The Case for Treating Cholesterol Before Plaque Appears | Dr Thomas Dayspring and Dr Dan Soffer

Almost all of us have atherosclerosis, and almost none of us are told so, because "normal" cholesterol is a population average rather than a physiological target. Dr Thomas Dayspring and Dr Dan Soffer, both Masters of the National Lipid Association, join me for a conversation devoted entirely to primary prevention.

They do not agree on everything, and that is the point. Tom argues ApoB is the cause of atherosclerosis. Dan calls it the necessary substrate. Between them you get an unusually honest look at how two experienced clinicians weigh evidence, uncertainty, and their own bias when treating someone who feels perfectly well.

What We Cover:

Why genes matter less for atherosclerosis than most people assume

Is ApoB causal, or simply necessary? The disagreement, in full

What "normal" cholesterol means, and the levels we are born with

LDL-C years: a five-second calculation you can run on yourself

What the 2026 dyslipidemia guideline changed

How they would manage a healthy man in his thirties with a family history and an ApoB of 100

Statin muscle symptoms, and the simple test that settles it

If you have ever been told your cholesterol is fine and wondered what that actually means, start here.

To connect with Dr Thomas Dayspring, find him on X, where he posts as @Drlipid. To connect with Dr Daniel Soffer, visit his Penn Medicine profile.