In this episode, we discuss: 00:00:00 - Intro 00:00:10 - Problems with the current 10-year risk assessment of cardiovascular disease (CVD) and the implications for prevention 00:14:32 - A primer on cholesterol, apoB, and plasma lipoproteins 00:22:07 - Pathophysiology of CVD and the impact of particle cholesterol concentration vs. number of particles 00:28:45 - Limitations of standard blood panels 00:33:10 - Remnant type III hyperlipoproteinemia-high cholesterol, low Apo B, high triglyceride 00:39:26 - Using apoB to estimate risk of CVD 00:42:57 - How Mendelian randomization is bolstering the case for ApoB as the superior metric for risk prediction 00:53:47 - Hypertension and CVD risk 01:05:49 - Factors influencing the decision to begin preventative intervention for CVD 01:11:37 - Using the coronary artery calcium (CAC) score as a predictive tool 01:23:27 - The challenge of motivating individuals to take early interventions 01:26:30 - How medical advancement is hindered by the lack of critical thinking once a “consensus” is reached 01:33:24 - PSK9 inhibitors and familial hypercholesterolemia: two examples of complex topics with differing interpretations of the science 01:39:49 - Defining risk and uncertainty in the guidelines 01:46:07 - Making clinical decisions in the face of uncertainty 01:51:58 - How the emphasis on consensus and unanimity has become a crucial weakness for science and medicine 01:59:58 - Factors holding back the advancement of apoB for assessing CVD risk, treatment, and prevention strategies 02:11:44 - Advantages of a 30-year risk assessment and early intervention
Allan, oh my. I could listen to him for 2 hours and 25 minutes! And I always forget that Peter is a great interviewer among all the other things he does so well. I like to hear about particle size, and wish Allan would have taken us deeper through his thoughts on that. Grateful to get stuff like this. What a gift.
Hi Peter , There have been a number of replies referencing Dr Malcolm Kendricks latest book "The clot thickens" which gives a more plausible hypothesis to CVD causation than just "APoB particles get stuck in the arterial walls" and infact does a great job of debunking this myth. Would be amazing if you and Alan could take a look into this , even better interview Malcolm so we can actually get to the truth of what is happening. I would love to hear your rebuttal to his hypothesis , so far he's just been ignored. Look forward to your reply.
Now let's talk about the significant increase of apoB in low/zero carb diets.. it's important to look at the context. Would be great if you can talk about it in the future. Thanks again for sharing.
I’m a cardiologist, MD, PhD; I didn’t go to Ivy League schools, but I felt I had very good training. This level of discussion is not found in medical school training. Thank you for the free CME. It’s the third time I hear this discussion and I am finishing his book to understand lipidology a little better. I absolutely agree that the science was dumb down and that somehow we got stuck in the 1990s. But I feel that things are changing slowly.
Your accuracy and honesty are refreshing. As a clinical pharmacist/drug info devotee, I've worked with residents who have a huge STATIC knowledge of general medicine. As they progress (especially into subspecialties) they don't really have the time to take a deep dive into many subjects, so they rely on associations to steer them. Personally I like following top notch resources (e.g. Allan Sniderman, Peter Attia, Tom Dayspring, Gil Carvalho) in specific areas.
May I ask the book you are reading ? I enjoy these conversations. I am a FNP . In family medicine these convos do not happen . I try to stay on the cutting edge of medicine. Thank you for your contribution
Dr. Sniderman, I am a clinical pharmacist and I did a presentation for our patient centered medical home which houses approx 30 primary care doctors - the physicians and providers are likely going to make apoB standard of care within our institution and it’s due to your amazing work. We commend you! Knowledge is power and it’s helpful to step out of the echo chamber of the AHA/ACC guidelines and into the primary literature to critically evaluate the evidence and optimize care. Thank you for all you do!!!
Please apply this same rigor to HCQ, sir. Big Pharma has managed to demonize this PROVEN PROPHYLACTIC & CURE ( per American Frontline Doctors). They provide 2 examples : 1900 & 2300 patients- one hospitalization 0 deaths !
I requested a Lipoa and a Apob test be added to my blood tests. United Health Care would not cover the tests and the total of the two came to $118. My Apo b is high. My primary said she doesn’t really know what that means. I am going to try and get a consult from a cardiac care center. I appreciate the information this video provides! Keep fighting the fight!
