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

**Peter Attia** (0:04)
Hey, everyone, welcome to The Peter Attia Drive. I'm your host, Peter Attia.
The Drive is a result of my hunger for optimizing performance, health, longevity, critical thinking, along with a few other obsessions I've gathered along the way. I've spent the last several years working with some of the most successful top-performing individuals in the world. And this podcast is my attempt to synthesize what I've learned along the way to help you live a higher-quality, more fulfilling life. If you enjoy this podcast, you can find more information on today's episode and other topics at peterattiamd.com.
In this podcast, I'm speaking with Dr. Ron Krauss. First and foremost, Ron is a very close friend and an amazing mentor. I was introduced to Ron probably five years ago and have worked with him closely in a number of capacities.
And he's always served as sort of one of the three or four lipidologists that when I get stumped on a really difficult clinical case, he's the person that I'm reaching out to, along with a couple of these other folks that hopefully we'll also have on the podcast at some point. So he is certainly recognized globally for his research in lipidology. He wears a ton of hats. He's a clinician, obviously a lipidologist. His interest in nutrition, genetics, drug research is quite profound.
He obtained, I believe, both his college degrees and medical degrees from Harvard. He's board certified in internal medicine, endocrinology, and metabolism. And currently he's a senior scientist and the director of atherosclerosis research at the Children's Hospital in Oakland. So in this episode, we talk about a lot of stuff, but obviously we're really focusing on atherosclerosis and cardiovascular disease. I was really excited to have this discussion with him because a lot of these topics, I've certainly covered in writing. As some of you may know, I have that sort of nine-part straight dope on cholesterol series on the blog that I probably wrote about four or five years ago. Obviously some of that's a little bit outdated. And I also was quite deliberate when I wrote that not to be prescriptive, meaning I don't really get into this is the drug treatment you would do for this. And I largely avoided a lot of that stuff. Whereas in this podcast, Ron and I get a little bit into this. This podcast was pretty technical at times.
So my hope is that both the curious patient will get a lot out of that. And hopefully the physician will get a lot out of this or the person that is also kind of on the front lines of having to make decisions about how to treat dyslipidemia and reduce the risk of atherosclerotic disease. I think a couple of really interesting things in this. I actually for the first time learned about Ron's motivation for this, both his family history and the five legendary articles that he read in the New England Journal of Medicine that largely shaped his career. This is the stuff we talk about with Friedrichsen, Levy and Lees, who I've written about in the cholesterol series because these guys are sort of the fathers of this space. We certainly get into one of the age-old debates about LDL particle size versus particle number. Lots of controversy here, and I don't represent that we've necessarily resolved it, but I think that's the beauty of talking with really smart, sophisticated, nuanced people is they have the humility to say we don't know the answer sometimes.
We really dive deep into the whole statin discussion. For reasons that aren't entirely clear to me, this has become an increasingly controversial area, and somehow it's turned into a binary discussion. Statins are good or statins are bad, and very few things in life tend to be that binary, so I'm sort of surprised that it's turned into that. I don't remember if I even say this on the podcast, but certainly people have probably heard me say this before, and I say it to patients all the time. Statins are tools, and the most important thing when you have a tool is knowing how to use it and knowing when to use it. So if you have a Phillips screwdriver, it's really important to know that it's very good at putting Phillips screws into things. It's not good at putting nails into things. It's not good at cleaning windows. So I hope we can shed some light on that. We talk a little bit about the really interesting and recent stuff around chronic inflammation and the role that that plays in atherosclerosis, even independent of cholesterol levels. And perhaps for me personally, one of the most interesting things we discussed was another very controversial topic, which is around niacin and niospan, which is a branded version of that. Those of you who follow this world will know that niacin was basically kicked to the curb a couple of years ago. And I think that Ron's insights into that are incredibly interesting and actually have even made me re-question or re-evaluate, I guess, my willingness to ever consider using it again. Ron does a great job explaining the HDL paradox, meaning why is it that all the pharmacologic efforts to raise HDL seem to also raise heart disease or at best make it no better.