Dr. Colbert’s Broadcast • Advanced Lipid Testing & Plaque Stability • Episode 2
Your Cholesterol Test Isn’t Enough: What You Need to Know | Dr. Don Colbert, MD Ep. 2
A standard lipid panel gives you four numbers. It does not tell you whether the plaque in your arteries is stable or ready to rupture. In this episode of Dr. Colbert’s Broadcast, Dr. Don Colbert, MD, Kyle Colbert, and Mary Colbert walk through the advanced blood markers most people have never been offered — lipoprotein(a), oxidized LDL, myeloperoxidase, Lp-PLA2, and particle testing — plus the diet, blood pressure, nitric oxide, and emotional factors that influence whether plaque stays quiet.
Read this before you change anything
This episode discusses prescription medications, including statins, by name. Nothing here is a recommendation to stop, reduce, or skip a medication your clinician prescribed. Stopping a statin, blood-pressure medication, antiplatelet therapy, or diabetes medication on your own can raise your risk of a heart attack or stroke. If you are having side effects, that is a reason to call your prescriber and discuss alternatives — not a reason to quit on your own.
For new chest pressure or pain, shortness of breath, pain in the arms, back, neck, jaw or stomach, cold sweat, nausea, unusual weakness, or lightheadedness, call 911 or your local emergency number.
Four numbers are not the whole picture
Most people leave a physical with the same four results: total cholesterol, LDL, HDL, and triglycerides. Dr. Colbert’s argument in this episode is that those four numbers describe how much cholesterol is floating in your blood — not how much plaque is in your artery walls, what kind it is, or whether it is inflamed and unstable.
That distinction matters because of how heart attacks actually happen. Most are not caused by an artery slowly closing to zero. They are caused by a plaque that ruptures, triggering a clot that shuts off blood flow in minutes. A plaque can be modest in size and still be dangerous if it is soft, inflamed, and thinly capped. A larger, calcified, stable plaque may sit quietly for decades.
Dr. Colbert notes that many of these markers are not routinely ordered, and that insurance coverage is inconsistent. It is worth being fair about why: some of these tests have strong guideline backing and some are used mainly by preventive and integrative clinicians while the outcome evidence continues to develop. Knowing which is which helps you have a more productive conversation with your own doctor.
Timely context: In March 2026, the American College of Cardiology and the American Heart Association released a new dyslipidemia guideline that replaced the 2018 cholesterol guideline. Two of its headline changes point in exactly the direction this episode argues for.
First, it recommends that every adult have lipoprotein(a) measured at least once in a lifetime — the first time universal Lp(a) screening has carried the strongest class of recommendation in a U.S. guideline. Second, it expands the use of apolipoprotein B (apoB) to assess risk that LDL-C alone can miss. Dr. Colbert has been ordering advanced markers for years; the mainstream position has now moved closer to his.
“When you have a heart attack, it’s from a ruptured plaque, from soft plaque rupturing.”
— Dr. Don Colbert, MD, in this episode
The three goals Dr. Colbert works toward
Rather than chasing a single cholesterol number, the episode frames prevention around three objectives. They are useful because they give you something to measure progress against.
1. Reduce the plaque
Lower the burden where possible. Dr. Colbert is candid that calcified plaque generally cannot be removed — the realistic aim is to slow or halt progression rather than erase it.
2. Stabilize the plaque
Reduce the inflammation and oxidation that make a soft plaque fragile. This is where the inflammatory markers in the panel below earn their place.
3. Prevent rupture
The event itself is the thing to avoid. Blood pressure control, blood sugar control, and not smoking all matter here alongside lipid management.
The advanced panel: what each marker actually tells you
Dr. Colbert orders many of these through Quest Diagnostics, which offers the Cleveland HeartLab panel. Here is what each one measures and where it currently stands in mainstream practice, so you know which to push for and which to discuss as optional.
