Half of heart attack patients had normal cholesterol.
Your annual physical runs a cholesterol test. There's a better one called ApoB that most doctors never order, and it predicts heart attacks more accurately. We run it, figure out your risk tier, build a plan to get you to your target, and recheck to confirm it worked.
How this protocol works
This isn't just testing. It's a coached cycle designed to get you where you want to be.
What we measure
ApoB
The particle that drives plaque
Every particle that builds plaque in your arteries carries one ApoB molecule. It's a direct count of what's causing damage. LDL cholesterol is an estimate. ApoB is the actual count.
Lp(a)
Your genetic cardiovascular risk
A genetic risk factor that doesn't change with diet or exercise. Most doctors never test it. Measured once, tells you your baseline forever. If it's elevated, it changes your entire plan.
Lipid panel
Standard cholesterol, reinterpreted
We run LDL-C, HDL-C, and triglycerides like your doctor does. The difference is we read them in context of your ApoB, not as standalone numbers. We also calculate remnant cholesterol and TG:HDL ratio from the same draw.
hsCRP
Inflammation in your arteries
A marker of systemic inflammation. Elevated hsCRP with elevated ApoB compounds your risk. Low hsCRP with high ApoB is a different conversation than high on both.
OxLDL + Lp-PLA2
Active plaque risk
OxLDL catches damaged particles. Lp-PLA2 catches the arterial inflammation they cause. Together they show whether plaque is actively forming.
Blood pressure series
A pattern, not a snapshot
A single office reading tells you almost nothing. We track readings across multiple visits and time points to see the real trend. Context matters more than any one number.
CAC score
Direct imaging of plaque
A coronary artery calcium scan shows plaque already in your arteries. Not ordered for everyone, only if your risk profile indicates it. When it's warranted, it changes the conversation.
What’s different after this protocol
You know whether heart disease is building in your arteries. Not from a guess based on standard cholesterol, but from the marker cardiologists actually use to make decisions.
If your risk is elevated, you won’t leave with a printout and a suggestion to “eat better.” Your team will already be working the problem with you: dietary changes based on your genetics, medication if the numbers call for it, a retest scheduled to see whether the plan is moving things.
One member put it this way:
“My former primary care said my cholesterol was ‘a little borderline, you don’t need to do anything.’ Protocol’s response was very, very different: ‘This is the number one thing.’ I went on medication and 30 days later I cut my cholesterol in half. Best-in-class numbers now.”
We retest. The results either moved or they didn’t. If they moved, the plan is working. If they didn’t, we adjust and keep going.
What this protocol delivers
- Your ApoB result and what it means for your chance of a cardiac event
- Your Lp(a), a genetic risk factor tested once that tells you your baseline forever
- A risk tier (A through D) with a personalized ApoB target for your situation, not a generic “keep it under 100”
- A plan built from your data: dietary changes, medication if the gap is too large for food alone, and a timeline for when to recheck
- A clear next step if initial changes aren’t enough
- A retest built into your plan, because the whole point is confirming the plan worked
- Ongoing monitoring built into your membership, with rechecks on a cadence your team sets
Your annual physical checks the wrong number
Heart disease kills more Americans than anything else. You knew that. What you probably didn’t know is that the cholesterol number your doctor checks every year isn’t the best predictor of whether you’ll have a cardiac event.
There’s a different test called ApoB.
In plain English: LDL cholesterol measures how much cholesterol is floating in your blood. ApoB counts the number of particles carrying it. Those particles are what burrow into your artery walls and build plaque. More particles, more damage, even when the total cholesterol looks fine.
Half of people hospitalized for heart attacks had LDL cholesterol below 100. Their doctors told them they were fine. Their ApoB would have said otherwise.
LDL and ApoB disagree in roughly 1 in 4 people. When they do, ApoB is the one that predicts what happens next. That’s not our opinion. It’s the data the cardiology guidelines are built on.
