Why Isn’t Lower LDL Ending Heart Disease? – TFP #025 | Philip Ovadia

In this episode of The Feldman Protocol, can heart disease prevention be asking the wrong question? Dave sits down with Philip Ovadia, MD, cardiothoracic surgeon, as the guest makes the case for looking beyond LDL alone. They discuss bypass surgery, why cholesterol-lowering hasn’t erased heart disease, insulin resistance, trial design, statins and PCSK9 drugs, real-food diets, CGMs, and how clinicians think about risk in practice.

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⏱ Chapters
3:04 – Dave sets the frame
9:41 – The preacher’s fallacy
16:22 – What else is cholesterol for?
23:02 – FOURIER stopped early
29:41 – When treatment still fails
36:22 – Who benefits from treatment?
42:59 – The patient mindset
49:40 – Building a new practice
56:21 – Insulin in the hospital
1:02:58 – Cholesterol stays central
1:09:39 – LDL vs A1C tradeoffs
1:16:20 – Politics and processed food
1:22:58 – Plants, meat, and real food
1:29:38 – One diet won’t fit all
1:36:20 – CGMs and self-testing
1:43:01 – Why Ovadia chose surgery
1:49:40 – The challenge of bypass
1:56:18 – VCAM and atherosclerosis
2:02:57 – Surgical feedback loops
2:09:37 – Coming out of surgery
2:16:17 – Arguments from medicine
2:22:56 – Low-carb doctor network
2:29:36 – Podcasting in person
2:36:18 – The diabetic pandemic
2:42:58 – Why disbelief happens
2:49:36 – Shift the focus
2:56:18 – ApoB takes center stage
3:02:58 – Small dense LDL debate
3:09:35 – Patients need clarity
3:16:16 – What the scans show
3:22:58 – Making sense of the paper
3:29:36 – Reading vessel segments
3:36:18 – What 100 hearts can show
3:42:54 – LDL as a distraction
3:49:36 – Arguing the phenotype

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