The Peter Attia Drive #23 - Tom Dayspring, M.D., FACP, FNLA – Part IV of V: Statins, ezetimibe, PCSK9 inhibitors, niacin, cholesterol and the brain
5 snips
Oct 18, 2018 AI Snips
Chapters
Transcript
Episode notes
Statins and LDL Receptors
- Statins' primary benefit comes from upregulating LDL receptors in the liver, enhancing LDL particle clearance.
- Direct cholesterol synthesis inhibition in cells outside the liver is less important.
Ezetimibe's Dual Action
- Ezetimibe (Zetia) works by inhibiting the Niemann-Pick C1-like protein, reducing cholesterol absorption in the gut and liver.
- This dual action depletes liver cholesterol, triggering increased LDL receptor expression.
Zetia Trials and ApoB
- Zetia trials may have provided limited value due to focusing on IMT, a poor surrogate for clinical outcomes.
- A better approach would have been to target hyper-absorbers or focus on apoB reduction.