250. When You Should Worry About LDL Cholesterol with Mike Fave
Jul 19, 2024
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Mike Fave, an expert in cholesterol and cardiovascular health, discusses various topics with Paul including gene mutations, downsides of lowering LDL, money in statins, PCSK9 Inhibitors, and primary vs. secondary prevention in cardiovascular disease. They explore the complexities of lipid lowering drugs and offer insights into understanding true risks for heart attacks.
Importance of comprehensive blood work for assessing cardiovascular health beyond basic lipid panel.
Concern over the financial incentives driving the promotion of lipid-lowering drugs.
Emphasizing the significance of diet quality and lifestyle choices in managing metabolic health.
Linkage between increased consumption of seed oils and rise in cardiovascular diseases.
Debating the risks and rewards associated with medications like PCSK9 Inhibitors and statins.
Deep dives
The Role of Processed Foods in Health
Processed junk food and its impact on health are discussed, highlighting the lack of financial incentive for pharmaceutical companies to promote healthier dietary choices.
Analyzing Lipids and Cardiovascular Risks
The podcast delves into the complexities of lipids, cholesterol, cardiovascular disease, and the implications of different drug therapies such as empedoic acid and statins in lowering cholesterol.
Understanding Blood Markers for Cardiovascular Risk
The importance of comprehensive blood work beyond a basic lipid panel is emphasized, focusing on markers like CRP, homocysteine, and lipoprotein phospholipase A2 to assess cardiovascular health.
The Impact of Diet on Health Outcomes
The significance of diet quality and lifestyle choices in managing metabolic health and reducing the risk of chronic diseases like obesity and cardiovascular issues is underscored, advocating for whole, unprocessed foods for optimal health outcomes.
Implication of Linoleic Acid in Cardiovascular Disease
Linoleic acid has been implicated in cardiovascular disease due to its oxidation products found in individuals with atherosclerosis. Higher amounts of oxidized linoleic acid in atherosclerotic plaques worsen the severity of atherosclerosis. Diets high in oleic acid or low in linoleic acid reduce LDL's susceptibility to oxidation.
Seed Oils and Cardiovascular Disease Trends
The rise in cardiovascular disease coincided with the increased consumption of seed oils around the 1950s and 60s. Evidence points to relationships between metabolic dysfunction, disease processes, and the consumption of omega-6 polyunsaturated fatty acids like soybean oil and canola oil.
Considerations on Lowering LDL with Drugs
The discussion on medications like Bempedoic Acid and PCSK9 Inhibitors raises concerns about their long-term effects on nutrient deficiencies, biochemical pathways, and overall health. The marginal benefits in reducing cardiovascular endpoints may not outweigh the risks involved, especially in healthy individuals.
Risk-Reward Profiles of Cholesterol-Lowering Drugs
Assessing drugs like Bempedoic Acid and PCSK9 Inhibitors in terms of their mechanisms, effects on all-cause mortality, side effect profiles, and long-term concerns reveals the complexities in comparing the risks and rewards associated with these medications.
Evolocomab vs. Alirocumab in PCSK9 Trials
Evolocomab and Ali-ROCUMAB, two PCSK9 inhibitors, showed contrasting effects in clinical outcome studies. While Ali-ROCUMAB decreased the risk of all-cause mortality, Evolocomab demonstrated an increased risk of mortality compared to placebo groups. The risk of certain adverse events like neurocognitive events and diabetes mellitus was not statistically significantly increased with PCSK9 inhibitors.
Statins & Risks Associated with Treatment
Statins, commonly used for cardiovascular risk management, have mixed results in clinical studies. While some studies show a marginal benefit for acute coronary syndrome patients, the overall mortality reduction from statins remains questionable. Known side effects of statins include myopathy, cognitive dysfunction, hepatotoxicity, and increased risk of diabetes. The pleiotropic effects of statins, such as anti-inflammatory benefits, are debated regarding their actual impact on cardiovascular health.
Today, Paul and Mike unpack their opinions about lipids. They talk about true risk for cardiovascular disease, primary versus secondary prevention, lipid lowering drugs, and share their thoughts on a recent podcast episode with Peter Attia.
*Produced by Mountain Valley Media
00:06:08 Blood markers & imaging techniques of metabolic function
00:14:38 Gene mutations
00:20:28 LDL & Plaque burden
00:27:23 Money in statins
00:31:38 Downsides of lowering LDL
01:21:23 The downsides of popular cholesterol lowering drugs
01:41:07 Should we fear heart attacks?
01:45:23 PCSK9 Inhibitors
01:52:43 Risk profile of Statins
01:53:02 Risk vs. reward of Ezetimibe
02:04:02 Primary vs. secondary prevention
Resources:
Debunking Sugar Claims: What Dr. Lustig Got Wrong On The Huberman Podcast:
