What happened in this episode?
Thomas DeLauer interviews Dr Anthony Jay, a researcher and author, about what Jay argues are under-emphasised drivers of atherosclerosis and how cardiovascular risk is communicated in clinical practice. Jay claims insulin resistance is a stronger predictor of early heart attack risk than LDL in large cohort research, and argues modern care over-focuses on cholesterol-lowering targets. He describes Lp(a) as an LDL particle with an added “tail” that binds oxidised byproducts, portraying it as partly protective during infection; he says levels can rise substantially after Covid and disputes the idea that Lp(a) is purely genetic.
Jay makes several allegations about drug evidence and incentives, including that PCSK9 inhibitors and newer lipid drugs are promoted on LDL reduction rather than demonstrated event reduction, and that reanalysis of a major PCSK9 outcomes trial showed higher cardiac deaths in the treatment arm. He also claims statins materially raise diabetes risk and says such trade-offs are not consistently discussed with patients.
On testing, Jay advises measuring fasting insulin and using scores such as HOMA-IR, and he recommends coronary artery calcium (CAC) scanning over CT angiography-based plaque quantification. He alleges CT angiography plaque estimates have large test-retest error and high inter-reader variability, making “plaque reversal” narratives unreliable. The conversation closes with discussion of fasting evidence, Jay’s criticism of a prominent anti-fasting headline, and the role of institutional and commercial pressures in nutrition and cardiology messaging.
