Allan Sniderman, a leading expert in lipoprotein metabolism, and Tom Dayspring, a specialist in atherosclerotic cardiovascular disease (ASCVD), share their insights on cardiovascular health. They discuss the limitations of standard lipid metrics and highlight apoB as a superior risk assessment tool. The conversation dives into the importance of early intervention and challenges misconceptions around cholesterol, advocating for proactive measures against ASCVD. Discover how understanding these factors can significantly alter prevention strategies.
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insights INSIGHT
Atherosclerosis's Inevitability
Atherosclerosis is the only inevitable disease; everyone dies with it, given sufficient lifespan.
Mitigating atherosclerosis impacts longevity by delaying chronic disease onset.
question_answer ANECDOTE
Sudden Death
In medical school, Peter Attia learned that sudden death is the most common first heart attack presentation.
This highlights the importance of early awareness and prevention.
insights INSIGHT
ASCVD Progression
ASCVD involves cholesterol buildup in artery walls, starting as fatty streaks and progressing to plaques.
This buildup reduces blood flow, causing ischemia and potentially fatal heart attacks.
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In this special episode of The Drive, we have pulled together a variety of clips from previous podcasts about cardiovascular disease to help listeners understand this topic more deeply, as well as to identify previous episodes which may be of interest. In this episode, Peter highlights the importance of understanding cardiovascular disease and why early intervention is critical. He also provides a primer on lipoproteins and explains the fallacy of the terms “good cholesterol” and “bad cholesterol.” Allan Sniderman discusses the metrics measured in routine blood work – along with the limitations of those standard panels – before explaining why apoB is a superior metric for determining risk. Additionally, Tom Dayspring explains the causal role of apoB in atherosclerotic cardiovascular disease (ASCVD) and the therapeutic goals for apoB concentration, and Peter explains how early and aggressive lowering of apoB could change the landscape of cardiovascular disease prevention.
We discuss:
The importance of understanding atherosclerosis early in life [2:25]
Defining ASCVD, its causes, and the role of cholesterol [8:00];
Why early prevention of atherosclerosis is critical [13:45];
Preventing atherosclerosis—two fatal flaws with the “10-Year Risk” approach [16:00];
Intro to lipids and lipoproteins: why there is no “bad” or “good” cholesterol [23:00];
Limitations of standard blood panels [35:45];
How Mendelian randomization is bolstering the case for apoB as the superior metric for risk prediction [39:30];
Therapeutic goals for apoB concentration [58:15];
How early and aggressive lowering of apoB could change the course of ASCVD [1:10:45]; and
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