Three clean time points now. Read against your own frame: historically healthy levels earned on lifestyle, drive the particle count down, stay off statins. The question is not the gap to a pharma number, it is whether the line keeps bending your way.
The one marker we said actually mattered, your LDL particle count, crossed out of "High" into "Moderate" for the first time and blew through your under-1400 checkpoint. LDL-P went 2011 → 1740 → 1253, down 38% from baseline and 28% since March (Cardio IQ, all three dates). Small dense LDL 520 → 327 → 246, down 53%. That is lifestyle beating the genetics on the exact signal that undersold you on a plain LDL-C number.
The honest asterisk: a cluster of metabolic markers ticked the wrong way since March (triglycerides, HDL, fasting glucose, ApoB). But your 90-day glucose average (HbA1c) and fasting insulin both improved, which says the metabolic dip is most likely day-of and recent-diet noise, not a real decline. Worth a clean recheck, not worth alarm.
These are the targets you set for this draw in your trajectory note, not the pharma-era numbers. Direction matters more than any single line.
| Marker | Nov 2024 | Mar 2026 | May 26 2026 | Checkpoint | Result |
|---|---|---|---|---|---|
| LDL-P (nmol/L) | 2011 | 1740 | 1253 | under 1400 | HIT |
| Small LDL (nmol/L) | 520 | 327 | 246 | lower than 327 | HIT |
| ApoB (mg/dL) | 129 | 96 | 99 | under 90 | MISS, up 3 |
| LDL-C (mg/dL) | 141 | 122 | 126 | under 100 | MISS, up 4 |
| Triglycerides (mg/dL) | 301 | 71 | 129 | hold under 100 | OVER, still healthy |
| HDL (mg/dL) | 45 | 42 | 40 | nudge up | MISS, down 2 |
| LDL peak size (Å) | 207.4 | 217.2 | 217.2 | toward 222.9 (Pattern A) | HELD |
| LDL pattern | B | B | B | toward A | STILL B |
Particle and pattern values: Cardio IQ Patient Progress Summary, pages 6-7 of the enhanced report. ApoB and standard lipids: Quest lipid panel, page 1. Nov 2024 ApoB (129) from your trajectory note.
Your chosen benchmark, the pre-ratchet "healthy" levels. Four of five still sit in the zone. The one that slipped is the trig/HDL ratio, and it slipped because both halves moved a little the wrong way at once.
| Marker | Mar 2026 | May 26 2026 | Healthy zone | In zone? |
|---|---|---|---|---|
| Total cholesterol | 181 | 190 | under 200 | YES |
| LDL-C | 122 | 126 | under 130 | YES |
| HDL | 42 | 40 | above 40 | AT THE LINE |
| Triglycerides | 71 | 129 | under 150 | YES |
| Trig/HDL ratio | 1.69 | 3.23 | under 2 | NO |
Trig/HDL computed from the panel: 129 / 40 = 3.23 (May), 71 / 42 = 1.69 (March), 301 / 45 = 6.69 (Nov 2024). Total cholesterol 190 read directly off the May panel.
This is the marker your trajectory note called "the one real signal." Particle burden, not the cholesterol number, is what your discordance flag was about. Every particle metric is bending down.
nmol/L. Optimal under 1138, Moderate 1138-1409, High over 1409.
nmol/L. Small dense LDL is the most atherogenic fraction.
All values: Cardio IQ Lipoprotein Fractionation, Ion Mobility (Cleveland HeartLab), pages 5-7 of the enhanced report.
Color follows good vs not-good direction, not the lab's in-range flag. Down is green where lower is better, up is green where higher is better.
| Marker | Mar 2026 | May 26 | Change | Risk band (May) |
|---|---|---|---|---|
| LDL-P (nmol/L) | 1740 | 1253 | −487 | Moderate |
| Small LDL (nmol/L) | 327 | 246 | −81 | High |
| Medium LDL (nmol/L) | 417 | 310 | −107 | High |
| HDL Large (nmol/L) | 7622 | 5691 | −1931 | Moderate |
| LDL peak size (Å) | 217.2 | 217.2 | 0 | Pattern B |
| ApoB (mg/dL) | 96 | 99 | +3 | Moderate |
HDL Large dropped from Optimal (green in March) back to Moderate. It is the clearest single regression on the cardio panel and pairs with the HDL-C drop to 40.
| Marker | Mar 2026 | May 26 | Change | Reference |
|---|---|---|---|---|
| Total cholesterol | 181 | 190 | +9 | under 200 |
| LDL-C | 122 | 126 | +4 | under 100 (lab flag) |
| HDL-C | 42 | 40 | −2 | 40 or above |
| Triglycerides | 71 | 129 | +58 | under 150 |
| Non-HDL | 139 | 150 | +11 | under 130 (lab flag) |
| Chol/HDL ratio | 4.3 | 4.8 | +0.5 | under 5.0 |
| Marker | Mar 2026 | May 26 | Change | Reference |
|---|---|---|---|---|
| HbA1c (%) | 5.5 | 5.4 | −0.1 | under 5.7 |
| Fasting insulin (uIU/mL) | 9.2 | 8.1 | −1.1 | 18.4 or under |
| Fasting glucose (mg/dL) | 95 | 101 | +6 | 65-99 |
| Uric acid (mg/dL) | 7.3 | 6.7 | −0.6 | 4.0-8.0 (gout target <6.0) |
| hs-CRP (mg/L) | <0.2 | <0.2 | flat | under 1.0 = low risk |
The single fasting glucose of 101 is one point over the cutoff, but HbA1c (your 90-day average) and fasting insulin both improved, so it reads as spot variation rather than a trend. Uric acid improved but is still above the 6.0 gout-prevention target.
