Cardiovascular Health · Goal Number One

Heart Health Plan

The clinical companion to the heart-first training dashboard. Where your lipids stand across three clean draws, the two engines pulling on them (supplements and activity), and exactly when and what to test next, the lifestyle-first, no-statin way.

Generated 2026-06-24 · Lab source: bloodwork.md and 2026-06-01 May 2026 Function Health Panel Review.md · Stack and fitness source: Ace Personal, Family and Health.md · Training signals: heart-first.pages.dev (2026-06-24)

The one-line verdict

The work is winning on the marker that actually predicts plaque, and plateaued on the headline number.

LDL particle count fell from 2011 to 1253 and crossed from High into Moderate for the first time, and small-dense LDL fell from 520 to 246 (May 2026 panel review). For a South Asian pattern-B profile, that is the win that matters most. The holdout is ApoB mass: 129 down to 96, then a tick back to 99, still off the under-90 checkpoint (Quest lipid panel p1). Backstopped by a calcium score of 6 and hs-CRP under 0.2, your actual cardiovascular risk reads low, which is why the no-statin call stands (May 2026 panel review).

Where you stand: the four markers that matter

ApoB

99 mg/dL

129 → 96 → 99 · goal <90

Plateau, off goal

LDL Particle Count

1253 nmol/L

2011 → 1740 → 1253 · beat <1400

Crossed into Moderate

Small-Dense LDL

246

520 → 327 → 246

Down 53%

Triglycerides

129 mg/dL

71 → 129 · trig/HDL 1.69 → 3.23

Drifted up, watch

All four sourced to bloodwork.md and the May 2026 panel review. Three clean time points: Nov 2024, Mar 2026, May 2026. The Aug 2025 draw is excluded as a 66-hour-fast artifact. Other anchors: Lp(a) 16 nmol/L optimal, hs-CRP under 0.2, CT calcium Agatston 6 (Jan 2, 2025), biological age 29.6 to 26.8.

Two engines, two halves of the profile

Supplement engine

Red yeast rice, berberine, bergamot, plant sterols. These upregulate the LDL receptor and block cholesterol absorption. They lower the cholesterol-mass side of the panel.

Owns: ApoB · LDL-C

Activity engine

Intervals, lifting, weight loss, sauna. These drive triglycerides down, nudge HDL up, and shift particles larger and less dense. They lower the metabolic and particle-quality side.

Owns: Triglycerides · HDL · particle size

This is the key to the whole plan. The two engines barely overlap. So when your May draw showed triglycerides up, HDL down, and trig/HDL at 3.23, the lever is the activity engine plus diet, not a new pill. And the particle-count win you already booked came mostly from the activity engine plus your EPA omega-3, not from the LDL-lowering supplements. Match the problem to the right engine.

The supplement engine, agent by agent

Agent (dose)	Role	How it works	Published LDL-C effect
Thorne Red Yeast Rice 2 caps, meal + dinner	Primary mover	Monacolin K is naturally occurring lovastatin. Blocks HMG-CoA reductase, upregulates the LDL receptor.	-15% to -25% population range
Berberine 2 caps/day, meal + dinner	Primary mover	Upregulates the LDL receptor by a non-statin pathway, so it stacks additively with red yeast rice. Also lowers ApoB and glucose.	-15% to -20% population range
Bergamot (Jarrow Bergamonte) 2 caps, meal + dinner	Primary mover	Polyphenols inhibit cholesterol synthesis and absorption. One of the few agents that also nudges HDL up.	-12% to -27% population range
CholestOff (plant sterols) 2 caps, meal + lunch + dinner	Primary mover	Plant sterols compete with dietary cholesterol for gut absorption. Different mechanism, stacks cleanly.	-8% to -10% population range
Omega-3 (SR Triple Strength) 690mg EPA / 310mg DHA	Particle-size lever	EPA-dominant, chosen for particle size not mass. Drives triglycerides down and shifts particles larger. Barely touches LDL-C.	trig -15% to -30% LDL-C neutral
Ubiquinol 1 cap, meal + dinner	Support	Reduced CoQ10 to offset the CoQ depletion from red yeast rice. Protects the primary mover, does not lower lipids.	n/a
Milk Thistle 1 cap, meal + dinner	Support	P-gp inhibition deliberately boosts berberine absorption. A force multiplier, not a mover.	n/a
D3 + K2 1 cap, meal + dinner	Support	K2 directs calcium away from arterial walls. Plays to the calcium-score story, not the ApoB number.	n/a

Doses and products: Ace Personal, Family and Health.md lines 113-128. Omega-3 EPA/DHA split: line 125.

