Summary
In a podcast episode titled "Dr. Ronald Krauss on LDL Cholesterol, Particle Size, Heart Disease & Atherogenic Dyslipidemia," Rhonda Patrick interviews Dr. Ronald Krauss, director of the atherosclerosis center at Children's Hospital Oakland Research Institute and adjunct professor at UCSF. Dr. Krauss discusses the nuances of lipoproteins that carry cholesterol and the importance of particle measurement in understanding heart disease risk.
Cholesterol is a crucial component of LDL, but there are many forms of LDL that range from small and dense particles to larger and more buoyant. The highest risk of heart disease is associated with particles that carry less cholesterol but have properties that make them more damaging to the arteries. This led to a rethinking of the role of cholesterol in heart disease risk. The origin of LDL particles is in the liver, and small LDL particles are associated with heart disease because they are associated with low HDL.
Dr. Krauss notes that efforts to reduce heart disease risk by treatments that raise HDL cholesterol have failed, while almost every treatment aimed at lowering LDL has been successful. The unintended consequences of the low-fat diet message that led to an increase in carbohydrates, particularly simple sugars like fructose, have also contributed to heart disease risk. Dr. Krauss emphasizes the importance of overall food context and dietary patterns in regulating heart disease risk from a dietary standpoint, rather than just focusing on individual nutrients.
The episode also focuses on the effects of statins on reducing heart disease risk and the potential over-prescription of the medication. Dr. Krauss notes that the LDL-lowering effects of statins are well-established, but there are concerns about their overuse and potential side effects, such as muscle damage and the development of diabetes. The decision to use statins for treatment is based on overall risk assessment that includes factors such as blood pressure, diabetes, and family history.
Overall, the episode highlights the importance of measuring lipoprotein particles and particle size, rather than just LDL cholesterol, in preventing heart disease. A new method called ion mobility can provide more refined and consistent particle measurements, but the standard lipid tests are still adequate for screening the general population. Patients must have a medical reason for getting the particle measurement test done, and insurance policies and Medicare are starting to reimburse for the test. The decision to use certain types of treatments is based on individual risk assessment, and the particle measurement can help identify individuals who would benefit from certain treatments.
