242. Debunking Cholesterol Myths: New Study Reveals Surprising Findings! With Dave Feldman
Dec 19, 2023
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Dave Feldman, a researcher studying LDL and cardiovascular risk, joins Paul Saladino on the podcast. They discuss a recent study about LDL and cardiovascular risk, the response from the medical community, and the role of credentials in online discussions. They also explore the risks and benefits of lipid-lowering therapies like statins and the effects of ketogenic and low carb diets on LDL cholesterol levels.
Lean individuals with elevated LDL and ApoB levels may not have the same risk of cardiovascular disease as the general population.
FH and lean mass hyper-responders, both with high LDL, are not the same and have differences in macrophage function and genetics.
The relationship between elevated LDL cholesterol and plaque formation may be context-dependent, and factors such as insulin sensitivity and overall health should be considered.
Deep dives
The Study on Lean Mass Hyper-responders
A study is conducted on a unique population of lean individuals with significantly elevated LDL and ApoB levels. The purpose of the study is to determine whether these individuals, who are metabolically healthy, have the same increased risk of cardiovascular disease and plaque formation as the general population.
Differentiating Between Familial Hypercholesterolemia (FH) and Lean Mass Hyper-responders
FH, a genetic condition resulting in high LDL levels, is compared to lean mass hyper-responders. These lean individuals with high LDL are not necessarily metabolically unhealthy like FH patients. Studies suggest differences in macrophage function and genetics, indicating that FH and lean mass hyper-responders are not the same.
Implications for Lipid Lowering Therapy and Contextual Risk
The conversation surrounding elevated LDL and ApoB levels in lean individuals raises questions about the potential risks and benefits of lipid lowering therapy. It is emphasized that not every increase in APOB-containing lipoproteins carries the same cardiovascular risk, and medication should be considered on a case-by-case basis. The need for a research-supported discussion on context-dependent risk factors is highlighted, with a focus on avoiding unnecessary medication and potential negative side effects.
No significant difference in coronary plaque burden between two groups
In a recent study, individuals following a ketogenic diet with elevated LDL cholesterol for an average of 4.7 years were compared to age-matched controls from Miami Heart who had lower LDL levels. Surprisingly, there was no statistically significant difference in coronary plaque burden between the two groups. While the study is ongoing and the results are preliminary, this finding challenges the context-independent lipid hypothesis and raises questions about the relationship between LDL cholesterol and plaque formation in different metabolic states.
Elevated LDL levels and plaque correlation not observed
Another interesting observation from the study was the lack of correlation between baseline LDL cholesterol levels and plaque burden in both groups. This finding counteracts the expectation that higher LDL cholesterol levels would be associated with increased plaque formation. However, the study is ongoing, and further analysis is needed to understand the complex relationship between LDL cholesterol and plaque formation. It is important to consider multiple contextual factors such as insulin sensitivity, genetics, and overall health when evaluating the impact of LDL cholesterol on cardiovascular health.
Today, Paul has Dave Feldman on the podcast to discuss, in depth, a recent study that he conducted about LDL and cardiovascular risk and what this may mean for the future of medicine.
