Lipids Done Properly
Beyond the four-line lipid panel
A standard lipid panel shows total cholesterol, HDL-C, LDL-C, triglycerides. Three of those are moderately useful; one (total cholesterol) is nearly useless. A longevity-grade lipid read adds ApoB, Lp(a), and sometimes LDL particle fractionation. That's where the predictive information lives.
ApoB targets by risk
Average-risk adult: aim for ApoB under 80 mg/dL. Existing CVD or diabetes: aim for under 60 mg/dL. Family history of early events or elevated Lp(a): aim even lower. The old "LDL-C under 100" target was built for population averages, not longevity optimisation.
Triglycerides — the carb feedback signal
Fasting triglycerides are less about dietary fat than about excess carbohydrate + insulin-resistance. Target: under 100 mg/dL. Optimal: under 80. Values over 150 almost always mean metabolic dysregulation worth investigating — not just "genetic."
Fill in the blank
Complete the statement about lipid interpretation.
Lp(a) — measure it once, then act for life
Lipoprotein(a) is genetically determined — it stays roughly constant for life — but ~20 % of adults carry elevated levels (>50 mg/dL or >125 nmol/L) that double or triple cardiovascular risk independently of LDL. Most people never get tested. The 2024 guideline: measure once for everyone, ever. If high, push ApoB much harder (under 50–60 mg/dL), and watch for the upcoming generation of Lp(a)-specific drugs (pelacarsen, olpasiran) reading out 2026–2027.
Key Takeaway
A proper lipid read = ApoB + Lp(a) + TG + HDL-C. Skip total cholesterol. Treat fasting TG as a metabolic-health barometer, not a fat-intake one. Measure Lp(a) once and act on it for life. And always compare your numbers to longevity-optimal ranges, not population-average ones.