In this episode, I sit down with Dr. Laurence Sperling, a world-renowned preventive cardiologist, to unpack the truth about early cardiovascular disease, how it progresses, and most importantly how we can prevent it.
We explore everything from cholesterol and blood pressure to genetic risk, environmental exposures, diet, and the role of screening tools like calcium scoring and CT angiograms. Dr. Sperling shares a refreshing, deeply informed perspective on heart health, breaking down complex science in a way that’s easy to understand and immediately useful.
In this episode, we cover:
- Why heart disease begins in childhood (or even before birth)
- How to detect atherosclerosis before symptoms arise
- LDL, ApoB, and lipoprotein(a): what they mean and how low is low enough
- Blood pressure, triglycerides, and what “normal” actually means
- When to get a coronary artery calcium score or CT angiogram
- Whether keto diets and high cholesterol can be “healthy”
- The real impact of GLP-1 meds, obesity, and stress
- Daily habits I’m adopting based on this conversation
- Why public health and policy are key to fixing this crisis
Whether you’re 25 or 65, this conversation is packed with insights that can help you live longer and better by understanding and protecting your cardiovascular system.
- 0:00:00 – Intro
- 0:01:24 – Why Prevention Should Start Before Birth
- 0:10:11 – Is It Genetics or Lifestyle? Understanding Risk
- 0:16:17 – Public Health Strategy That Prevents Millions of Heart Attacks
- 0:21:55 – How Geography and Income Impact Heart Disease Risk
- 0:29:25 – Familial Hypercholesterolemia and Lifetime Cholesterol Exposure
- 0:34:00 – What Diet and Lifestyle Patterns Lower Risk Long-Term
- 0:45:49 – LDL, HDL, and the New Science of Non-HDL Cholesterol
- 0:53:39 – Does High Blood Pressure Still Harm Arteries if ApoB Is Low?
- 1:05:24 – Lipoprotein(a): The Triple Threat You Should Know About
- 1:08:22 – When Should You Start Cardiac Risk Assessments?
- 1:17:23 – Can a Calcium Score of Zero Be Misleading in Younger Adults?
- 1:23:58 – CT Calcium vs. CT Angiogram: Which Scan Is Right?
- 1:33:25 – Is Subclinical Atherosclerosis the Same as Heart Disease?
- 1:40:03 – What Are Optimal LDL and Blood Pressure Levels to Prevent Heart Disease?
- 1:48:07 – How GLP-1 Drugs Help With Weight and Heart Disease Prevention
- 1:57:10 – Public Health Policies That Could Save Millions
- 2:01:19 – Cardiologist-Approved Daily Habits for a Healthy Heart
- 2:05:20 – Outro
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Resources:
- Family Heart Foundation – Learn about inherited cholesterol disorders
- FunctionHealth.com/simonhill – Get my blood test protocol
- ThePreventScore.org – Try the new cardiovascular risk calculator
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More about Dr Laurence Sperling
Laurence S. Sperling, M.D., FACC, FAHA, FACP, MASPC is the Founder and was the Director of The Heart Disease Prevention Center at Emory (1997-2019). He is currently the Katz Professor in Preventive Cardiology at the Emory University School of Medicine, and Professor of Global Health in the Rollins School of Public Health. Dr. Sperling served as the Executive Director of the CDC / CMS Million Hearts Initiative from 2019-2024. He served as the President of the American Society for Preventive Cardiology from 2014-2016 and as a member of the writing committee of the 2018 ACC/ AHA/ Multi-Society Guideline on the Management on Blood Cholesterol. He currently is an Associate Editor for the American Journal of Preventive Cardiology, and Chair of the World Heart Federation Roadmap for Cardiovascular Disease Prevention among People Living with Diabetes. He served on the Writing Committee of the American Heart Association Cardiovascular Kidney Metabolic Health (CKMH) Initiative which has brought forth the importance of an integrated approach to prevention and treatment in this high-risk population.
Dr. Sperling founded (in 2004) and directs the first and only LDL apheresis program in the state of Georgia. He was the PI for The National FH Registry site at Emory. He has received awards for excellence in teaching (including 4 Golden Apple Awards and The Dean’s Teaching Award), mentorship (Emory SOM 2018 Mentorship Award). He received the Emory School of Medicine Alumni Award of Honor (2017), the Right Care Leadership Award for Precision Medicine in Heart Attack and Stroke Prevention (2022), the CDC Shepard Award for original research publication (2022), American Society for Preventive Cardiology Pioneer in Prevention Award (2023), National Lipid Association Honorary Lifetime Achievement Award (2024), Medical Association of Atlanta Aven Cup Award for outstanding contribution to education, medicine, and the arts (2024), the National Association of Chronic Disease Directors Joseph W. Cullen Excellence Award for Impact in Public Health (2024), and the National Forum for Heart Disease and Stroke Prevention Heart Healthy and Stroke Free Award (2024).. He is an elected member of the Association of University Cardiologists. He has authored over 450 manuscripts, abstracts, and book chapters. Dr. Sperling has delivered invited presentations on every continent except for Antarctica. He lives in the Druid Hills neighborhood of Atlanta with his wife, Dr. Sidney Barr. Their sons, Mathew and Daniel, live in California and Atlanta.
