A few months ago I wrote a LinkedIn post about my decision to start taking statins. I had resisted for several years after being told I had a high coronary artery calcium score, and what changed my mind was straightforward: a handful of people I knew well, fit and healthy-looking triathletes with no obvious warning signs, had heart attacks. One of them died. That was enough.

The post prompted Katherine Caris-Harris to get in touch. She is a performance nutritionist who works largely with driven, high-achieving athletes. Her point was not that I was wrong to take statins. It was that there was a lot more to understand before I could be confident I was making a fully informed decision. That conversation became this podcast.

What followed was one of the more uncomfortable realisations I have had in recent years.

The test your GP runs is not what you think it is

When your GP checks your cholesterol, they are running something called an LDL-C test. What most people do not realise is that LDL-C is not directly measured. It is an estimate, calculated from a formula using your total cholesterol, HDL and triglycerides. It looks at the total mass of cholesterol in a group of carrier particles. It does not look at the size or number of those particles, which is where the real risk information sits.

Katherine's view is direct: the science showing that LDL-C is a poor predictor of cardiovascular disease risk has been established for a long time. The reason it remains the standard test is not because it is the most accurate. It is because it is the cheapest.

The two markers that give a much better picture are ApoB and Lp(a). ApoB measures the actual number of carrier particles in the blood. It is the smaller, denser particles that can most easily penetrate arterial walls and cause damage, and ApoB is a far better indicator of that risk than the estimated LDL-C figure. Lp(a) is largely under genetic control and less modifiable through lifestyle, but knowing it is elevated gives you important information about your overall risk profile. When I asked my GP to test for both, the answer was no. Not available on the NHS.

Listen to the full podcast HERE: Is your cholesterol test telling you the truth?​

Fit athletes are not as protected as they assume

This is the part of the conversation that struck me most, because I recognise the thinking in myself and in athletes I coach. We are lean, we train regularly, we do not smoke. Surely that is protection enough. Katherine's response to that assumption is measured but clear.

Cardiovascular fitness is not the same as cardiovascular health. Standard testing can give a falsely reassuring picture, particularly for athletes whose training creates additional demands on the system. The body produces cholesterol for a reason. It is essential for cell repair, hormone production, brain function, vitamin D synthesis and more. The enemy is not cholesterol itself. It is inflammation and oxidative stress, and athletes produce plenty of both.

There is also the question of what we eat around training. The cake at the halfway cafe, the gel every hour, the energy drinks. When you are lean and burning through calories, it is easy to assume the body is handling all of it. Katherine sees elevated fasted insulin and HbA1c in a significant number of athletes, indicating their blood sugar regulation is under more strain than their training would suggest. One night of poor sleep can temporarily induce insulin resistance. Do that regularly enough, and the picture changes.

What the statin conversation is actually about

Katherine is not anti-medication. Her position is simply that the decision to take any medication should be made with the fullest possible picture in front of you. Statins work by reducing LDL-C, and for people who have already had a cardiovascular event, the evidence for their benefit is reasonably strong. For primary prevention in otherwise low-risk individuals, the numbers to treat are considerably higher, meaning more people need to take the medication to prevent one event.

There are also some athlete-specific considerations worth knowing. Statins work through a pathway that also reduces production of CoQ10, an antioxidant that plays a role in energy production at the cellular level. This is connected to the muscle ache that some people experience on statins. It is something Katherine monitors with her clients, and for athletes specifically, it is worth being aware of.

None of this means statins are wrong. It means the conversation around them needs to be more complete.

Test, do not guess

Katherine's closing message was simple and I think it is the right one. Most of us spend serious money on bikes, kit, race entries and training plans. We track power, pace, heart rate and sleep. We know our FTP and our CSS and our threshold pace. What most of us have never done is test what is actually happening inside the engine.

Markers like ApoB, Lp(a), homocysteine, fasted insulin, red blood cell magnesium and a full thyroid panel including T3 are not standard NHS tests. Some of them are not cheap. But if you are a driven endurance athlete over 50 who wants to keep doing what you love for another twenty years, knowing what is going on under the hood is probably worth more than the next set of carbon wheels.

Go to your GP armed with the right questions. If they cannot or will not run the tests, look at private options. And do not assume that because you look and feel fit, everything is fine. That assumption is precisely what Katherine is pushing back against.

KEY TAKEAWAYS

• Standard NHS cholesterol testing uses an estimated LDL-C figure that does not measure particle size or number, which is where cardiovascular risk is actually determined. ApoB and Lp(a) give a much more complete picture and are worth asking for.
• Fit endurance athletes are not automatically protected. Chronic training stress, poor sleep, high sugar intake around training and the physiological changes that come with age over 50 can all contribute to elevated cardiovascular risk markers that standard testing will miss.
• Statins reduce LDL-C but also lower CoQ10 production, which matters for energy and muscle function in athletes. For primary prevention in low-risk individuals, the evidence base is less clear-cut than is often presented. Understanding your full picture before making that decision is not anti-medicine. It is sensible.

CTA (Nurture)

The Battle Ready approach has always been about understanding the whole system, not just the training metrics. If you want to build the kind of durability that keeps you performing well into your 50s and beyond, SWAT is built around exactly that. Find out more HERE:

Thanks for being part of the tribe. I’m here to help you stay Battle Ready! Simon