This talk single handedly shows the problems with science acceptance in the US but also the reasons why we must to a better job of showing the power of science. What an amazing human being, Allan Sniderman. Wow. Privileged to have the opportunity to have listened to him talk and the medical community needs more of what he's done. Thanks Peter Attia for what you do and your thoughts in this arena. Spectacular talk.
agreed. even though there definitely are flaws, it's important it's also the scientific community and science itself that is the best tool to overcome those flaws in scientific acceptance.
I think it shows the power of consensus and how individuals outsource their cognition. A one-page executive summary is the final word for almost all doctors? The selection process for papers and conclusions drawn are committee decisions with an almost forced/DeFacto unanimity?
I feel that this conversation between these 2 brilliant men gives me the knowledge and credibility to advocate for myself with my own doctor. And I'll share the information with family and friends. Don't downplay the impact you have made. Thank you so much for this
I’m a first year med student and we just wrapped up our lipo protein lectures and my professor was adamant LDL-C is the gold standard…. Despite the explanation that the apoB value gives a count of the atherogenic particles… it’s a bit defeating as a student I must admit.
I love how this conversation began with a thoughtful discussion of ApoB and migrated into a philosophical exploration of the systematic weaknesses of our current clinical guideline process and a rumination on the nature of uncertainty
Everything ends up in philosophy if the participants have adequate curiosity - start with the saltiness of salt and you could end up at epistemology! lol!
What a great discussion. I was on statins for 30 years. I am 64. I became pre-diabetic and in 2019 stepped into diabetes with an A1C of 6.6. I started a low carb diet and by late 2020 reversed my diabetes. Lowest A1C became 5.8 and all my liver and kidney values came back to normal after years of out of range. I wanted to stop the statins so doc ordered a CAC. My score was 1.something. Now my LDL and total cholesterol were high (trig. very low and HDL high) so doc ordered another CAC and now that score is 26. In only 3 years. I see my doc this week and after a TON of research on my part (both pre-treatment like this discussion and anti-statin) I think I will choose to go back on a statin (per my doc's recommendation). I will also ask about an APOb test. I have to convince myself that I can control my previous diabetes through diet, which I did. I may not want to live to 85 but 75 is certainly a goal.
Wow! To be so lucky! Most people would not have a CAC that low after 30yrs of being on a statin! I think I would just be on Linus Paulings Heart Protocol and a few other supplements and call it a day! My last CAC was 458 down from 660 which is a 30% reduction achieved in 20 months...think about that!
@denzaharo9326 your right about gum issues. That would set off calcification for sure. It's very odd all those years, and a near zero CAC score doesn't make sense.
FASCINATING! I've listened to this discussion twice - Drs Sniderman and Attia are refreshing voices. Both are deep thinkers, but what I like the most, they don't guess. Instead of curing or masking symptoms, they research and search for root cause.
Shocking that this has only 246 thousand views given its significance. Profoundly helpful Peter. Thank you. I had an environmental exposure due to the stealth use of a diesel generator by a Crystal Geyser Bottling plant a block away over a 12 month period during lockdown that pushed me into dyslipidimia with adverse neurovascular outcomes that were only documented after admission for a TIA to Adventist Hospital in St. Helena I have not yet been properly diagnosed.at Stanford Medical after 12 months. I am on atoravastin and have begun to shift my dietary and supplemental intake based on watching your videos over time. Deeply appreciative to you.
lol, I'm used to hearing Peter's voice a LOT more on these podcasts. But he just lets Dr. Sniderman talk, because what he's saying is pure gold. I got my doctor to start testing me for ApoB.. I've refused statins, and managed to lower my ApoB from 186 (on a strict keto diet) to 83 by adding 2 cans (~600 g) of legumes per day, cutting red meat and SFA and exercising even more. And by incorporating 50-50 salt (half potassium chloride, half NaCl), I've dropped BP to 110/69 in my early 60s.
This is interesting. I feel like my lpa and apoB have only deteriorated since starting keto and low carb in 2017 to address elevated A1C. My A1C never got better. Lots of stress and I don't exercise, so I get that s perhaps a supercritical missing link at least on A1C, but I have been told by a cardiologist at Cornell studying lpa is that lpa is genetic and nothing can really be done to improve it (not diet or exercise). I am taking niacin on and off. Not a fan. Maybe I need to go back to my old life just lowish grain, lots of beans and cut back on dairy and finally commit to regular exercise.
@@nathalierey7663Yes to everything you say. But as to your last point, there's no "maybe" about it. The human body is designed to be active, every day. 10,000 steps is a good target. Exercise always bored me, until I realized I could binge watch all the shows while on my elliptical or spin bike. So now that's what I do. Every damn day.
