EP301: Discussing Bad cholesterol and CAD Dr Kostner and Dr Sangster

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Episode Summary Dr. Warrick Bishop, a cardiologist and CEO of the Healthy Heart Network, hosts this episode featuring Dr. Karam Kostner (joining from Austria) and Dr. Tony Sangster (from Adelaide). The discussion focuses on the complex relationship between LDL cholesterol and coronary artery disease, exploring why cholesterol levels alone don't accurately predict heart disease risk and examining the nuances of different cholesterol particle types. Key Takeaways: High LDL cholesterol is recognized by cardiologists as a main driver of coronary plaque formation, though not everyone with high LDL develops coronary artery disease. Not all LDL cholesterol particles are equal; Ronald Krauss's research identified different particle sizes (large fluffy "A pattern" versus small dense "B pattern"), with small dense particles showing much greater correlation with heart disease. Cholesterol levels alone are poor predictors of who will develop heart disease—people with high cholesterol can have healthy arteries and vice versa, making prediction challenging without additional assessment. For people with established coronary disease (previous heart attacks, strokes, or bypass surgery), over 25 years of robust research confirms that lowering cholesterol significantly reduces future cardiac risk. Imaging the arteries (coronary calcium scores or carotid artery imaging) provides better individual assessment of cholesterol's actual impact on arterial health than blood tests alone. The triglyceride-to-HDL ratio is a useful marker: ratios below 1.5 indicate predominantly favorable large LDL particles, while elevated triglycerides correlate with problematic small dense particles. Even large, favorable LDL particles can contribute to plaque formation if present in excessive quantities, as particle size difference alone doesn't completely eliminate risk. High triglycerides in diabetic patients increase risk of microvascular complications affecting small blood vessels in organs like the eyes, kidneys, and extremities. Low-carbohydrate diets may naturally reduce triglyceride levels and improve the LDL particle profile, offering a potential dietary approach to managing these risk factors.