The Peter Attia Drive #185 - Allan Sniderman, M.D.: Cardiovascular disease and why we should change the way we assess risk
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Nov 29, 2021 Allan Sniderman, a leading Professor of Cardiology at McGill University, discusses the merits of using apoB as a more reliable metric for assessing cardiovascular disease risk. He critiques the conventional risk assessment models and their limitations, especially for younger individuals. The conversation covers the complexities of cholesterol, the significance of particle counts, and the importance of nuanced risk evaluations. Allan also emphasizes early intervention and raises concerns about the lack of innovation in current medical practices surrounding cardiovascular health.
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CVD Risk Assessment Flawed
- Cardiovascular disease (CVD) risk assessment should consider causes, like ApoB, not just 10-year risk.
- Current guidelines prioritize age and sex, neglecting premature disease and delaying interventions.
Early Atherosclerosis
- Atherosclerosis begins early, often showing up in autopsies of young adults who died from unrelated causes.
- This highlights the importance of early intervention and prevention, even in those deemed low-risk.
ApoB Superiority
- ApoB, a protein on lipoproteins, is a better CVD risk predictor than LDL cholesterol.
- Counting ApoB particles is crucial because more particles, even with the same cholesterol level, mean higher risk.