Thank you! I have enjoyed this podcast tremendously. I've learned so much. what a pleasure it is to listen to two brilliant scholars who are offering pure knowledge, decency and common sense and serving it with so much humility. so rare. so desired. so appreciated.
Given Peter's enthusiasm for rapamycin, it would have been nice if he discussed how risk for cardiovascular disease is impacted by rapamycin use. We know that three independent studies have shown that 6-10 weeks of rapamycin treatment is enough to cause a reversal of some of the key measures of heart function (EF, FS and E/A) in old mice back to about halfway to that of the young mice (that is, it takes a 60-65-year-old back to about a 30-year-old in a human equivalent approximation). Does it lower CVD risk also?
My guess on blood pressure being a mechanical engineer I’m not a doctor or a medical person is that it’s as simple as the total resistance of the circulatory system. And the resistance of the circulatory system would be a function of the resistance of all the individual parts. And I’m guessing that this resistance increases with a variety of factors including athroscrelosis, inflammation, kidney function, sodium levels, hydration regulation, and the ability of blood vessels in general to allow blood flow. So we see that blood pressure goes down with BMI probably because a smaller body has less resistance. Muscle tone would be a big factor I’m guessing assuming higher muscle tone has better blood flow.
It seems to me that the only way to change the way risk is assessed (which will never happen but should) is that for one week out of the year, doctors should go to a conference led by the leading scientists doing studies in their specialty to discuss the latest results and to figure out the best possible way to diagnose and treat diseases. Instead, we have doctors who are following what they learned in med school, their residency or read in a New England Journal of Medicine article years ago, along with whatever the pharmacological industry is currently pushing. Not the best recipe to prevent disease.
You'd hope so!! It used to be called CPD (continuing professional development), but whose scrutinising in out low regulation world? When its all market forces the only rubric is how much money the doctors and pharma can screw out of the public. Patients dying is not much of a feedback loop.
@@annettestevens2260 i attended such a conference recently. They talked about LDL and statins and plant based diets. It was myopic and unsatisfying. I will not attend such a conference again. Much more information on RUclips.
:) When you get to 74 you will become very interested in living to 84…and the ‘’work” you are doing now will very likely give you good quality of life, even over 90.
I had a stent placed in 2019 at age 46. I had 99% blockage in my LAD artery. By God's grace it was discovered before I had a heart attack. No family history, never had cholesterol at or above 200, not obese or diabetic, never drink or smoke. I ask my cardiologist why, he doesn't have an answer, just tells me to exercise, eat a plant based diet and take my cholesterol meds. For some reason I'm just not satisfied with that answer.
Also no high blood pressure. But as I listen to this I did have low gel numbers and higher triglicerides, so maybe that was the cause. I had never heard of the apob
@@tg3728 What are "gel" numbers? By the way, your high triglycerides would suggest your diet was too high in sugar and carbs, thereby provoking high insulin, thereby provoking arterial damage, thereby leading to a 99% blocked LAD. Ask your cardiologist whether he thinks it's possible that years of hyperinsulinemia may have had something to do with your heart disease and see what he says.
@@Malcolm-Achtman I'm not sure what you mean by 'gel numbers, but I will research it. Thank you for the info, I will do that! The main thing now I is to prevent it from happening again.
Listening to this for the second time. I lowered my blood pressure by going low carb. Also, at the same time, I ditched all industrial oils. Hopefully, an anti inflammatory diet will extend my life. Most of my relatives on my dad's side (Scotch-Irish) died young of heart attacks.😢
Bottom line question. Do I understand that if ApoB is even slightly elevated, starting treatment with something like a statin, will slow the atherosclerosis process thereby reduce time to onset of Events?
Gentlemen, I don’t have the words to thank you for this wonderful episode. Great to see Peter in such awe of his guest (also a great show of respect). Beyond the specifics, there was just so much wisdom packed in this interaction (worth listening to multiple times). Again a huge thank you to both of you and teams behind the scenes who made this happen
I haven't finished the video yet, but it seems to me that this discussion should include in-depth mention of D3 activation by K2 .....if you are talking about calcification.