| Marker | What it measures | Where it stands |
|---|---|---|
| Lipoprotein(a) “Lp little a” |
An inherited, particularly atherogenic lipoprotein particle. Largely genetic and stable across your life. | Strongest backing of the group. 2026 guidance recommends it for every adult, once. |
| Apolipoprotein B apoB |
The number of atherogenic particles, rather than the cholesterol they carry. Catches risk LDL-C underestimates. | Guideline-endorsed for selective use, especially with diabetes, high triglycerides, or metabolic syndrome. |
| Oxidized LDL | LDL particles that have been chemically damaged. Oxidation is a step in plaque formation, and Dr. Colbert ties it to fried and refined seed oils. | Available commercially; used more in preventive practice than in routine cardiology. |
| Myeloperoxidase MPO |
An enzyme released by white blood cells that signals active inflammation in the artery wall. Dr. Colbert calls it a check-engine light. | Specialty marker. Interpret alongside the full picture, not in isolation. |
| Lp-PLA2 | An enzyme associated with inflammation specifically inside the vessel wall, linked to plaque buildup and instability. | Specialty marker, same caveat as MPO. |
| NMR LipoProfile | Uses nuclear magnetic resonance to count LDL particles and size them. Small, dense LDL is considered more atherogenic than large, buoyant LDL. | Established test. Many clinicians now use apoB for a similar purpose at lower cost. |
| hs-CRP | General, whole-body inflammation. Non-specific, but widely available and inexpensive. | Long-recognized risk-enhancing factor. Easy first ask if your doctor is hesitant about the rest. |
On the specific target numbers in the episode: Dr. Colbert cites cutoffs from his own practice and lab. Reference ranges and units differ between laboratories — Lp(a) alone is reported in both nmol/L and mg/dL, which are not interchangeable. Always read your result against the range printed on your own report, and ask your clinician what it means for you specifically.
Lipoprotein(a): the inherited risk most people have never been tested for
If you take one action item from this episode, make it this one. Lp(a) is an LDL-like particle with an extra protein attached that makes it both more plaque-forming and more clot-promoting than ordinary LDL. Roughly one in five people worldwide carries an elevated level, and because it is inherited, it does not show up as a lifestyle problem you can spot from the outside.
Dr. Colbert says he checks it whenever he sees a family history of heart attacks in the forties and fifties. That instinct is sound — premature family history is exactly the pattern elevated Lp(a) produces. As of 2026, the recommendation goes further: every adult should have it measured at least once, regardless of family history. Because levels are genetically set and stable, one test is generally enough for life.
If your Lp(a) is normal
You can set the marker aside and focus on the factors you control — LDL, blood pressure, blood sugar, weight, activity, and tobacco. No need to retest.
If your Lp(a) is elevated
Current guidance is to treat every other modifiable risk factor more aggressively — particularly LDL-C. Elevated Lp(a) is also worth mentioning to first-degree relatives, since it runs in families.
One update worth knowing: Dr. Colbert says in the episode that no medication lowers Lp(a). That was the accepted position for a long time, and it remains true that statins and ezetimibe do not lower it. The picture has since shifted in two ways.
PCSK9 inhibitors — including Repatha, which Dr. Colbert discusses elsewhere in this same episode — lower Lp(a) modestly, on the order of 15–25%. And several targeted therapies designed specifically to lower Lp(a) by 80–95% are in late-stage trials. None is FDA-approved yet, and approval depends on trials showing that lowering the number actually prevents heart attacks. If your Lp(a) is high, this is a good question for your clinician about whether a trial or a specialist referral makes sense.
About the nutritional approach discussed: Dr. Colbert describes using alpha-lipoic acid and aged garlic in his practice for patients with elevated Lp(a). This reflects his clinical experience over many years. In fairness to readers, controlled trials have not established that either supplement meaningfully lowers Lp(a) — a meta-analysis of randomized trials found no significant Lp(a)-lowering effect for garlic. Both have been studied for other cardiovascular measures, including modest blood-pressure and LDL effects for aged garlic. If you try either, treat it as a supportive addition to a plan built on proven risk reduction, keep your clinician informed, and recheck your labs.
Where imaging fits alongside the bloodwork
Blood markers describe the chemistry. Imaging shows the anatomy. Dr. Colbert uses both, and the episode revisits the tools covered in Episode 1: the coronary artery calcium (CAC) score, coronary CT angiography (CCTA) with AI-assisted plaque analysis, nuclear stress testing, and cardiac catheterization.
The 2026 guideline gives CAC scoring a defined role: it is recommended for adults at borderline or intermediate risk who are undecided about starting cholesterol medication, and if any calcium is present, statin therapy is recommended. That is a useful frame — the test is most valuable when the result would actually change a decision.
On catheterization, Dr. Colbert makes a point worth repeating: some people avoid it out of fear, and a cath can identify and treat a blockage in real time. He also notes that treatment approaches vary between practitioners, and that a second opinion is reasonable before committing to a major procedure. Both of those are fair. What a reader should not take from this is that any one procedure is universally preferable — that decision depends on which arteries are involved, how many, your other conditions, and your surgeon’s and cardiologist’s assessment.
