July 2, 2018

Podcast

#03 – Ron Krauss, M.D.: a deep dive into heart disease

"Anybody interested in this field should probably understand the origins." —Ron Krauss

by Peter Attia

Read Time 6 minutes

Whenever I’m stumped on a patient case, or in my thinking about lipids, Dr. Ron Krauss is one of the first people I turn to for insight. I’m not alone. Ron is recognized globally for his research into lipidology and has worn many hats in his career, including clinician, lipidologist, nutrition, genetics, and drug researcher. He received both his undergraduate and medical degrees from Harvard and is board certified in internal medicine, endocrinology, and metabolism. He’s currently the senior scientist and director of atherosclerosis research at Children’s Hospital in Oakland.

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My hope is that both the curious patient and the physician can get a lot out of this episode by being more informed about dyslipidemia and the interventions used to reduce the risk of atherosclerotic disease, cerebrovascular disease, and peripheral vascular disease.

We discuss:

  • The pathogenesis of atherosclerosis;
  • How early atherosclerosis begins;
  • Ron’s motivation for getting into lipidology;
  • How reading an article series in the NEJM in 1967 had a profound impact on him and his career;
  • The “battle” between LDL particle size and particle number;
  • The use of statins;
  • The role of chronic inflammation in atherosclerosis;
  • Why niacin may have been unjustly dismissed as a therapeutic option;
  • The HDL paradox: why drugs that raise HDL-C seem to elevate (or have little impact on) heart disease risk;
  • Mendelian randomization: nature’s randomized trial;
  • How PCSK9 inhibitors work and why they may be underutilized;
  • Lp(a); and
  • More.

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Ronald Krauss, M.D.

Ronald M. Krauss, M.D., is the:

  • Senior Scientist and Director of Atherosclerosis Research at Children’s Hospital Oakland Research Institute;
  • Adjunct Professor in the Department of Medicine at UCSF and in the Department of Nutritional Sciences at UC Berkeley; and
  • Guest Senior Scientist in the Department of Genome Sciences of Lawrence Berkeley National Laboratory.

He received his undergraduate and medical degrees from Harvard University with honors and served his internship and residency on the Harvard Medical Service of Boston City Hospital.

He then joined the staff of the National Heart, Lung, and Blood Institute in Bethesda, Maryland, first as Clinical Associate and then as Senior Investigator in the Molecular Disease Branch.

Dr. Krauss is board-certified in internal medicine, endocrinology and metabolism, and is:

  • a member of the American Society for Clinical Investigation;
  • a Fellow of the American Society of Nutrition and the American Heart Association (AHA); and
  • a Distinguished Fellow of the International Atherosclerosis Society.

He’s a member of the U.S. National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, founder and past Chair of the AHA Council on Nutrition, Physical Activity, and Metabolism, and a National Spokesperson for the AHA.

Dr. Krauss has also served on both the Committee on Dietary Recommended Intakes for Macronutrients and the Committee on Biomarkers of Chronic Disease of the Institute of Medicine of the National Academy of Sciences.

He has received numerous awards including the AHA Scientific Councils Distinguished Achievement Award and the Centrum Center For Nutrition Science Award of the American Society for Nutrition, and he is listed in Who’s Who in America and the World.

Dr. Krauss is on the editorial boards of a number of journals and is Associate Editor of Obesity.

Dr. Krauss has published nearly 400 research articles and reviews on genetic, dietary, and drug effects on plasma lipoproteins and coronary artery disease.

In recent years Dr. Krauss’ work has focused on interactions of genes with dietary and drug treatments that affect metabolic phenotypes and cardiovascular disease risk. [chori.org]

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  1. @Peter&Team – Big fan and avid (non-scientist) listener. One big question remains for me: As an avg 30yo male, I need 360deg baseline view of my body’s metrics, that I can then investigate (DIY). What myriad of tests could be requested to create a “Personal Health Thumbprint”? Goal- over time understand my outliers, predispositions, and experiment w/learning. Applied Podcasts vs Interesting Podcasts…

    Thanks!
    Sean F

  2. Hi Dr. Attia,

    I’ve been following your writings and lectures for quite some time, and greatly enjoy this website/podcasts, even though I am not a medical professional I find your analysis and insights on the connections between health, nutrition and longevity fascinating.

    Listening to this talk with Dr. Krauss was very interesting, the level of knowledge shared was amazing and although I lost track of some of the more technical aspects, I think I managed to follow (will not pretend to understand) most of it.

    One question that did come up while listening, and I was wandering about, is about the use of Statins which you both (as I understand) recommend. Since it is contrary (I think) to some views promoted by other MD’s, that they are not only
    ‘not benign’ but mostly useless. This is especially true when marketed as a wide range ‘good for all/does no harm’ preventative treatment. So the harm from taking them may outweigh the benefits.
    Having said that, I wanted to ask this question – how relevant are the opinions expressed concerning the development of CVD and the importance of having ‘low cholesterol’, to those of us following a ketogenic diet, compared to the general population? I am assuming that most of the patients walking into your clinics are eating a SAD/mostly SAD diet, and therefore there are some differences in the implications of seeing a high LDL-C/P when on a different diet?

    Thanks,
    Modi

  3. This was a great podcast and worth a second listen! Thanks to both of you!! In response to the podcast I checked in with my doc re: niacin supplementation. Currently, he’s got me on a K/D supplement to address elevated APOb-we’re gonna retest after 6 months. He said K/D supplementation was better b/c the niacin flush was problematic for many individuals at the efficacious dose. It would be great to read a thoughtful comparison of the two supplementation approaches (pros, cons etc). It would also be interesting to know if doing both K/D supplementation and lower dose niacin would have a synergistic beneficial (or antagonistic deleterious) effects.

  4. Dr. Attia, this is a great discussion and very educational. However I am curious about a couple things I would love to see you address. This discussion was focused on using statins. I would like to understand, or have a future podcast address, what diet and lifestyle treatments you recommend before, or in parallel with, statins and other prescription drugs. For example, a moderate carb Paleo diet or low carb ketogenic paleo diet. Also, given the unknown longer term outcomes >5yrs from statin usage and the shorter term no reduction in mortality outcomes, and all the side effects of statins, how statins are a preferred treatment.

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