The Peter Attia Drive
#23 - Tom Dayspring, M.D., FACP, FNLA – Part IV of V: Statins, ezetimibe, PCSK9 inhibitors, niacin, cholesterol and the brain
Episode guests
Podcast summary created with Snipd AI
Quick takeaways
- Understanding the impact of different lipid-modulating drugs on cholesterol and overall health.
- Significance of personalized lipid management for optimizing health outcomes.
- Balancing cholesterol synthesis and absorption rates for tailored lipid-lowering strategies.
- Individual considerations in statin therapy to account for cognitive effects and liver function tests.
Deep dives
Exploring the World of Lipid-Modulating Drugs
Delving into the realm of lipid-modulating drugs, this episode discusses the impact and mechanisms of various medications. From statins to fibrates and niacin, the podcast sheds light on drug classes and their effects on cholesterol and overall health.
Understanding Fibrates and Their Role in Lipid Control
Fibrates, like fenofibrate and gemfibrozil, are examined for their lipid-lowering abilities, particularly in individuals with elevated triglycerides and low HDL cholesterol levels. The podcast highlights the mechanisms of fibrates in reducing triglyceride-rich VLDL particles and impacting lipid metabolism.
Insights into Fibrates' Clinical Efficacy in Diabetic Patients
The podcast underscores the clinical significance of fibrates, especially in diabetic patients with high triglycerides and low HDL cholesterol. It showcases how fibrates could potentially reduce microvascular complications in diabetes, such as retinopathy, neuropathy, and renal disease.
Considerations for Lipid Management and Personalized Treatments
The discussion delves into the importance of personalized lipid management, emphasizing the need to tailor treatments based on individual lipid profiles and health conditions. The podcast provides insights into the diverse effects of lipid-modulating drugs, offering a comprehensive view of their role in optimizing health outcomes.
Statins and Cognitive Impairment
While statins are considered the backbone of anti-lipid therapy, individual considerations are crucial in their usage. The impact on cognitive function varies among patients, with some showing mild cognitive impairment. Monitoring liver function tests is standard practice, however, elevated transaminases may not always signify statin toxicity, warranting an individualized approach. Statins may have neural and vascular effects, with careful evaluation needed in patients showing cognitive changes.
Desmosterol Levels and Statin Therapy
Desmosterol levels can serve as a marker for cholesterol synthesis, aiding in customized statin management. Lowering cholesterol absorption with ezetimibe alongside statins can modulate desmosterol levels and boost synthesis. Evaluating hyperabsorbers and genetic longevity models can optimize lipid-lowering strategies.
Individualized Approach to Statin Therapy
Personalizing statin therapy based on desmosterol markers and absorption patterns can enhance effectiveness and minimize side effects. Balancing cholesterol synthesis and absorption rates can cater to individual patient needs, maximizing the benefits of lipid-lowering treatment.
Considerations with Statin Therapy
Thorough evaluation of desmosterol levels, genetic factors, and absorption patterns can guide statin therapy customization. The interplay between cholesterol synthesis and absorption presents opportunities for tailored lipid-lowering strategies, promoting optimal outcomes for patients' cardiovascular health.
In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part IV, Peter and Tom review the history and current use of drugs to prevent cardiovascular disease. They also discuss why some drugs appear to be more effective than others, an in-depth conversation about niacin, cholesterol and brain health, and the futility of using CKs (creatinine kinase) and liver function tests to identify adverse effects in statins, to name a few topics in this episode.
We discuss:
- Bile acid sequestrants and statins [2:00];
- Ezetimibe (Zetia) [15:00];
- PCSK9 inhibitors [27:30];
- Fibrates [41:00];
- Fish oil, DHA, and EPA [1:01:00];
- Niacin [1:05:15];
- PCSK9 inhibitors [1:23:45];
- Cholesterol, statins, and the brain [1:30:00];
- Elevated creatine kinase (CK) and liver function tests (LFTs) on statins [1:50:30]; and
- More.
Learn more at www.PeterAttiaMD.com
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