Ep. 352 Lipid Masterclass: Apo-B Labs and Women's Heart Health with Dr. Thomas Dayspring
Apr 13, 2024
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Dr. Thomas Dayspring discusses women's heart health, abnormal lipids, ApoB testing, and lifestyle modifications. They delve into ideal lab values, diagnostic limitations, estrogen's impact on LDL clearance, menopause effects, cardiovascular risks for women, and absorption challenges with cholesterol. The podcast explores APOB lab values, genetic factors, diagnostic tests, and hormone therapy for heart health in women.
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Quick takeaways
High APOB levels indicate cholesterol metabolism issues affecting heart health.
Hormone replacement therapy during menopause can prevent heart disease and mortality in women.
Liver function is vital in regulating lipid metabolism and APOB levels, impacting cardiovascular risk.
Deep dives
Understanding APOB and Lipid Abnormalities
When evaluating lipid abnormalities, it is crucial to consider factors like APOB and how the body manages cholesterol absorption and synthesis. A high APOB level can indicate issues with cholesterol metabolism, influencing heart health. Individuals with metabolic issues or genetic predispositions may absorb or synthesize cholesterol in excess, impacting APOB levels. Addressing the underlying causes of high APOB involves strategies to regulate cholesterol absorption, liver function, and LDL receptor activity.
Women's Health Care and Hormone Replacement Therapy
In women's health care, especially during perimenopause and menopause, understanding the impact of hormone replacement therapy (HRT) on heart health is crucial. HRT can play a significant role in preventing heart disease and overall mortality in women. Tailoring HRT to individual needs, considering factors like estrogen levels, genetic predispositions, and cardiovascular risk, can help optimize treatment outcomes. Collaborating with a knowledgeable healthcare provider who understands the complexities of HRT and cardiovascular health is essential for personalized care.
Cholesterol Absorption and Synthesis Mechanisms
Cholesterol absorption and synthesis mechanisms play a significant role in regulating lipid levels and cardiovascular health. Understanding how the body handles cholesterol, both in absorption from the gut and synthesis in the liver, is key to managing lipid abnormalities like high APOB. Factors such as genetic influences, metabolic conditions, and hormonal changes, especially in women approaching menopause, can impact cholesterol metabolism. Therapeutic approaches that target cholesterol absorption and synthesis pathways can help effectively lower APOB levels and improve heart health.
Role of Liver Function in Lipid Regulation
The liver plays a central role in regulating lipid metabolism and APOB levels in the body. Liver function, including cholesterol synthesis, LDL receptor activity, and cholesterol excretion pathways, directly influences APOB and overall lipid profiles. Dysfunctions in liver processes, such as cholesterol overload or impaired LDL receptor function, can lead to elevated APOB levels and increased cardiovascular risk. Therapeutic interventions that support liver health and cholesterol clearance mechanisms are crucial in managing lipid abnormalities.
Personalized Therapy for Lipid Disorders
Personalized therapy for lipid disorders should consider individual factors like cholesterol absorption rates, genetic predispositions, and hormonal influences on cholesterol metabolism. Tailoring treatment approaches to address specific mechanisms contributing to high APOB levels, such as cholesterol absorption blockers or liver function enhancers, can effectively lower cardiovascular risk. Collaborating with healthcare providers knowledgeable in lipid metabolism and personalized medicine can help optimize treatment strategies for managing lipid abnormalities and promoting heart health.
Dr. Thomas Dayspring joins me again today for the third class in our Lipid Masterclass Series. Dr. Dayspring brings a wealth of expertise as a certified specialist in internal medicine and clinical lipidology, holding fellowships with the American College of Physicians and the National Lipid Association.
This hour-long class is devoted to women's health and abnormal lipids. We continue with our conversation about ApoB, discussing ways to look at other lipid abnormalities related to abnormal ApoBs and talking about our ideal lab values and lifestyle modifications, briefly touching on my lipid journey and the medication I have been taking for the past six months. We examine diagnostics and their limitations, getting into CACs, coronary artery calcification scoring, CIMT, the labs we need to look at, the role of Lp(a), and how it affects our heart. We look into the changes women experience from losing estrogen in menopause, clues women can use to predict future cardiovascular risk, how estrogen helps clear LDL from the body, and the changes occurring with menopause, including higher ApoBs. We also dive into risks women face for cardiovascular disease, the impact of the Women's Health Initiative study, and absorption and synthesis challenges with cholesterol.
Stay tuned for more!
IN THIS EPISODE YOU WILL LEARN:
Why ApoB testing for inherited lipoprotein disorders is essential
Why hypo beta lipoproteins (HDL) are critical for maintaining good health
The benefits of a holistic approach to treating high cholesterol
The three stages of prevention for atherosclerosis
How Lp(a) impacts heart health
The importance of assessing early heart function through Lp(a) testing
How your pregnancy history can help in predicting your risk for cardiovascular disease
Why should women be more concerned about cardiovascular disease than breast cancer?
How the Women’s Health Initiative led gynecologists to be more cautious about prescribing HRT
How genetically mediated cholesterol abnormalities can impact our ability to absorb and synthesize cholesterol
Bio:
Thomas Dayspring MD is a Fellow of both the American College of Physicians and the National Lipid Association and is certified in internal medicine and clinical lipidology. After practicing in New Jersey for 37 years, in 2012, he moved to Virginia to serve as an educational director for a nonprofit cardiovascular foundation until mid-2019 as a Chief Academic Advisor for two major CV laboratories. Since then, he has served as a virtual cardiovascular / lipidology educator. Career-wise he has given over 4000 domestic (in all 50 states) and several international lectures, including over 600 CME programs on atherothrombosis, lipids/lipoproteins (and their treatment), vascular biology, biomarker testing, and women’s cardiovascular issues. He has authored several manuscripts and lipid textbook chapters and performed several podcasts. For several years, he was an Associate Editor of the Journal of Clinical Lipidology. He was the recipient of the 2011 National Lipid Association’s Presidents Award for services to clinical lipidology and the 2023 Foundation of NLA Clinician/Educator Award. He has over 34K followers on his educational Twitter (X) feed (@Drlipid). He has Gold Heart Member status as a professional member of the American Heart Association, and he serves as a Social Media Ambassador for the European Atherosclerosis Society and the National Lipid Association.
