Larry Kaskel, MD

I have written here before about my growing conviction that coronary artery disease is not just about LDL, inflammation, or bad luck. It is time to talk about what might be the elephant in the cath lab: infection.

A recent pathology study out of Japan looked at coronary plaque samples from patients with symptomatic CAD. Using both immunohistochemistry and PCR, they found Chlamydia pneumoniae in every single sample. All fifty plaques …

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For decades, neurology has told us that Alzheimer’s disease is caused by toxic proteins (amyloid plaques and tau tangles) that clog the brain. Pharmaceutical companies have poured billions into anti-amyloid drugs designed to wash them away. The results? Repeated failures, high-profile disappointments, and a handful of marginal approvals with no meaningful improvement in patients’ lives. Sound familiar? In cardiology, we’ve built an entire industry on lowering LDL cholesterol. Statins move …

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We have all been told the story: High cholesterol leads to heart disease, and statins are the magic bullet. The JUPITER trial, published in The New England Journal of Medicine in 2008, became one of the most heavily publicized pieces of “proof” supporting that belief. It claimed that rosuvastatin significantly reduced heart attacks, strokes, and cardiovascular events, even in people with normal LDL cholesterol levels.

But what if I told you …

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He literally rolls into my office every three months, shoes still clipped to his carbon-fiber lifestyle. Lycra damp, Apple Watch buzzing, resting heart rate of 42. He is fit, smart, and tightly wound.

“Doc,” he begins, eyes wide, “I read that morning workouts burn more fat and lower clotting factors. Should I move my rides earlier? Or maybe late evening is better for heart rate variability?”

This is a man who, when …

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I see it every week in my practice: Patients obsessed with their cholesterol numbers. LDL, HDL, triglycerides, the full alphabet soup. They have been trained to believe these numbers hold the keys to life and death.

But here is something I cannot stop thinking about: When you look under the microscope, an atherosclerotic plaque (the thing that clogs arteries and leads to heart attacks) looks an awful lot like a tuberculosis …

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I am an internist and, once upon a time, a card-carrying lipidologist. I have spent years watching medicine’s “standards of care” quietly stretch like elastic waistbands. What begins as a targeted therapy for a small group of high-risk patients slowly expands until everyone and their grandmother is expected to be on it. That phenomenon has a name: guideline creep.

How it works

The cycle is simple:

• A landmark trial shows benefit in

…

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As physicians, we are trained to prescribe, to fix, to optimize. Our patients expect it, and frankly, so do we. I built a career around lipid panels, trial data, and prescriptions meant to shave percentage points off cardiovascular risk. But lately, I find myself offering something far less high-tech and far more radical: a walk.

Walking is slow. Impractical. Rarely the efficient choice. Which is exactly why it matters.

Everywhere around us, …

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As a practicing internist and lipidologist, I have long been trained to believe in the cholesterol hypothesis. Statins were not just recommended; they were the gospel. Lower LDL, save lives. That mantra was repeated at every lecture, every conference, every guideline committee.

But like many dogmas in medicine, the cracks are there if you dare to look. And some of the most damning cracks are found in a set of randomized …

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In my practice, I care for many patients obsessed with longevity. They fast, they microdose, they meditate, they cold plunge, they gulp down supplements by the handful. They optimize their labs with the fervor of a hedge fund manager optimizing a portfolio. They read Peter Attia and Andrew Huberman like scripture.

And yet, they still die.

This is not cynicism; it is reality. Over the years, I have watched patients do everything …

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As a physician, I spend most of my days telling patients to walk more, eat better, stress less, and maybe, just maybe, go to bed before midnight. So when I came across a piece on ancient Roman and Greek health habits, I had to laugh. Turns out, they were doing a lot of things right — without fitness trackers, $12 smoothies, or a trillion-dollar wellness industry.

We like to think of …

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A new gene-editing therapy just dropped LDL cholesterol by 69 percent — with a single injection. One shot, permanent effect. Cue the headlines: “Game-changer!” “End of statins!” “Revolution in heart disease!”

Here we go again.

Let’s be clear: I’m not anti-innovation. I’m not against gene therapy. I’m against making the same mistake again and again, just with better marketing and shinier tools.

VERVE-102 is the latest miracle-in-a-vial — a CRISPR base-editing therapy that …

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Coronary artery disease is still the world’s number-one killer.

That’s despite statins, PCSK9 inhibitors, stents, bypasses, and decades of lifestyle messaging.

We’ve gotten better at managing heart attacks, but we haven’t cured heart disease. Or prevented it. Or even figured out exactly what causes it.

As an internist and lipidologist (in recovery), I spent years chasing cholesterol numbers, especially HDL. I gave talks for Abbott. I pushed niacin like it was salvation. Then …

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For decades, you were told that whole milk was the devil in a glass. Doctors (including me), dietitians, and public health agencies told you to toss the red cap and grab the blue — skim, 1 percent, or 2 percent milk. Why? Because whole milk had fat. And fat, particularly saturated fat, was supposed to clog your arteries like grease in a kitchen drain.

Except we were wrong.

The fat in whole …

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In the late 1970s, a Japanese biochemist named Akira Endo discovered a compound from fungus that inhibited HMG-CoA reductase, the enzyme responsible for making cholesterol. It was an academic curiosity at the time. No one knew if lowering cholesterol would prevent heart attacks—it just lowered a number on a lab slip.

That compound eventually became lovastatin, and in 1987, Merck brought it to market with no proof of improved outcomes—only a …

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