What if your cholesterol looks normal, your 10-year risk score is just 2.3%, and you're still a ticking time bomb? Josh Wageman, PhD, DPT, a clinical lipid specialist, physician assistant and author of The Home Security System and the Lipid Neighborhood, joins Dr. David Spiro on HuMed to tell the story of a fit, running friend whose Lp(a) and coronary artery calcium score revealed heart disease his routine labs had missed.

His friend's family history was riddled with heart attacks, yet his blood pressure, blood sugar and LDL were all normal. One conversation on a 5:30 a.m. run led to two extra tests: an Lp(a) of 128 mg/dL and a calcium score of 2,814. He needed a five-vessel bypass, and a year later he finished a half Ironman. Dr. Wageman explains why he calls Lp(a) "the felon of the lipid neighborhood," what a low-dose coronary calcium (CAC) scan shows and what it costs, and how statins, ezetimibe and PCSK9 inhibitors work, told through his mailman metaphor. It's a warm, often funny conversation about prevention, friendship, and using what you know to help the people you love.

In this episode:
– Normal cholesterol, a 2.3% risk score, and a calcium score of 2,814
– "Got plaque? Get a CAC": what a coronary calcium scan shows
– Why Lp(a) is "the felon of the lipid neighborhood"
– A five-vessel bypass, then a half Ironman a year later
– The four pillars of your heart's home security system
– Why Lp(a) is worth checking at least once in a lifetime
– Menopause, statins and rising Lp(a)
– Statins, ezetimibe and PCSK9 inhibitors, explained with mailmen
– "Prioritize protein and eat real food"

Chapters
00:00 "He was a ticking time bomb"
00:18 Meet Josh Wageman, clinical lipid specialist
01:38 Why stories stick better than textbooks
02:13 "Beyond the 10-year risk calculator"
02:41 A runner friend with a worrying family history
03:40 "Got plaque? Get a CAC"
04:01 Normal labs and a 2.3% risk score
05:05 "He picked the wrong parents": an Lp(a) of 128
05:35 A coronary calcium score of 2,814
06:20 A ticking time bomb and a five-vessel bypass
07:08 A half Ironman one year after surgery
07:57 What a calcium scan is, and what it costs
09:28 From reactive to preventive medicine
10:01 Does a calcium score show narrowing?
11:07 "You're fine till you're not"
11:58 The four pillars of your home security system
12:58 Lp(a): the felons of the lipid neighborhood
14:18 The genetic piece: one in five people
16:06 Checking Lp(a) at least once in a lifetime
17:10 Menopause, statins and rising Lp(a)
18:02 The patient whose Lp(a) jumped on a statin
19:02 Statins, plaque and the art of medicine
21:30 Beyond "HDL good, LDL bad": the mailman metaphor
22:34 Statins, ezetimibe and PCSK9, in plain English
24:18 Why metaphors and stories matter
25:30 Ultra-processed food and the fat-free era
26:28 "Prioritize protein and eat real food"
28:05 What "real food" means, and what about eggs?
30:18 Glucose "dollar bills" and your fat "savings account"
32:36 Where to find his book
33:23 Closing reflections

Josh's book, The Home Security System and the Lipid Neighborhood, is on Amazon, with links at lifelovelipids.com.

This episode is education and storytelling, not individual medical advice. Talk with your own clinician about testing and treatment.

HuMed unveils the human side of medicine, hosted by Dr. David Spiro, MD.

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