In this episode of The Feldman Protocol, how much does metabolic health shape cardiovascular risk beyond what standard lipid markers can reveal? Dave Feldman sits down with Scott Murray (MD), a UK-based interventional cardiologist, to explore plaque imaging and its limitations, the role of visceral and perivascular fat in heart disease, the lipid energy model and lean mass hyper-responders, cardiac fuel metabolism and heart failure with preserved ejection fraction, and the challenges of conducting and interpreting cardiovascular trials.
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⏱ Chapters
0:00 – Cold open & Scott's intro
14:21 – Scott's cardiology practice
17:28 – Invasive vs. CT angiography
24:49 – Collaterals & microvascular function
34:31 – Glycocalyx & endothelial health
40:28 – Perivascular fat & imaging
51:14 – Imaging, CAC, and plaque noise
1:00:04 – Lipid hypothesis & population context
1:07:05 – CT plaque measurement variability
1:19:42 – Perivascular inflammation & Caristo scoring
1:29:07 – Lipid energy model discussion
1:49:43 – LP(a), acute-phase markers & reverse causation
2:05:01 – LMHR study timeline & next scans
2:22:57 – Heart fuel preference & HFpEF
2:39:08 – PCSK9 trials & all-cause mortality
2:52:06 – Run-in periods & trial design concerns
3:05:00 – Context, guidelines & patient conversations
3:17:35 – GLP-1 peptides & obesity biology
3:26:28 – Where to find Scott & closing thoughts
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