You can't stent a capillary: Why aging starts in your smallest blood vessels

What if the real driver of aging isn't your mitochondria or your telomeres but the tiny capillaries you never think about? Double board-certified emergency and internal medicine physician Kenneth Ro returns to the show to make a compelling case that microvascular decline is the overlooked upstream force behind nearly every disease of aging. In this episode, based on his KevinMD article "How the microvasculature drives the human aging process," he explains why your body shuts down capillaries you stop using through a process called capillary rarefaction, and how that quietly starves tissues of oxygen long before symptoms appear. You will hear how microvascular disease connects diabetic complications, heart failure with preserved ejection fraction, and even sepsis under one unifying framework. He also shares why exercise works at a level deeper than most clinicians discuss, what GLP-1 agonists may be doing to your pericytes, and why VO2 max and heart rate variability are your best windows into microvascular health. This episode will change how you think about what it truly means to age well. Tune into our episode "2026 Cholesterol Guidelines: LDL goals, lipoprotein(a), and coronary calcium scoring," brought to you by Novartis Pharmaceuticals Corporation. For the first time in eight years, LDL cholesterol goals have changed, and preventive cardiologist Seth Baum says the new guidelines are a long-overdue course correction. He breaks down the new LDL targets for your highest-risk patients, why the LDL hypothesis should be retired in favor of the LDL fact, why lipoprotein(a) screening finally belongs in every patient's workup, what a coronary calcium score over 300 really means for how aggressively you treat, and how to talk to statin-skeptical patients without losing their trust. Listen now at KevinMD.com/cholesterol. VISIT SPONSOR → https://kevinmd.com/cholesterol Partner with me on the KevinMD platform. With over three million monthly readers and half a million social media followers, I give you direct access to the doctors and patients who matter most. Whether you need a sponsored article, email campaign, video interview, or a spot right here on the podcast, I offer the trusted space your brand deserves to be heard. Let's work together to tell your story. PARTNER WITH KEVINMD → https://kevinmd.com/influencer SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended