Paul Saladino MD podcast 228. Cholesterol debate with Dr. Alo
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Aug 15, 2023 Dr. Paul brings on Dr. Mohammad Alo, a cardiologist and personal trainer, to discuss the cholesterol debate. They explore topics such as cardiovascular risk, insulin resistance, metabolic health of Americans, LDL and atherosclerosis, fasting insulin, arteries and veins, genes and lifestyles, seed oils versus saturated fat, and the problems with totality of evidence.
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Treat Elevated LDL Early Rather Than Waiting For Calcium Score
- Dr. Alo recommends early LDL control and prevention rather than waiting for late-stage calcified disease.
- He compares waiting for CAC to waiting for lung cancer before advising smoking cessation.
Insulin Resistance Alters LDL Risk Relationship
- Paul Saladino contends LDL is not the proximate cause; insulin resistance and LDL oxidation within the arterial wall matter more.
- He highlights studies where LDL risk disappears when stratified by insulin-sensitivity proxies and notes discordant genetic cases (e.g., GSD1a) and elderly data.
Early Subclinical Plaque Found In Young Healthy Cohorts
- Dr. Alo recounts PISA and CARDIA trials finding substantial subclinical atherosclerosis in young, lean cohorts with LDLs of ~110–150 mg/dL.
- In PISA, 45% with LDL 110 had plaque; LDL 150 associated with ~64% subclinical atherosclerosis.