One blood draw. That’s all it takes. Every year it goes unchecked is another year of risk nobody told you about.
We don’t hand you a report and wish you luck
Education materials arrive before your first visit, and you fill out a questionnaire covering family history, current medications, and risk factors. From there your care team works the problem with you, draw by draw, result by result.
See the full process
Your care team draws blood for ApoB, Lp(a), a full lipid panel, and hsCRP (an inflammation marker). Blood pressure is tracked across visits, not just a single reading when you’re already stressed. If your risk profile calls for it, a coronary artery calcium scan is scheduled.
Your team walks you through every result. You get a risk tier, A through D, with a personalized ApoB target. Not “try to get it lower.” A target your team works toward. Your Lp(a) result is explained in plain language, because it’s genetic and it changes what your plan looks like.
Your action plan covers dietary changes based on your full lipid profile and inflammation markers, an exercise prescription coordinated with Physical Capacity, and supplements if indicated. If the gap between where you are and where you need to be is too wide for lifestyle alone, your clinician starts medication. No six-month wait to “see if diet works first” when the numbers say it won’t.
Ongoing. ApoB is rechecked after medication changes and at a cadence your team sets. Risk tier is reassessed as part of your ongoing care. Your full team stays with you on this.
We match the intensity to the risk
After your labs come back, you get one of four tiers. The tier determines how aggressive your plan is.
Tier A: high risk. Most aggressive ApoB target. Family history, existing plaque, or very elevated numbers. Your physician is involved from the start. Medication is part of the conversation immediately. This tier gets the most clinical attention because the data demands it.
Tier B: elevated risk. Ambitious ApoB target. High enough that lifestyle changes alone probably won’t close the gap. Your clinician builds the plan with medication on the table if the first round of changes doesn’t move things far enough.
Tier C: moderate risk. Moderate ApoB target. Lifestyle changes are the main tool. Your team works with you on diet and exercise. Medication stays in reserve.
Tier D: lower risk. Maintenance ApoB target. Results are in a reasonable range. You’re here to confirm that, get your genetic baseline with Lp(a), and have a plan for keeping things where they are.
Your plan includes a recheck. The targets aren’t suggestions. They’re what your team works toward, and the recheck shows whether you got there.
Common questions
Is this protocol right for me?
A few patterns fit. Your LDL came back borderline and your doctor said not to worry. You want a second opinion from a test that actually predicts cardiac events. Heart disease runs in your family and you've wondered for years whether you're next. You're on a statin and nobody has ever checked whether it's doing its job. Or you ran a panel through Function Health or similar, something got flagged, and nobody told you what to do about it.
Do I need to complete other protocols first?
No. This can be your first protocol after The Foundation. A lot of members start here because of family history or cholesterol that came back flagged.
What if I'm already on a statin?
We'll find out if it's working. A surprising number of people take statins without ever having their ApoB tested. We measure it directly, check whether your current dose gets you to your tier target, and adjust if it doesn't.
How does this work?
Timeline depends on your risk tier and whether medication is involved. Your team tests ApoB, builds a plan to hit your target, and retests to confirm it moved. Ongoing monitoring is built into your membership.
What comes after this protocol?
Your cardiovascular data shapes what comes next. Most common: Metabolic Health, because insulin resistance affects how your body clears ApoB particles. If medication is part of your plan, liver function and nutrient levels get tracked through Nutrient Optimization. The exercise prescription your team builds here feeds into Physical Capacity. Your team recommends based on your results.
What does this cost?
Included in Protocol membership: $695/mo, or $7,500/yr prepaid (save $840). The Foundation Assessment is the on-ramp: $1,500 standalone, included with annual membership.
From the Protocol blog
Your ApoB has a number. Do you know it?
One blood draw. One number that predicts cardiovascular risk better than the cholesterol test on your last physical. Book a discovery call and we'll tell you whether Cardiovascular Risk is the right place to start.
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