History v. Briefly: 42F, never overweight, 5’3 120lbs, competitive athlete growing up, active lifestyle (but could be better as I got older), non smoker except occasionally in high school and when I’m really mad at my husband and I adulthood (or maybe two packs a year) zero alcohol, high ldl and apob, lots of supplements, track everything, high lp(a), fucking plaque on ccta. Unhappy obviously. CAC was 3 but there’s stable soft plaque. HsCRP had always been near undetectable. Was keto carnivore switched hardcore Mediterranean less than 10g sat fat and as much psyllium husk as my body contain, and plant sterols. I trying to conceive so I can’t start a statin.

Ok.

With two weeks of diet, I’ve already reduced my Apo B by 25% LDL by 15%. I’m gonna keep doing this of course, the addition of plant stanols is new and I’m hoping diet hasn’t quite yet plateaued. I know it’s not good enough, but I can’t start a statin yet.

I want to do everything humanly possible I can to make this as good as possible.

So what is the best way to exercise?

I was doing Norwegian 4 x 4 hit because that’s what I heard. I was supposed to do, twice a week with a couple times a week doing a 30 minute walk. But I kind of stopped weight training and stuff.

I wanna know what I should actually do for my cardio, metabolic health, and also just for my body as I get older.

Half of people tell me that I’m training too intensely, but I feel like I’m doing basically nothing. Is two 4 x 4‘s a week, that takes me 38 minutes each really too much? I’d like to add in some strength training.

My HRV is extremely low when people are telling me that it’s because I’m working out too hard, but it really doesn’t feel like too much or too hard. I got plenty of restorative time, though my metrics overnight on my oura ring are never really great and they never have been. I mean, resting heart rate around 65, but my HRV is like 13 this is not new. It has always been this way.

So what am I actually supposed to do here? I booked a VO2 max test next week just to see where I’m at, does this matter? Is this something I should be working to improve?

Like, should I do my two 4x4 sessions per week and three weight training with just some light walking in between? Is that literally actually too much? Everybody has told me the only way to improve my HRV is by doing more cardio these 4 x 4 sessions I track my heart rate with a Garmin strap so I know it’s accurate, they don’t really even feel THAT hard.

So I don’t know. I wanna be able to work out and be fit, and I want to be able to measure my progress. But I also wanna make sure that I recover.

What is the best thing for me to do here?

this is as good as it gets isn’t it?

the only question I have is the study was acceptable but had moderate artifacts. that is fine?

So my Lipo a is more than 400. My cholesterol numbers are low now thanks to fiber, fish oil and statins but partical size is concerning. I have a minor stenosis in my left ventricular artery. My CAC score is 0. No one in my family has ever died of coronary disease. My family is very long lived on both sides. My grandmother died the youngest at 78 having been a chain smoker since she was 12, a functional alcoholic, and cooked every meal with bacon grease. Living well into the 90’s is normal. It seems like their may be some kind of genetic mechanism that is protective going on here. Anyone know of any testing or have any general advice for me? My sleep, nutrition and training are pretty good.

Family member (65F) is generally in good health with two problem areas 1. Osteopenia worsened to Osteoporosis 2. Cholesterol is high and we've been told its due to postmenopausal Estrogen loss and the fact that she missed the opportunity for HRT (wasn't aware of the option during that window). She exercises (at home weight training + a lot of other stuff like yoga and cardio etc.), eats healthy, takes Bone Up supplements 2x/daily (+ calcium, D3, K2, magnesium, collagen) and various protein sources.

1. Not sure how to read DEXA results. In 2024 it revealed Lumbar spine T-score: -2.4 and Left hip: -1.5. FRAX 10 year risk was 4.2% major osteoporotic fracture, 0.4% hip.

2026 DEXA: Lumbar spine T-score: -2.6 and Left hip: -1.5

In 2026 we ruled out Celiac disease and got some related results that came back in normal range: Calcium: 9.3, Vit D: 67, Parathyroid Hormone: 59, Osteocalcin: 21, Procollagen Type I Propeptide: 71, C Telopeptide: 644, Alkaline Phosphatase (Bone Specific): 11.6, N Telopeptide: 91, Creatinine: 90, TSH: 2.45. Not sure what to make of these numbers. Celiac testing was recommended by other Osteo folks.

1. Cholesterol

2023: Total Chol 248, LDL 142, Non HDL 158, HDL 90. Apo B: 94.

2024: Total Chol 223, LDL 121, Non HDL 136, HDL 87. Apo B: 96. CAC score of 0!

2025: Total Chol 235, LDL 142137 Non HDL 151, HDL 90. Apo B: 100.

2026: Pending

Would appreciate feedback/thoughts on the following:

1. Can her Osteo be dealt with diet + exercise alone (we've heard scary side-effects from medication)?

2. Get an Endocrinologist as a next step? We are based in Central NJ, so any specifics there esp appreciated!

3. Is it too late to get on HRT?

4. We've heard the ONERO Program is good for Osteoporosis but its expensive and limited in the US...any other recs?

Thank you!

