Ronald Krauss

So we've talked to, you know, Matt Putoff about CAC testing.

We've talked to Ronald Krauss about lipidology.

We talked to Kevin Mackey about interventions, particularly on the sort of nutrition side.

And so, you know, we were supposed to actually do this conversation a few months ago and we had to reschedule it, which I think has actually been beneficial because the guidelines we're going to spend a lot of time on today are now sort of out in the world.

You mentioned there the small dense particles and I think it's worth spending another minute on the physiology here because the story that you'll often hear again in the sort of online circles about why ApoB is better than LDL is because of that distinction that ApoB is a true count of all the dangerous particles and LDL could is counting both the large fluffy ones and the small dense ones.

And again, the simplification you'll often hear is that the small dense ones are the dangerous things.

I mean, Ronald Krauss talked about this a little bit.

Mackey talked about this as well, that it's not that the large fluffy ones are completely benevolent.

We have.

I reached out to Peter when I wanted to write the Journal of Clinical Lipidology report, and he very nicely declined, saying that he wasn't an expert on this and that I should talk to someone like Ronald Krauss.

We talked to him.

Now he's senior author on that.

I looked at the trial, and there were some major issues with it.

Um, we ended up writing a letter to the editor, which is the thing you do as an academic, right? You're like, "Okay, I have qualms about your data, so I'm going to write a fancy letter to you." [laughs] Uh, anyway, but I, I know how this thing works, so I recruited a fellow, um, full professor MD PhD who I know, uh, from Oxford, and then one of the most highly respected lipidologists in the world, somebody big in the, like, heart health lipid field named Ronald Krauss.

Uh, and we got-- I got them to write this letter with me, sign on to it, so it carried a lot of weight, and then we wrote to the journal saying, "You actually have this problem with your study." I don't wanna lose people because it's not really the thrust of the story, but I will describe the problem, which is, um, basically what they were doing is they were reporting this massive benefit of LDL lowering to a target of fifty-five, um, which is pretty low versus seventy.

But first of all, the effect they were reporting was like biologically implausible, like it couldn't really occur.