| Marker | Mar 2026 | May 26 | Change | Reference |
|---|---|---|---|---|
| OmegaCheck (% wt) | 6.8 | 6.5 | −0.3 | 5.5 or above = optimal |
| Omega-3 total | 6.8 | 6.5 | −0.3 | higher better |
| DHA | 4.2 | 3.5 | −0.7 | 1.4-5.1 |
| Omega-6/Omega-3 ratio | 5.2 | 4.5 | −0.7 | lower better |
| Omega-6 total | 35.8 | 28.8 | −7.0 | lower less inflammatory |
Omega-3 status is still optimal (6.5, above the 5.5 cutoff) though slightly off March. The omega-6 to omega-3 ratio improved, a less-inflammatory direction.
Four non-lipid items carry a flag this draw. Three are benign in context. The fourth, the red-cell picture, is the one worth a follow-up test.
| Marker | Mar 2026 | May 26 | Reference | Flag | Read |
|---|---|---|---|---|---|
| Fasting glucose (mg/dL) | 95 | 101 | 65-99 | High | Likely spot noise. A1c and insulin both improved. |
| MCH (pg) | 25.9 | 26.3 | 27.0-33.0 | Low | Mild hypochromia, see red-cell note below. |
| Arachidonic acid (% wt) | 8.7 | 8.3 | 8.6-15.6 | Low | Omega-6, low from clean diet. Benign. |
| Linoleic acid (% wt) | 25.3 | 17.4 | 18.6-29.5 | Low | Omega-6 seed-oil marker, dropped hard. Benign, arguably good. |
Only MCH is flagged, but the whole red-cell line moved down together since March, which the single flag hides. Low MCH means smaller, paler cells, and that paired with a hemoglobin drop is the textbook early-iron-deficiency signature. Everything is still inside the normal range, so this is a "check it, do not panic" item: a ferritin and iron panel would tell you whether iron stores are the cause.
| Red-cell marker | Mar 2026 | May 26 | Change | Reference |
|---|---|---|---|---|
| Hemoglobin (g/dL) | 15.0 | 13.6 | −1.4 | 13.2-17.1 |
| Hematocrit (%) | 46.6 | 42.4 | −4.2 | 39.4-51.1 |
| Red blood cell count (M/uL) | 5.79 | 5.17 | −0.62 | 4.20-5.80 |
| MCV (fL) | 80.5 | 82.0 | +1.5 | 81.4-101.7 |
| MCH (pg) | 25.9 | 26.3 | +0.4 | 27.0-33.0 |
CBC with differential, Quest, page 3. Hemoglobin, hematocrit, and RBC are all still in range but dropped in step. MCV and MCH ticked up slightly yet MCH is still just below the floor. Suggested follow-up: ferritin plus iron panel at the next draw.
The shape of this, trigs up, HDL down, fasting glucose up, ApoB flat, while particle clearance and A1c improve, is a recent-diet or short-window pattern, not a failure of the program. The clearance engine (LDL-P, small LDL, insulin, A1c) kept getting better. A clean recheck in 8 to 12 weeks, tightened on the days before the draw, would confirm whether the trig/HDL move was noise.
Your old note questioned whether 327 was really "High" using a borrowed under-527 cut point. Your own report now prints the range: Small LDL optimal under 142, Moderate 142-219, High over 219. So 246 is genuinely still "High" on your own assay, down hard from 327 but not yet optimal. The borrowed cut point was wrong. Real target: get under 219, then under 142.
Your genotype is 3/3, the neutral type, not the high-risk E4. This matters: your Pattern B and particle burden are not genetically locked by APOE4, which supports the thesis that lifestyle can keep moving them. It also keeps your absolute risk lower than the particle number alone suggests.
APOE genotype from the genetic cardiovascular markers section (reported 03/18/2026, page 7). Small LDL reference range printed on page 8 of the enhanced report.
Nothing here changes the lifestyle-first call. Your absolute-risk markers are quiet: hs-CRP under 0.2, no diabetes (A1c 5.4, insulin 8.1), APOE 3/3, and the particle count is now falling fast rather than stalled. The lifestyle case is strongest exactly when the trend is bending, and it is. A statin stays a genuine last resort, only if the particle trend truly stalls well above goal over multiple clean draws, and it remains your call.
Bottom line: the genetics are still losing to the work on the metric that matters most. The metabolic side took a small step back this draw, but the 90-day markers say that is probably noise. Keep driving, recheck clean in 8 to 12 weeks.