The Curbsiders Internal Medicine Podcast 518: Cardiology Meets Longevity
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Mar 23, 2026 Greg Katz MD, cardiologist and prevention expert at NYU focused on advanced lipidology and long-term risk reduction. He talks about when ApoB and Lp(a) change management. He explains how coronary calcium and CTA act as tiebreakers. He explores spotting early cardiometabolic risk and the role of wearables and CGMs.
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Lipid Panel Reveals Two Different Risks
- A standard lipid panel tells two distinct physiologic stories: atherogenic particle load (LDL/non-HDL) and metabolic health (TG/HDL).
- Dr. Greg Katz uses TG/HDL ratio to gauge insulin resistance and metabolic syndrome along a continuous spectrum.
Use ApoB To Uncover Hidden Atherogenic Particle Burden
- Order ApoB when triglycerides are elevated or metabolic syndrome is present to detect particle-number discordance.
- Dr. Greg Katz: ApoB often better predicts risk than LDL when TGs crowd cholesterol, and is inexpensive and actionable.
Treat Lp(a) As A Tiebreaker For Aggressive Prevention
- Use Lp(a) as a risk enhancer and tiebreaker for aggressive management when elevated, especially with family history of premature ASCVD.
- Dr. Greg Katz considers Lp(a) >100–150 nmol/L alarming and may push for earlier meds or imaging.