Notes from the Practice
Patients arrive with specific questions — about Lp(a), CAC scores, ApoB, family-history risk, lifestyle plateaus, the cholesterol therapy pipeline. Many of those questions deserve a longer answer than a fifteen-minute visit can hold.
These posts are where I write the longer answer. They follow the evidence, name the studies, and call out where the contrarian arguments have a point and where they don't. Written for the patient who already has the labs and wants to think through what they mean.
Posts are written by Rahul C. Deo, MD, PhD — a cardiologist and co-founder of Atman Health.
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The other half of your heart
Everything most prevention advice covers is the arteries. The heart muscle stiffens on its own schedule, in people whose arteries are fine, and it is measurable years before symptoms. What to measure, and what the evidence supports doing about it.
Read more →Reversing plaque: how far cholesterol has to fall, and why the calcium score rises
Coronary plaque can be reduced, and the calcium score often rises while it happens. What the imaging trials actually measured, how low the evidence supports going, and which number is worth following over decades.
Read more →Dementia, your heart, and the APOE gene
More patients are worried about dementia than their hearts. Blood pressure control has randomized trials showing it lowers dementia risk; the cholesterol link is real but inferential; and the APOE gene everyone fears is a cholesterol-transport gene.
Read more →Particle number: counting LDL instead of weighing it
LDL particle number, small dense LDL and a pattern letter of A or B. What the evidence supports, why much of the apparent discordance with LDL cholesterol turns out to be arithmetic, and the order worth testing in.
Read more →Cholesterol balance: production, absorption, and which drug should work
A Cholesterol Balance panel sorts you into Over Producer, Balanced, or Over Absorber. It is not a risk score, the formula behind it is not published, and the one decision it can inform is whether ezetimibe is likely to help you.
Read more →Fatty acids and the heart: beyond the omega-3 index
A fatty acid panel flags your omega-3 index, EPA, and DHA, each green, yellow, or red. The trials are genuinely split, the target is soft, and the practical question is how to use the panel without over-reading it.
Read more →Statins: the arguments you've heard, and what the evidence actually shows
The five common social-media arguments against statins, and what the trials actually show. What is settled, where the nuance lives, and the modern lipid toolkit beyond just statins.
Read more →GLP-1, SGLT2, and the heart: what the trials revealed about weight and cardiovascular risk
Cardiology has been surprised by what the GLP-1 and SGLT2 cardiovascular outcome trials revealed. The cardiac diseases that travel with weight, and what weight loss alone won't finish.
Read more →The perils of standing still
How preventive cardiology has changed over twenty years, and why too many patients are still getting the 2008 version of the conversation.
Read more →A new pattern for cardiology visits
Labs and imaging reports in hand, LLM-driven self-analysis, and no PCP involved. A new pattern of how patients are arriving for cardiology care.
Read more →Lp(a) therapies: what we have today, and what's coming
No FDA-approved Lp(a)-specific therapy exists yet. But four drugs in late-stage trials may change that in 2026–2028. What to do today, and what's worth waiting for.
Read more →Diet, cholesterol, and the saturated fat controversy
Saturated fat raises LDL. LDL causes heart disease. The contrarian arguments are mostly wrong, but not entirely, and the nuance matters. What the evidence actually says.
Read more →The new cholesterol guidelines: Lp(a), ApoB, and treating at lower thresholds
The 2026 ACC/AHA dyslipidemia guidelines lowered treatment thresholds, expanded the toolkit beyond statins, and elevated Lp(a) and ApoB. What it means for patients.
Read more →Cleerly, CCTA, and calcium scores: which heart test, when?
Patients ask about Cleerly scans constantly. When CT coronary angiography and AI-quantified plaque scans actually change care — and when they don't.
Read more →How does virtual cardiology work?
There's a nationwide shortage of cardiologists and months-long waits. Almost all cardiology problems short of a procedure can be handled well by telehealth.
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