[Angela Foster] (0:15 - 1:32)
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That's why they're a long-term sponsor of this podcast. You can get 20% off your first order at timeline.com forward slash Angela. That's timeline.com forward slash Angela. One of the things I wanted to speak to you about just because this is so common for women is that as we go through perimenopause, you often quite start to see LDL cholesterol going up. Some of that, I think, is with that interplay of oestrogen reductions. My understanding is that LDL is important and that ApoB is that extra marker for you to be able to really analyse in a bit more detail your LDL and whether you have kind of atherosclerotic kind of plaque building up and things like that.

Can you just explain about LDL because it's actually quite a polarised situation on social with some people saying, oh, it doesn't matter. Can you explain your position on this from a longevity perspective?

[Dr. Darshan Shah] (1:32 - 5:18)
Absolutely, Angela. And I do want to say something that will really empower your readers. Whenever something is polarised, whenever people are asked to take sides on something, whenever someone's chanting from the rooftops, LDL is bad, LDL is good.

That should be every single person's indication that it is an end of one situation, which means, yes, it could be bad for some people and good for others. It could be a problem that does not need to be treated in some people, and it could be something that we actually might want to raise the levels in somebody or lower the levels of somebody else. Whenever you hear this kind of, I would say, dogma being spouted out there or strife in what people are saying, it's because it's an end of one situation, which we really have to look at it in your individual biology.

So here's what I would tell people about LDL, keeping that in context, is that I see thousands of patients. We have 20 clinics all over the world now, and I'm looking at hundreds and thousands of biomarkers, and I get all the data on people. And what I can tell you is I've seen LDL be a massive problem for people, and I've also seen on the other end of the spectrum, LDL is absolutely not an issue at all.

And so when I look at a marker like LDL, I'm trying to assess where on the bell-shaped curve you are. So a bell-shaped curve is whenever you look at a statistical analysis of a group of people, most of them will fall somewhere in the middle of a bell shape, and then you have what's called one and two standard deviations away, and even three standard deviations away from the middle of the bell curve, meaning a particular intervention might work for the average, and it might be harmful for some or super good for others.

And so we're always trying to look at where does someone sit on the bell curve of LDL. And what I can tell you is that there are some people that if you have no inflammation and you have no high blood pressure, and you have no genetic risk factors, having a high LDL will not matter at all. In fact, I just saw a guy at the gym, I just went to the gym, dropped off my kids, and I saw this guy and he was asking me about his LDL.

This guy goes to the gym every single day, I've never not seen him at the gym. He's extremely healthy, his LDL is 150, and he's a little bit worried. And I know him very well, because he also sees this as a patient, and we check what's called a clearly cardiovascular scan on him, a clearly scan is an AI enhanced visualisation of all of his coronary blood vessels.

He has zero plaque on his blood vessels. And so when I see that, I'm like, oh, here's a guy that's living with an LDL that's in, you know, a normal doctor put him on a statin for, and he has zero plaque, there's no reason for him to have a statin. Then I've seen other people who have a high LDL, but you know, they go, they drive to work an hour here in LA every day, they don't get a chance to ever go to the gym, maybe just on the weekends, they go out to dinner and drinks every night after work, and their LDL might be 120, but they have a tonne of plaque in their blood vessels, even plaque in their arteries going to their brain.

And these are people that do need to be on a statin or a PCSK9 inhibitor or something. So you can't look at LDL just by itself. You have to look at what is your level of inflammation in your body?

What is your metabolic health looking like? What is your genetic risk of heart attack? Do you have other confounding cholesterol issues such as LP little a or small particle dominance?

Those are all factors that you have to take in account about LDL. So you know, when people ask me this question about LDL, they're often frustrated because they think I'm not giving them an answer. And that's because there is no answer unless I see you as a patient and we determine for your individual biology, what is the level of LDL that's going to be appropriate.

