It may sound surprising: how can someone with perfect cholesterol still have a heart attack? But that’s exactly what longevity expert Dr Vassily Eliopoulos, a Cornell-trained doctor, has been warning people about. In a viral Instagram post, he explained that the cholesterol tests most people rely on for years are now outdated and often fail to reveal the real risks hiding inside the body.He explained that these outdated tests, known as lipid panels, only measure part of the picture and can miss dangerous underlying issues. Many people, from professional athletes and CEOs to everyday fitness enthusiasts, are walking around with silent heart disease, completely unaware that their arteries are narrowing despite “healthy” cholesterol readings.
Normal cholesterol levels can still be deadly: Doctor warns
According to Dr Eliopoulos, nearly 60% of all heart attacks occur in people whose cholesterol levels appear normal. This statistic challenges one of the most common assumptions in modern medicine that normal cholesterol equals a healthy heart.The problem lies in what standard lipid panels actually measure. These tests mainly focus on LDL (“bad”) cholesterol, HDL (“good”) cholesterol, and total cholesterol. While these numbers provide basic insight, they don’t reveal the full story of what’s happening inside your arteries. Someone can have ideal LDL levels yet still experience dangerous plaque buildup that blocks blood flow and triggers a heart attack.Dr Eliopoulos explained that relying on LDL alone is like “looking at the surface of the ocean and assuming you know what’s below.” It’s a partial snapshot that overlooks the most critical details.
Advanced heart health tests most people don’t know about
Dr Eliopoulos pointed out that the true indicators of cardiovascular risk are found in more advanced markers; the ones most routine tests ignore.ApoB (Apolipoprotein B) is one such marker. It counts the number of LDL particles in the blood rather than just measuring their total cholesterol content. Each of these particles has the potential to deposit cholesterol into artery walls, leading to plaque formation. The higher the ApoB count, the greater the risk of atherosclerosis, even if LDL levels appear normal.Then there’s Lipoprotein(a), or Lp(a). This is a genetic variant of LDL that affects around one in five people. Elevated Lp(a) can dramatically increase heart disease risk, but it’s not routinely tested and, crucially, no standard medication like statins can lower it. For those with high levels, lifestyle and targeted monitoring become vital.Finally, Dr Eliopoulos stressed the importance of inflammation markers, particularly high-sensitivity C-reactive protein (hs-CRP) and oxidised LDL. Chronic inflammation is the hidden driver of heart disease, silently damaging artery walls and accelerating plaque growth. Even if cholesterol levels are balanced, high inflammation can make the arteries unstable and prone to rupture.
Advanced heart scan that reveals silent plaque before symptoms appear
While blood tests show chemical risk, imaging shows the physical reality. Dr Eliopoulos described the CCTA (Coronary Computed Tomography Angiography) scan with Cleerly analysis as a game-changer for modern heart health.This advanced test provides a clear, visual look at the actual plaque inside the arteries something traditional tests can only guess at. The Cleerly technology uses AI to analyse CT scans and classify plaque as either soft, fibrous, or calcified. Soft plaque, in particular, is highly unstable and most likely to rupture, leading to heart attacks.“I’ve seen ultra-fit founders with six-pack abs and textbook cholesterol who still had dangerous, silent plaque buildup,” Dr Eliopoulos said. The lesson? Physical fitness and good cholesterol numbers don’t always equal protection. True prevention lies in identifying and addressing what’s beneath the surface.
How advanced testing helps detect risk before it becomes irreversible
For anyone serious about heart health, Dr Eliopoulos advocates a more advanced and personalised approach. Instead of settling for “your labs look fine,” he encourages patients to dig deeper and understand their true cardiovascular profile.That means testing for:
- ApoB – to count plaque-forming particles, not just measure cholesterol mass.
- Lipoprotein(a) – to uncover inherited risk factors.
- hs-CRP and oxidised LDL – to detect inflammation and oxidative stress.
- CCTA with Cleerly analysis – to see real plaque and measure true risk.
This type of testing, he explained, is often used by “high performers” individuals who don’t just want to survive, but thrive long-term. They know that early detection and precise measurement can mean the difference between prevention and crisis.“Optimal health isn’t about guessing,” he said. “It’s about seeing what’s really going on.”Also Read | Henna can reverse liver damage: Japanese scientists reveal how a natural plant dye may help reverse fibrosis and repair the liver