Dr Scott Murray – Is IVUS Plaque ‘Regression’ Just Measurement Noise?

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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