Cholesterol-lowering: what to do when statins are hard to tolerate
Dr. Colbert is direct in this episode that some patients struggle with statins, particularly with muscle aches, and that a meaningful number stop taking them. That problem is real and well documented. His response is not to abandon LDL lowering — it is to find a route the patient can actually stay on.
The options he discusses fall into a few categories. All of them are decisions for you and your prescriber.
Lower or intermittent statin dosing
Dr. Colbert notes that patients who cannot tolerate a high dose often do fine on 5–10 mg. A tolerated low dose beats an abandoned high dose.
Non-statin prescriptions
Ezetimibe (Zetia), colesevelam (Welchol), bempedoic acid, and PCSK9 inhibitors such as evolocumab (Repatha) all lower LDL through different mechanisms and can be layered.
Plant sterols and soluble fiber
Both work in the gut to reduce cholesterol absorption. Modest effects individually, but well tolerated and additive to other measures.
Red yeast rice
Described in the episode as a natural statin — which is close to literally true, and the reason it needs care. See the safety note below.
Red yeast rice safety: Red yeast rice contains monacolin K, which is chemically identical to the prescription drug lovastatin. That means it can cause the same muscle and liver side effects as a statin, and it should not be combined with a prescription statin without medical supervision. Potency also varies widely between products because it is regulated as a supplement, not a drug. Tell your clinician and your pharmacist if you take it.
A note on the side-effect account in the episode: Dr. Colbert relays a report of someone developing an autoimmune condition after a statin dose increase. Individual reports like this cannot establish that a medication caused a condition. Statins do have real, documented side effects that deserve a serious conversation with your prescriber — and that conversation is the right response, rather than stopping treatment.
Diet, blood pressure, and the lining of your arteries
Olive oil, and why the type matters
Dr. Colbert’s dietary centerpiece is a healthy Mediterranean pattern built around extra virgin olive oil — specifically high-polyphenol and high-oleocanthal oil, which comes from olives harvested early, before they ripen. It takes far more olives to produce, which is why it costs more and is harder to find. He takes roughly two tablespoons a day.
The mechanisms he describes are reasonable ones: reducing oxidative stress, limiting LDL oxidation, supporting blood vessel dilation, and reducing platelet aggregation. Mary asks a good practical question in the episode about whether more is better, and the answer is no — olive oil is calorie-dense and large amounts will cause digestive upset well before they cause benefit.
Seed oils and oxidized LDL
The episode connects repeatedly fried and refined seed oils to oxidized LDL. This is an area of genuine ongoing scientific debate — the evidence on seed oils is more mixed than the episode’s framing suggests, and much of the concern centers on oils heated repeatedly at high temperatures rather than on the oils themselves. What is not controversial: reducing deep-fried and ultra-processed food is good for your arteries by several independent mechanisms.
Blood pressure and nitric oxide
Dr. Colbert explains endothelial dysfunction clearly: the lining of your blood vessels is a single cell thick, and it produces nitric oxide, the gas that lets arteries dilate on demand. Production declines with age, which means arteries do not open the way they should when demand rises. He uses beetroot extract and grape seed extract, along with sodium reduction, and mentions an Ayurvedic herbal preparation for blood pressure.
Two practical cautions. Herbal blood-pressure preparations vary considerably in composition, and some traditional formulas contain botanicals with real pharmacological activity and real drug interactions — identify exactly what is in any product before taking it, and tell your prescriber. And if you already take blood-pressure medication, adding a supplement that also lowers blood pressure can stack effects; monitor at home and report what you find.
Kyle asks a sharp question in this segment: can someone with soft, unstable plaque safely take nitric oxide boosters? It is a good instinct, and the honest answer is that this has not been specifically studied. If you have known unstable plaque or established coronary disease, clear any vasodilating supplement with your cardiologist first — especially if you take nitrates.
Bleeding-risk note: Garlic, high-dose fish oil, and several other supplements discussed in this episode can affect platelet function. If you take aspirin, clopidogrel, warfarin, or a direct oral anticoagulant, or you have surgery or a dental procedure scheduled, review your full supplement list with your clinician or pharmacist.
Cellular energy, forgiveness, and the heart
The heart contains more mitochondria than any other tissue in the body, for an obvious reason: it never stops working. Dr. Colbert discusses supporting cellular energy production with CoQ10 in its ubiquinol form, NAD+, and D-ribose, alongside the nutritional foundation above. These are best understood as general cellular and cardiovascular wellness support — not as treatments for heart failure or any diagnosed cardiac condition, and never as a replacement for prescribed cardiac therapy.
