The Proof with Simon Hill Preventing and treating cardiovascular disease (Lipid Series - Part 3) | Dr Thomas Dayspring
Lifestyle Helps But Drugs Needed
- Lifestyle improvements reduce many chronic diseases, but cannot eliminate atherosclerotic heart disease entirely.
- Pharmacological interventions are necessary to achieve physiologic ApoB levels seen in children.
Statins' Key Mode of Action
- Statins inhibit cholesterol synthesis mainly in the liver to upregulate LDL receptors.
- Most LDL cholesterol/ApoB reduction occurs at the lowest statin dose; higher doses yield smaller incremental benefits.
Use Desmosterol to Monitor Brain Risk
- Monitor serum desmosterol to gauge brain cholesterol synthesis when on statins.
- Stop statin dose escalation if desmosterol approaches the 20th percentile to avoid cognitive risks, especially in dementia-prone individuals.
Episode #253. In Part Three of the blood lipids series, we take a deep dive into interventions to lower the risk of atherosclerotic cardiovascular disease (ASCVD). While nutrition is the most powerful lifestyle tool we have to dramatically decrease ApoB, there certainly remains a need for pharmacological interventions – and in this episode, Dr Thomas Dayspring and I walk through four main drug classes, discussing their mechanism of action, effectiveness, and safety profile.
We discuss:
- Intro (00:00)
- Evolution of cardiovascular disease treatments (03:42)
- Are we becoming a drug-dependent society? (07:30)
- Bile acid sequestrants, statins, and more (13:54)
- Cholesterol-lowering drugs and cognition (35:12)
- Is Bempedoic acid a good statin alternative? (47:39)
- Ezetimibe and nuances you should know (55:46)
- PCSK9 inhibitors (1:03:32)
- Do statins increase the risk of diabetes? (1:14:58)
- Gene therapy targeting PCSK9 (1:19:20)
- Pelacarsen for lowering Lp(a) (1:23:48)
- Can we take drugs that raise HDL to lower cardiovascular disease risk? (1:26:38)
- HDL and atherosclerosis (1:34:59)
- Elevated triglycerides and atherosclerosis (1:46:48)
- Takeaways (2:05:12)
- Outro (2:08:31)
The best place to connect with Dr Thomas Dayspring is on Twitter, @DrLipid. Learn more about Dr Dayspring’s career and current work on LinkedIn.
Head to The Proof website for the full show notes, including supporting studies and my key takeaways.
To assist with the digestibility of this content, Dr Dayspring, my team, and I have included extensive illustrations and graphs in the video format of these episodes. If you are visually inclined, you can watch these episodes on The Proof YouTube channel. Even if you prefer listening through audio the first time, I highly recommend coming back for a second pass with the video versions. These episodes are investments into a healthier future.
Get your copy of the Lipid Series Cheat Sheet at theproof.com/lipidseries. This comprehensive resource provides valuable insights on assessing your risk, preventing, and treating atherosclerotic cardiovascular disease (ASCVD), the leading cause of death worldwide. The PDF not only highlights key learnings from the 3-Part Lipid Series but also includes a 1-week meal plan designed to promote healthy cholesterol levels.
Enjoy, friends.
Simon
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Simon Hill, MSc, BSc (Hons)
Creator of theproof.com and host of The Proof with Simon Hill
Author of The Proof is in the Plants
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