[Angela Foster] (5:19 - 5:40)
And so with the ClearlyScan, right, I don't think that's yet widely really available in the UK. We have some other kind of ultrasound style testing that people can do. What would they be looking at then alongside on their blood work and speaking to their physician about?

It would be the LPA, the ApoB, the LDL and the inflammation markers to kind of get a fuller picture.

[Dr. Darshan Shah] (5:41 - 7:53)
Yes, absolutely. So if you're looking at specifically cardiac risk, remember, we know that these markers indicate a certain amount of risk of cardiac disease, right? So risk is something that is developed as a concept when you have a massive group of individuals and you look at their LDL and you see how many of them have heart attacks, right?

And we have much better biomarkers of risk now than LDL. LDL is like a biomarker of the 1970s and 80s. Now we've moved on from that.

So as physicians that are really up in the science, we're looking more at ApoB, we're looking at particle sizes, and we're looking at LpA. LpA is not captured in your standard cholesterol panel. So those are the markers I would definitely look at as far as cholesterol markers.

And then you also want to look at how much inflammation is going on. So HSCRP, homocysteine levels, and you also want to look at your metabolic health, which is fasting insulin, uric acid levels, haemoglobin A1c is another one as well, and triglycerides. And so you want to look at all of that in context.

Now, what I will say is the cardiac scanning is available in different forms in the UK and also all throughout Europe, all over the United States, and there's different forms of it. And what's good about cardiac scanning is now we know for N of 1 on you, on your particular biology, we're not looking at risk, we're looking at what's actually going on at your blood vessels. So the first scan there is a coronary calcium CAC score, or the CT scan that's 10 minutes long that we can see how much calcification is happening in your blood vessels, even though calcification is a late sign of cardiac blockages, at least we know.

And then from there, there's a CT angiogram that I know is available, Angela, there. And then the CLEARLY scan, you take that CT angiogram CD or the data from it and you send it to a company called CLEARLY, and they have AI look at each blood vessel individually and lay it out and see how much plaque is developing, both calcified plaque and soft plaque. So you can still get it done, even if you're in the UK, it just might take a little bit of legwork.

[Angela Foster] (7:53 - 9:20)
Yeah, and then it can be uploaded. Interesting. I hope today's episode inspired you on your journey to vibrant health and high performance.

Make sure you check out the show notes for a summary of all the important links to everything we talked about. And if you enjoyed this episode, hit the follow button and share it with a friend on social media or leave a review over on Apple Podcasts. Remember, achieving high performance health is about getting 1% better each day.

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Angela and special guest Dr. Darshan Shah, look at the polarising world of cardiovascular health, specifically demystifying the role of LDL cholesterol. 
They challenge the traditional one-size-fits-all approach to statins, arguing that heart health must be viewed through the lens of individual biology—where factors like inflammation, genetic risk, and lifestyle can make the same LDL level a non-issue for one person and a crisis for another

WHAT YOU WILL LEARN

• LDL is Not Always the Enemy: A high LDL reading alone doesn’t guarantee heart disease; its impact depends on individual context
• The Power of ApoB and Lp(a): Traditional cholesterol panels are often insufficient; more modern biomarkers like ApoB(a superior risk marker) and Lp(a) (a genetic factor) provide a much clearer picture of cardiovascular risk.
• AI in Diagnostics: The Clearly scan uses AI to analyse CT angiograms, allowing doctors to see the actual buildup of both calcified and soft plaque in the coronary arteries rather than just guessing based on blood work.
• Precision Over Dogma: Because cardiovascular health is an "N-of-1" situation, interventions like statins or PCSK9 inhibitors should be based on actual arterial health

Disclaimer: The High Performance Health Podcast is for general information purposes only and do not constitute the practice of professional or coaching advice and no client relationship is formed. The use of information on this podcast, or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for medical or other professional advice, diagnosis, or treatment. Users should seek the assistance of their medical doctor or other health care professional for before taking any steps to implement any of the items discussed in this podcast.