The segment that may stay with viewers longest, though, is the one about emotions. Mary and Dr. Colbert make the case that anger, bitterness, and unforgiveness are not merely spiritual problems but physiological ones — they constrict blood vessels and raise blood pressure. Chronic psychological stress is a recognized contributor to cardiovascular risk, so the underlying point is well founded.
Kyle shares a personal example about praying blessing over people he was in conflict with during a lawsuit, and describes it as freeing. Whatever your framework, the practical instruction holds: carrying resentment has a physical cost, and putting it down is worth doing deliberately.
“God did not design us to carry all this deadly emotion.” — Mary Colbert
Your next-appointment action plan
- 1Ask for a lipoprotein(a) test. If you have never had one, you are due — current guidance says once for every adult. It is a single blood draw and you never need to repeat it.
- 2Ask whether apoB would add anything. Particularly relevant if you have diabetes, metabolic syndrome, or high triglycerides, where LDL-C can understate your true particle burden.
- 3Write down your family history first. Who had a cardiac event, at what age, and on which side. Premature events in the forties and fifties change the conversation more than any single number.
- 4If statins are the sticking point, say so plainly. There are several non-statin routes to a lower LDL. Your prescriber cannot offer them if they do not know you are struggling.
- 5Bring your complete supplement list. Every bottle, with doses. Several items in this episode interact with common cardiac medications.
- 6Build the foundation regardless. Whole foods, olive oil, fiber, consistent movement, sleep, blood pressure and blood sugar control. No panel result changes the value of these.
Divine Health products and resources related to this episode
These are supportive wellness tools that fit the nutritional themes of the broadcast. They are not treatments for coronary artery disease, and they are not substitutes for testing, prescribed medication, or medical care.
CircuZone
Relevant to the nitric oxide and endothelial function discussion. A berry limeade powder formulated to support the body’s natural nitric oxide production, healthy circulation, and blood pressure already within a normal range.
Q10 Vital — CoQ10
Connects to the segment on mitochondria and cellular energy in heart tissue. Formulated for bioavailability, supporting cellular energy production and antioxidant defense.
NAD+ Powder
Named directly by Dr. Colbert during the discussion of mitochondrial support and energy production. A lemon-lime powder for daily cellular energy support.
Fiber Zone
Soluble fiber binds cholesterol in the gut — the same mechanism behind one of the prescription options discussed. Provides a blend of soluble and insoluble fiber including psyllium and prebiotic inulin.
Wild Alaskan Salmon Omega-3
Omega-3 fatty acids from wild Alaskan salmon oil, supporting cardiovascular wellness. Relevant to the triglyceride and inflammation themes across this series.
High Potency Turmeric with BioPerine
Ties to the inflammation markers discussed in the advanced panel. Combines 95% curcuminoids with sunflower phosphatidylcholine and BioPerine for absorption.
Live Long and Strong
Dr. Colbert refers to this book repeatedly during the episode as the place where he lays out the health markers in full detail. If this article made you want to go deeper on the numbers, this is the companion resource.
Browse the full Heart Zone collection →
Supplement safety: Dietary supplements are not a substitute for statin therapy, blood-pressure medication, antiplatelet therapy, or any other prescribed cardiovascular treatment. Several ingredients discussed in this episode can interact with blood thinners and blood-pressure medications. Talk with your healthcare professional before starting anything new, and bring your full list to every appointment.
Questions to take to your next appointment
- ✓Have I ever had my lipoprotein(a) measured? If not, can we add it to my next draw?
- ✓What is my LDL-C target given my personal risk category, and am I currently at it?
- ✓Would apoB or hs-CRP tell us something my current panel is missing?
- ✓Given my family history, would a coronary artery calcium score change what we do next?
- ✓If I am having side effects from my current medication, what alternatives could we try before I stop?
- ✓Do any of the supplements I take interact with what you have prescribed?
Watch, share, and get tested
The message of Episode 2 is not that your doctor is failing you. It is that the standard panel was designed to answer a narrower question than the one you actually care about — and that better questions are now available to you. Start with Lp(a). It is one blood draw, once in your life, and it may be the most informative number you have never been given.
Sources and further reading
- 2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia (Circulation)
- American College of Cardiology: Updated Guideline for Managing Lipids and Cholesterol
- American Heart Association: Lp(a) Discovery Project
- JACC: 2026 Dyslipidemia Guideline Hub
- Circulation: Lipoprotein(a) as a Pharmacological Target
- American Heart Association: Coronary Artery Calcium Test
- Phytotherapy Research: Aged Garlic Supplementation, Blood Pressure and Lipid Profile — Systematic Review and Meta-Analysis
