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ONE OF MY patients, a well-groomed man in his mid-50s, always showed up in my office on time and prepared. This was how he approached everything. He tracked his workouts, his sleep stages, and his protein intake. He managed stress with cold-water plunges at dawn. He prided himself on his fitness, telling me as he sat down across from me that his trainer told him he was “healthier than most 20-year-olds.”

So I thought hard about how to approach the conversation about his cholesterol levels. They didn’t match his disciplined lifestyle, which meant that telling him that he was at high risk for a heart attack and stroke would be hard…

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