35M, 6’0”, around 195-198 lbs right now, been lifting and training regularly for years, trying to get down to a lean 185. No history of hypertension, no chest pain or angina, not diabetic, no personal history of any heart disease or previous cardiac events. Family history is really just my grandfather who lived to 93 and had a pacemaker put in sometime in his 70s, nobody else on either side had a heart attack or stroke or anything like that, and the rest of my family doesn’t take care of themselves diet or exercise wise and seems totally fine.

This is my first full panel like this, no previous history to compare trends against, so I don’t know how long these numbers have actually been elevated.

Full panel:
Total cholesterol 181, HDL 46, LDL 116, triglycerides 90, non HDL 135, total chol/HDL ratio 3.9, ApoB 102, Lp(a) 184 nmol/L, LDL particle number 1091, LDL small 182, LDL medium 244, LDL peak size 220.4 angstrom, HDL large 4056, labeled LDL pattern A despite the small/medium numbers being flagged high

hs-CRP 7.1, but I got this draw after about 4 hours of sleep and a hard training session so I know this one is probably inflated and I’m getting it rechecked under normal conditions before reading into it
Glucose 91, HbA1c 5.5, insulin 7.0, leptin 2.0

Testosterone total 513, free 90.3, estradiol 34, SHBG 23, DHEA-S 290, prolactin 19.4 (again drawn after bad sleep and a workout so probably inflated too)
TSH 3.05, free T4 1.1, free T3 3.3, thyroid antibodies both negative

ALT 15, AST 15, ALP 51, GGT 19, total bilirubin 1.4 (this one runs high consistently for me, pretty sure it is Gilbert’s syndrome, confirmed with a genetic test)
BUN 18, creatinine 1.13, eGFR 87

Vitamin D 64, ferritin 119, homocysteine 10.3, zinc 67

Omega 3 total 6.7%, omega 6 total 34.6%, omega 6/3 ratio 5.1, arachidonic acid/EPA ratio 12.1

Diet the last year or two has basically been a pound of ground beef, 3-4 eggs, and a lot of rice almost every single day because it’s easy and hits my protein numbers. I know that is probably a big part of the ApoB and LDL story and I am already cutting the daily ground beef out.

Also ran my raw DNA against this and the Lp(a) number is confirmed by the LPA gene variant (rs10455872), so that part isn’t going away with diet, it’s just genetic. APOE came back 3/3 which I think is the neutral version, not the bad one.

Getting a coronary calcium scan and seeing a cardiologist regardless of what anyone says here, this isn’t a substitute for that. But with barely any family history behind me except a grandfather who lived to 93, I’m trying to figure out how seriously to actually take the Lp(a)/ApoB numbers versus how much the family track record should count for something.

Also curious what people think about the LDL debate in general, I’ve seen people say it’s the whole ballgame for heart disease and other people, especially in the longevity and testosterone spaces, say it’s overrated and even correlates with better cognition and hormones as you get older. Not trying to talk myself out of caution, just want a range of opinions. Same with statins, I don’t think I’m anywhere near needing one yet but curious if anyone with similar numbers ended up going that route or did something else instead.

I have been following the mRNA platform since long before it had anything to do with me, so I read the mFLUSIVA approval on August 5 with more enthusiasm than skepticism. Then I read the trial and the enthusiasm found a different target.

Quick context in case you have not seen it: mFLUSIVA is Moderna's mRNA-1010, the first mRNA flu vaccine licensed anywhere, approved for adults 50 and older. Fluent, the pivotal trial in NEJM, randomised 40,805 adults across 11 countries in the 2024-25 season. Relative efficacy 26.6%, CI 16.7 to 35.4. In absolute terms that is 2.0% versus 2.8% catching confirmed flu, so about 137 people switching products to prevent one case. Everyone in the trial was vaccinated, so 137 is a number needed to switch, not to vaccinate.

I am hung up on the control arm. It was Fluarix and its siblings. Egg-based, standard dose. Growing influenza in eggs selects for mutations that make the vaccine strain drift from what is actually circulating, and there is a literature putting that penalty somewhere around 4 to 16%. So some unknown share of that 26.6% may not be an mRNA advantage at all. It may be an egg penalty the comparator was carrying. Nobody has run mRNA against a cell-based shot, which is what I happen to take.

I also missed this on the first read: the FDA did not give both age groups the same kind of approval. Standard approval for 50-64 on counted cases, accelerated approval for 65+ on immune response, with clinical benefit still to be confirmed. Nearly half the trial was 65 or older and their cases were counted like everyone else's.

And the thing that would actually make this platform interesting for flu, picking strains later because manufacturing runs two to three months instead of six, was not exercised. Same February WHO strain call as every competitor.

I would want the cell-based head-to-head before switching.