis, increasing cardiovascular risk independently of other factors.

LDL cholesterol, often labeled as "bad cholesterol," plays a critical role in your cardiovascular health.
A thread about what is it and why should be aware about your LDL cholesterol levels. LDL-C is atherogenic, meaning it contributes to the formation of arterial plaques, while HDL cholesterol is thought to be protective against coronary heart disease.

This is why LDL-C is considered "bad cholesterol" while HDL is "bad cholesterol"
nature.com/articles/10013…

What are Triglycerides & Why Should You Care?

Triglycerides are a type of fat found in the blood, which serve as a major source of energy for the body.
They are important because they provide the energy needed for various bodily functions & are stored in fat cells for later use What happens when you have ⬆️ Triglycerides?

High levels of triglycerides in the blood can be a risk factor for Coronary Artery Disease (CAD) and heart attack, as they are associated with atherogenic lipoproteins that contribute to the development of atherosclerosis.