#334 - Cardiovascular disease, the number one killer: development, biomarkers, apoB, cholesterol, brain health, and more | Tom Dayspring, M.D.
Feb 3, 2025
auto_awesome
Tom Dayspring, a leading expert in clinical lipidology, dives deep into the intricacies of atherosclerotic cardiovascular disease (ASCVD), a major global health concern. He explains how ASCVD develops silently over decades, emphasizing the importance of early detection. Dayspring discusses the critical role of apolipoprotein B (apoB) and the often-overlooked risk factors, including insulin resistance and kidney health. Additionally, he explores how cholesterol impacts brain health, debunking myths about statins, and highlights the significance of dietary choices in managing cardiovascular risk.
Atherosclerotic cardiovascular disease (ASCVD) develops silently over decades, highlighting the critical need for early detection and preventive measures.
Key risk factors for cardiovascular disease extend beyond traditional views and include insulin resistance and chronic kidney disease, necessitating personalized prevention strategies.
Apolipoprotein B (apoB) acts as a crucial marker for assessing cardiovascular risk by correlating to the number of atherogenic particles in circulation.
Cholesterol's significant role in brain health is emphasized, noting its unique metabolism in the brain and the potential cognitive effects of statin therapy.
Deep dives
Mission of the Podcast
The podcast aims to make the science of longevity accessible to a general audience, emphasizing the importance of health and wellness content. It strives to provide top-quality information without reliance on paid advertisements, supporting its mission through membership subscriptions. Members receive exclusive content and benefits, designed to enhance knowledge in the health space. This approach reflects a commitment to fostering a well-informed audience motivated to improve their health.
Understanding Atherosclerosis
Atherosclerosis is highlighted as a significant cause of cardiovascular disease, posing risks to both men and women globally. The discussion outlines the pathological processes involved, particularly the deposition of cholesterol in the arterial walls, leading to narrowed arteries and potential blockages. The importance of understanding how this disease develops over time is emphasized, as it can manifest subtly before presenting serious health risks. Educational engagement on this topic is crucial, given its implications for public health.
Risk Factors for Cardiovascular Disease
Various non-modifiable and modifiable risk factors for cardiovascular disease are discussed, including age, family history, smoking, and lipid disorders. The podcast stresses the role of insulin resistance and chronic kidney disease as impactful risk factors, complicating the traditional views centered around high blood pressure and cholesterol levels. Understanding these factors individually allows for more personalized strategies in cardiovascular disease prevention. The conversation seeks to enhance awareness of how these risks can accumulate over time.
The Role of ApoB in Lipid Metabolism
ApoB is identified as a critical factor for cholesterol transport in the body, playing a vital role in understanding cardiovascular health. It serves as a gauge of the number of atherogenic particles circulating in the bloodstream, particularly low-density lipoproteins (LDL). By establishing a clear connection between ApoB levels and cardiovascular disease risk, the discussion aims to inform methods for monitoring and managing lipid-related health. This understanding opens pathways for targeted therapies to reduce cardiovascular risk effectively.
Link Between Cholesterol and Brain Health
Cholesterol's essential role in brain health is a focal point of discussion, underscoring its production within the central nervous system. The conversation explores how cholesterol impacts neuronal function, memory, and cognitive health, with an emphasis on the differences in cholesterol metabolism in the brain compared to the rest of the body. The importance of maintaining a balanced cholesterol level in the brain is highlighted, as excessive cholesterol can lead to neurodegenerative diseases. Understanding these dynamics encourages approaches to support brain health through lifestyle and dietary changes.
Impact of Statins on Cognitive Function
The potential cognitive side effects of statin use are explored, reflecting the ongoing debate regarding their impact on brain health. While statins have been shown to lower cardiovascular risk, a subset of patients has reported experiencing brain fog or cognitive impairment. The conversation contextualizes these effects within the broader framework of cardiovascular treatment goals, comparing statins to newer lipid-lowering agents. This analysis encourages prudent monitoring and individualized treatment strategies for patients on statin therapy.
Future Directions in Lipid Management
Looking ahead, the podcast highlights advancements in lipid management, including the development of new pharmacological agents aimed at lowering ApoB. These innovations promise to improve patient outcomes by offering alternatives to traditional statin therapy. The importance of educating healthcare providers on these emerging treatments is emphasized as critical to optimizing cardiovascular care. Overall, the future landscape of lipid management is poised for transformation, fostering more effective prevention strategies.
The Importance of Education and Research
The podcast underscores the necessity for ongoing education for healthcare professionals about cholesterol and lipid management to enhance patient care. By providing accurate information on the role of lipid markers such as ApoB and LP(a), healthcare providers can make informed decisions regarding risk assessment and management. The importance of patient awareness and understanding of their lipid profiles and risk factors is also emphasized. Commitment to health literacy is framed as key to better patient outcomes and overall public health improvements.
Tom Dayspring is a world-renowned expert in clinical lipidology and a previous guest on The Drive. In this episode, Tom explores the foundations of atherosclerosis and why atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide for both men and women. He examines how the disease develops from a pathological perspective and discusses key risk factors, including often-overlooked contributors such as insulin resistance and chronic kidney disease. He breaks down the complexities of cholesterol and lipoproteins—including LDL, VLDL, IDL, and HDL—with an in-depth discussion on the critical role of apolipoprotein B (apoB) in the development of atherosclerosis. Additionally, he covers the importance of testing various biomarkers, the impact of nutrition on lipid levels, and the vital role of cholesterol in brain health, including how cholesterol is synthesized and managed in the brain, how it differs from cholesterol regulation in the rest of the body, and how pharmacological interventions can influence brain cholesterol metabolism.
The pathogenesis of ASCVD: the silent development over decades, and the importance of early detection for prevention of adverse outcomes [10:45];
Risk factors versus risk markers for ASCVD, and how insulin resistance and chronic kidney disease contribute to atherosclerosis [17:30];
How hyperinsulinemia elevates cardiovascular risk [24:00];
How apoB-containing lipoproteins contribute to atherosclerosis, and why measuring apoB is a superior indicator of cardiovascular risk compared to LDL cholesterol [29:45];
The challenges of detecting early-stage atherosclerosis before calcification appears [46:15];
Lp(a): structure, genetic basis, and significant risks associated with elevated Lp(a) [55:30];
How aging and lifestyle factors contribute to rising apoB and LDL cholesterol levels, and the lifestyle changes that can lower it [59:45];
How elevated triglycerides, driven by insulin resistance, increase apoB particle concentration and promote atherosclerosis [1:08:00];
How LDL particle size, remnant lipoproteins, Lp(a), and non-HDL cholesterol contribute to cardiovascular risk beyond apoB levels [1:21:45];
The limitations of using HDL cholesterol as a marker for heart health [1:29:00];
The critical role of cholesterol in brain function and how the brain manages its cholesterol supply [1:36:30];
The impact of ApoE genotype on brain health and Alzheimer's disease risk [1:46:00];
How the brain manages cholesterol through specialized pathways, and biomarkers to track cholesterol health of the brain [1:50:30];
How statins might affect brain cholesterol synthesis and cognitive function, and alternative lipid-lowering strategies for high-risk individuals [1:57:30];
Exciting advancements in therapeutics, diagnostics, and biomarkers coming in the next few years [2:09:30];
Recent consensus statements on apoB and Lp(a) from the National Lipid Association (NLA) [2:12:30]; and
