Heart disease is the leading cause of death, but it’s also one of the most preventable. Decades of research have established a strong causal role for LDL and other ApoB-containing particles in atherosclerosis, and we now have multiple proven ways to lower them. The harder question is how to turn that evidence into a decision for an individual person.

Mike Haney talks with Johns Hopkins cardiologist Dr. Seth Martin, a co-author of the new 2026 dyslipidemia guidelines, about what the latest evidence says we should actually measure and act on. The throughline is pragmatic: lower exposure to atherogenic particles earlier and for longer, use additional tests when they can change a decision, and distinguish interesting new measurements from ones that have actually been shown to improve outcomes.

Free course: Improve your metabolic health

Get our free email course on how glucose, nutrition, exercise, sleep, and measurement can help you build habits that support better energy and long-term health: ⁠https://levels.link/wnl

What We Cover:

Why the evidence that LDL and ApoB-containing particles cause atherosclerosis is so strong
What “lower for longer” means and how the new LDL and ApoB goals change with cardiovascular risk
When ApoB adds useful information beyond a standard lipid panel
Why the guidelines recommend against routine LDL particle-size testing
How PREVENT risk scores and coronary calcium scans can help decide when treatment makes sense
What decades of statin research tell us about benefits, muscle symptoms, and diabetes risk
How much lifestyle changes typically move cholesterol, and when non-statin drugs enter the picture
Why common heart-health supplements don’t have the evidence behind proven lipid-lowering therapies

🎙️ About the Guest:

Dr. Seth Martin is a professor of medicine and preventive cardiologist at Johns Hopkins, where he directs the Advanced Lipid Disorders Program and Digital Health and AI Lab at the Ciccarone Center for the Prevention of Cardiovascular Disease. He is a co-developer of the widely used Martin-Hopkins LDL cholesterol equation and served on the writing committee for the 2026 ACC/AHA dyslipidemia guideline.

📍What Dr. Seth Martin & Mike Haney discussed:

00:04 - LDL and ApoB are causal. Lower for longer
07:10 - Guidelines set the standard. Not your doctor
11:40 - 2026 shift: earlier treatment, PREVENT, lower goals
17:01 - LDL near zero does not eliminate cholesterol
19:59 - Hard numbers are back, and lower
23:05 - ApoB if a high result changes treatment
27:42 - No trial says treat particle size instead of LDL
34:51 - PREVENT is for people not already high risk
38:52 - Calcium 300 can push the goals. Zero can mean lifestyle first
44:29 - The 3% statin line, and the choice just under it
51:22 - Muscle symptoms uncommon. Statin can move prediabetes diagnosis earlier
56:21 - Lifestyle often lowers LDL about 10%, not the whole benefit
59:05 - Other proven drugs when a statin is not enough
1:05:31 - Statin beat the supplements. Fish oil can raise AFib risk

🔗 Helpful Links:

2026 Guideline on the Management of Dyslipidemia: ⁠Read the guideline and supporting materials⁠
The New Cholesterol Guideline: What to Know — Johns Hopkins: Read the Johns Hopkins summary
PREVENT-ASCVD Calculator.: ⁠Use the PREVENT calculator⁠
Martin-Hopkins LDL Equation: Learn about the Martin-Hopkins method
SPORT Trial — JACC (2022): Read the SPORT trial

Watch the conversation: https://youtu.be/vRfhof5dOZw

Find us on YouTube: ⁠https://youtube.com/levelshealth?sub_confirmation=1⁠

👋 Who we are:

Levels helps you understand your metabolic health with personalized data, expert guidance, and tools that connect your daily choices to measurable changes in your body. Our goal is to help you make better decisions about food, exercise, sleep, and long-term health.

Look for new shows every month on A Whole New Level, where we have in-depth conversations with thought leaders about metabolic health.