Whenever I’m stumped on a patient case or in my thinking about lipids, Ron is one of the first people I turn to for insight. Ron is recognized globally for his research into lipidology and has worn many hats in his career, including clinician, lipidologist, nutrition, genetics, and drug research.
In this episode, we explore heart disease at its origins before diving into the highly discussed, largely misunderstood, role of LDL and inflammation in atherosclerosis. Ron also shares his insights on the evidence for and against statins and other lipid-lowering therapies. My hope is that both the curious patient and the physician can get a lot out of this episode by being more informed about dyslipidemia and the interventions used to reduce the risk of atherosclerotic disease. We covered a lot of ground on this critically important topic.
We discuss:
- The pathogenesis of atherosclerosis [7:00];
- How early atherosclerosis begins [12:40];
- Ron’s motivation for getting into lipidology [43:00];
- How reading an article series in the NEJM in 1967 had a profound impact on him and his career [43:30];
- How PCSK9 inhibitors work and why they may be under-utilized [47:00];
- Mendelian randomization: nature’s randomized trial [49:15];
- The “battle” between particle size and particle number [52:00];
- The use of statins [1:04:45];
- The role of chronic inflammation in atherosclerosis [1:24:15];
- Why niacin may have been unjustly dismissed as a therapeutic option [1:40:45];
- The HDL paradox: why drugs that raise HDL-C seem to raise (or have little impact on) heart disease risk [1:43:00];
- Lp(a) [1:47:45];
- And more.
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