Paul Saladino MD podcast 242. Debunking Cholesterol Myths: New Study Reveals Surprising Findings! With Dave Feldman
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Dec 19, 2023 
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.
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Lean Mass Hyperresponder Phenotype Explained
- Feldman identified the lean mass hyperresponder phenotype: very high LDL, very high HDL, and low triglycerides in lean, low-carb athletes.
- He tracked this triad since 2017 and hypothesized it isolates ApoB exposure without metabolic dysfunction, making it ideal to study plaque risk.
Monogenic FH Differs Mechanistically From Diet LDL
- Monogenic FH causes cellular lipid-handling dysfunction (e.g., impaired LDL receptor) and different macrophage behavior versus diet-induced high LDL.
- Brown and Goldstein's monogenic FH patients had extreme LDL and early heart disease, so findings may not generalize to diet-induced LDL elevations.
Matched CT Angiography Found No Plaque Difference
- The Lundquist study scanned 100 lean mass hyperresponders with coronary CT angiography and matched 80 to Miami Heart controls; mean LDL in Feldman's group was 272 mg/dL.
- There was no statistically significant difference in coronary plaque burden between groups and no correlation between baseline LDL and total plaque score.