Everyday Wellness: Midlife Hormones, Menopause, and Science for Women 35+ Ep. 527 HRT Changes Your Lipids More Than You Think – The Surprising Truth About Menopause & Heart Disease with Dr. Thomas Dayspring | Women's Cardiovascular Health
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Dec 10, 2025 
Join Dr. Thomas Dayspring, an internal medicine physician and lipidology expert, as he unravels the surprising effects of hormone replacement therapy on lipids and heart health. He shares insights on choosing the right estrogen, the role of PCSK9 inhibitors, and the surprising cardiovascular signals from GLP-1 treatments. Discover how chronic stress impacts cardiovascular risk and why testing ApoB is crucial for prevention. With actionable strategies and a focus on modern lipid management, Dr. Dayspring's advice is a must for anyone navigating midlife health.
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Monitor ApoB After Hormone Therapy
- After starting menopausal hormone therapy, monitor ApoB because it drives cardiovascular risk more than HDL changes.
- Prefer low-dose oral estradiol with a non-androgenic progesterone and repeat lipid testing to gauge individual response.
PCSK9s: Potent but Restricted
- PCSK9 inhibitors are the most potent ApoB-lowering drugs but are reserved for high-risk patients due to cost.
- Payers require failure of cheaper therapies or clear high-risk status before approving PCSK9 agents.
Personal GLP-1 Experience
- Thomas Dayspring shared his personal use of GLP-1 receptor agonists over many years for weight and insulin sensitivity.
- He credits GLP-1 therapy with helping prevent heart problems and preserving his health into older age.
