If you’ve had a heart attack, your LDL cholesterol should be below 55.
Most patients have never heard that number. Dr. Waqas Malick hears it every day.
“At those levels, that’s when you can achieve plaque regression,” said Malick, who directs the Lipids and Cardiometabolic Disease Program for Valley Medical Group, part of Valley Health System. Below 55 milligrams per deciliter, the body doesn’t just stop adding plaque to artery walls — it can actually start reversing it.
The problem is getting there. And the bigger problem, Malick said, is that almost nobody is doing the work required to find out.
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Malick joined Valley 10 months ago after training at NYU, Columbia, and Mount Sinai’s Fuster Heart Hospital, where he completed a research fellowship in preventive cardiology and lipoprotein metabolism. He brought a specialty that’s still rare in most cardiology practices: an entire program built around lipids, cholesterol, and the long, unglamorous process of getting a patient’s numbers exactly where they need to be.
The patients fall into three groups. Some have never had a cardiac event but carry serious risk factors — obesity, a family history, or a genetic condition like familial hypercholesterolemia. Others have already developed plaque that hasn’t caused a problem yet — what shows up on a calcium score or a CT angiogram before there’s ever a symptom. And some have already had the heart attack, the stent, the bypass, and want to make sure it never happens again.
A growing share of that last group has discovered something specific: lipoprotein(a), a genetic cholesterol marker most people have never been tested for, and most doctors don’t routinely check.
“It’s a new cholesterol protein that we’re encouraging everyone to have checked,” Malick said.
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Men show up disproportionately in that first category — the ones who haven’t had an event yet, but should be worried.
“Men tend to have far more often premature disease,” Malick said. “It’s rare to find a woman with a heart attack in her 40s and 50s, but with men you hear it all the time.”
He’s careful not to overstate it — he points out that women are, if anything, under-screened for heart disease relative to men, and he’s not interested in painting all men as careless about their health. But the pattern in his own practice is hard to ignore, and so is who tends to walk a reluctant relative through the door.
“Have I seen wives, or even a sister, bring someone in because they’re not getting on top of it themselves? Yes,” he said. “Have I seen the other way around? No. I’ve never seen a brother bring his sister in.”
There’s an exception worth noting, though. Malick said the explosion of longevity-focused podcasts and online health content — built largely around biomarkers, supplements, and optimization — appeals disproportionately to men. The audience is there. It’s just being reached by influencers instead of cardiologists.
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What Malick is offering isn’t a single consultation. It’s structured, repeated follow-up — the part of preventive cardiology that rarely happens in a standard practice, mostly because there isn’t time for it.
Patients on statins or newer add-on therapies are supposed to have bloodwork checked every three months until they hit target levels. Patients on GLP-1 drugs like Ozempic, Mounjaro, Zepbound, or Wegovy are supposed to be seen roughly monthly while doses are adjusted upward in stages. Almost no cardiology practice has the bandwidth to do either consistently.
“That’s what the programs try to offer,” Malick said. “Not just a consultation, but a continuous form of care.”
Demand caught up with the program fast. After a slow first six to eight months, Malick said he’s now booked out two to three months for new patients. The age range skews younger than a typical cardiology practice — most of his patients are in their 30s through early 60s, though he treats patients in their 80s with the same intensity.
One real-world snag: insurance coverage for GLP-1 drugs remains inconsistent for patients without diabetes, despite mounting evidence the drugs benefit obese patients regardless of diabetes status. Malick expects that to change as new Medicare coverage rules and price reductions take effect this year.
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Ask Malick what a man with a family history and a few extra pounds — but no symptoms — should actually do, and the answer starts with testing, not lifestyle.
“You’ve got to make sure you’re testing for the right biomarkers,” he said — lipid panels, an A1C, liver enzymes that can flag fatty liver disease. Then, depending on age, plaque imaging: a calcium score or CT angiogram that shows whether disease has already started forming inside the arteries.
“Having a calcium score of even 50 or 100 at age 40 is very different than having a calcium score of 100 at age 70,” he said.
Only after the screening does Malick get to lifestyle — and when he does, diet comes first, ahead of exercise.
He points to what’s often called the Mediterranean-style approach: olive oil, nuts — walnuts and almonds in particular, though peanuts and cashews count too — seeds, fish, and avocados, all high in anti-inflammatory fats. Alongside that, a high-fiber diet built around vegetables, thick-skinned fruits like berries, apples and pears, and whole grains.
“There’s randomized controlled trial evidence for diet,” he said, citing research showing olive oil and nut intake alone significantly reduce cardiovascular events.
Exercise still matters — Malick calls it one of the best things a person can do — but he’s realistic about why diet wins out as the first recommendation. A workout isn’t just the workout itself.
“It’s not just time for the exercise,” he said. “You need time to shower, time to make sure you’re getting appropriate nutrition afterward. That’s what makes it hard for people.”
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None of it works, Malick said, without the testing that comes first. A man can eat well and exercise and still be carrying a genetic risk factor he doesn’t know about — the kind that only shows up in a lipid panel or a calcium score, not a scale.
That’s the entire premise behind the program: find out what’s actually there before it becomes a heart attack, a stent, or worse.
“You’ve got to make sure you’re not missing disease,” he said, “because a lot of it is genetic.”
For information about Valley Medical Group, go to valleyhealth.com/valley-medical-group.