The activity engine

Activity	Primary effect	Published range (population)	Relevance to you now
Aerobic / interval training Norwegian intervals, three a week	Triglycerides down	-15% to -30% aerobic-exercise meta-analyses	The single biggest lever on the marker that just spiked: trig 71 to 129. Your intervals are the right tool.
Aerobic consistency	HDL up	+3 to +6 mg/dL about +5%, exercise trials	Your chronic low spot, HDL 40 to 42. Exercise is one of the few non-drug HDL movers.
Aerobic + weight loss	Particle size, B toward A	real shift hard to give one %	The win already booked: small-dense LDL 520 to 246. Activity plus EPA omega-3 did this, not the LDL pills.
Weight loss ~20 lb, per Ace 2026-05-08	LDL-C and ApoB down	-0.8 mg/dL per kg weight-loss lipid studies	A real ApoB contributor layered on top of the supplements.
Resistance training your lifting days	LDL-C modest	-5% or less resistance-training meta-analyses	Small direct lipid effect. Real job is body composition and insulin sensitivity, which feed trig and HDL.
Sauna ~20 minutes post-lift	Not a lipid lever	CV mortality, BP Laukkanen Finnish cohort	Helps the heart-first goal directly, just not through the lipid panel.

Read both effect columns honestly. Every percentage on this page, supplement and activity alike, is a published population range, not your measured personal effect, and they do not sum to a single number. Five supplements, a 20 lb weight loss, OMAD, interval training, and a tighter diet all changed at once, so no one can split your ApoB drop into "this much came from berberine" or "this much from the intervals." What is provably yours, and fully sourced, is the measured trajectory: particle count and small-dense LDL down hard, ApoB plateaued, triglycerides drifted up. The effect columns only explain why each lever is in the plan and which half of the profile it pulls.

Your next checkup

May 26, 2026

Last clean draw. Particle count crossed into Moderate. Trig and trig/HDL drifted up, flagged as likely short-window noise but unconfirmed.

Now, Jun 24, 2026

Run-up window. Tighten diet, hold aerobic volume, protect sleep. This is what makes the next number interpretable.

Early Aug 2026

Reminder set. Beginning-of-August nudge to book the appointment.

Aug 27, 2026

Recheck draw (locked). The 8-to-12-week recheck the May review called for, at the 13-week mark so a tightened diet has time to register.

Cadence from the May 2026 panel review open follow-up: clean recheck of trig/HDL and ApoB in 8 to 12 weeks, target Aug 2026, diet tightened in the run-up.

Order this draw	Why
ApoB + Advanced Lipid	The core question: is ApoB moving back toward goal
Trig / HDL	Confirm the May drift was noise
Uric acid	Gout watch, 7.3 last clean draw, target under 6.0
Iron panel	Close the red-cell drop the May review flagged
Hgb electrophoresis optional, one-time	Settle the suspected beta-thalassemia trait

Draw protocol, non-negotiable. Standard 12 to 14 hour overnight fast only. Never an extended fast, and not within 48 hours of intense endurance work. The Aug 2025 false alarm came from a 66-hour fast.

Targets for the Aug 27 draw

Marker	Last clean value	Target	Source
ApoB	99	under 90	bloodwork.md scorecard
LDL particle count	1253	under 1400	scorecard; stretch under 1138
Trig / HDL ratio	3.23	under 2.0	May 2026 panel review
Triglycerides	129	toward 71	your Mar 2026 value
Uric acid	7.3	under 6.0	health doc, gout line
Biological age	26.8	hold under 26.8	health doc, line 129

Two markers need to move: ApoB and trig/HDL. The rest are already where you want them. If August shows trig/HDL back under 2 and ApoB ticking toward 90, the May drift was noise and nothing in the protocol needs to change. If ApoB is still stuck near 99 with clean trig, that is the honest signal that the nutraceutical stack has found its floor, and that is the conversation to have then, on your terms, not before.

What to watch between now and August

Triglycerides are the live one. They respond to the activity engine and diet, not a pill. Consistent aerobic volume over the next 6 to 8 weeks is the lever.
Sleep is undercutting you. The heart-first dashboard shows 5.6 hours last night against a 7.5 target and readiness amber today (heart-first, 2026-06-24). Short sleep blunts the exact insulin-sensitivity and triglyceride benefits the activity engine is supposed to deliver.
ApoB is the holdout, not a crisis. 96 then 99 is a plateau just above goal, against a calcium score of 6 and hs-CRP under 0.2. The risk anchors are reassuring. The number is the project, the risk is already low.

Personal heart-health summary for Ace Hemani. Lifestyle-first, no-statin protocol is the documented standing call; this page is not medical advice and not a prescription nudge. Effect-size ranges, supplement and activity alike, are general published clinical-trial figures for broad populations, included to explain plan design, and are explicitly not decomposed onto Ace's personal result. Personal lab values trace to bloodwork.md and 2026-06-01 May 2026 Function Health Panel Review.md; stack, fitness, and weight figures to Ace Personal, Family and Health.md; training signals to heart-first.pages.dev as of 2026-06-24. Three clean draws used (Nov 2024, Mar 2026, May 2026); Aug 2025 excluded as a 66-hour-fast artifact.