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.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter 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 More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

World-renowned lipidologist Tom Dayspring returns to give an update on the current thinking in lipidology as a follow-up to his 2018 five-part podcast series. In this episode, Tom discusses the growing consensus that atherogenic lipoproteins are essential drivers of atherosclerotic vascular disease. Tom further emphasizes apolipoprotein B (apoB) and lipoprotein(a) (Lp(a)). He provides insights into risk assessment, including which lab metrics to use, how to interpret them, and the appropriate therapeutic targets. Additionally, Tom discusses the most recent developments in lipid-lowering drug therapies—from the continued evolution of PCSK9 inhibitors, to the latest understanding of EPA and DHA, and the most recent addition of bempedoic acid to the list of therapeutic agents. We discuss: The latest in the field of lipidology and cardiovascular disease [3:45]; Apolipoproteins—the key to understanding lipid biology [9:30]; ApoB as a preferred metric over LDL-P [16:30]; Therapeutic goals for apoB concentration [21:45]; Drivers of atherosclerosis [34:15]; Overview and current thinking on high density lipoproteins (HDLs)—Is it a useful metric? [37:00]; Lipoprotein(a)—the most dangerous particle you’ve never heard of [55:00]; Are low density lipoprotein triglycerides (LDL-TGs) a useful metric? [1:13:15]; Tom’s preferred lab measurements [1:17:45]; The latest in lipid-lowering therapies [1:21:30]; The different pathways among various lipid-lowering drugs [1:30:45]; The latest on EPA and DHA [1:38:15]; Fibrates—an underappreciated treatment for hypercholesterolemia [1:49:45] and; More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/tomdayspring6  Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.