Dear Peter, I’m a fellow MD (with at least an above average knowledge of lipidology). I usually enjoy your podcast…. But this?!. Myopic, pro-statin (“great therapy”? Really? show me a study with more than a absolute minimal effect) apoB/cholesterol-centric lecture, with next to nothing on metabolic health, micronutrient status, inflammation, type A and B lipoprotein pattern, oxidation, insulin resistance and so on, and I know you know a lot about this stuff. I know particle count is important, but I my opinion you left so many other important points. Cardiovascular disease (atherosclerosis) is an inflammatory condition (or so I’ve let myself convince), you dont mention the condition of either the Apo-B/cholesterol (healthy vs oxidized/rancid) or the state of the artery (healthy vs inflammed) as something of grave importance for the risk? Just that Apo-B get stuck in there and that’s the cause of AS. I simply don’t agree. And the short part on hypertension was at best laughable. When you can reverse HT in patient after patient with almost the same therapy (NOT drugs, but with good sleep and overall lifestyle changes).. it gives you quite a good hint on what is at least a part of the pathophysiology (although of course multifactorial). I my opinion. When you reverse insulin resistance, optimize micronutrients, lower kortisol and catecholamines and lower chronic inflammatory most hypertension resolve itself. It’s absolutely not just “age”. Maybe I’m suffering from a bit of cognitive dissonance here. But I was disappointed.
I can help I think! More than absolutely minimal effect: one example (there are many more) is 4S with which the NNT for all cause mortality was 30 and NNT to prevent major coronary event was 15 over 5.2 years? Idk about you but that is a great therapy - absolutely amazing! Especially in the era where apoB levels were not targeted, probably would have seen better outcomes if they were (based on Johanneson 2021)
I agree 100%. I am not a doctor, but a patient with high Total Cholesterol,(familial) and high LDL. But healthy-high HDL levels, Triglyceride: HDL ratio is .76, normal Homocysteine, HBA1C, CPR markers etc. My ApoB : APOA1 ratio is 0.7. The first thing my GP said: "Gotta get you on statins now!" I said: " And you want to kill off my mitochondrial functioning, and give me a very high risk for Alzheimer's, in the 'hopes' that this drug will lower my chances of a heart attack ( and it has statistically shown to NOT in any significant way), never!" How many cardiologists are even aware that when taking a statin, you MUST also take enzyme Co Q 10, to save your mitochondria? It is insanity....Willful ignorance and big-pharma pay-backs that are bordering on criminal negligence...The motto "Do No Harm", is a big joke.
I agree, it is disappointing not to consider the lack of good evidence for statins. If statins are so amazing, why haven’t we seen miraculous improvements in CVD?
Thank you so much for this. So courageous and so truthful. I first recognized that I had to do my own research and sometimes push back against what doctors advised when I was diagnosed with luminal a breast cancer. It is so frightening to stand on your own and choose your path based on your best assessment of all the information and your individual case. Now I learned that I have HDL of 125 mg/dl-- very high, very rare, and potentially dangerous and once again I am trying to figure out what to do on my own, in the face of clinicians who persist in telling me that high HDL is good, certainly nothing to worry about. I feel cursed by the lousy genetics but blessed to have the information in presentations like these. And, though my individual case details are rare, I feel now like I am not rare or alone in trying to figure out things myself, in the face of harried and uninformed clinicians.
I don't get how you can have a conversation that includes cholesterol and not mention that a higher cholesterol provides a survival advantage for older folks. Wish I could provide sources, but I only remember the data.
I've heard that also, but it's hard to grasp since it is not uncommon for cholesterol to drop in elderly people and very sick people, thus making it appear that those with high cholesterol live the longest. The whole correlation is not causation thing. So much we don't understand about this makes it so frustrating.
When I was first diagnosed with cancer my cholesterol , iron and vitamin D was really low … now that I’m in remission all those numbers are within normal range or higher
What treatment? Not statins. Not manipulating HDL. my husband was on statins 12 years when he had a heart attack at 68. He required 4 stents, so damage was still happening.
ApoB "sufficiency" is a wrong term. Modifiable is a better term. There are several factors that can modify the rate of transcytosis of ApoB particles. TNF-alpha. Estrogens. Genetic mutations. Blood glucose. What has to be done - is to quantify the modifiers. Then we will know the safe level of ApoB for a given person.
56:00 pathogenesis of Systemic Hypertension:(SHT) We believe tbe loss of elasticity in the aorta to be causative for SHT in cats. I am in veterinary cardiology and we often see SHT in older cats, and a interesting feature of thus is what we call colloquially the "lazy aorta". On a lateral radiograph we can see the aorta displaced ventrally in the descending thoracic portion. Histopathologically, these aorta demonstrate more fibrous tissue than a younger aorta. Dr. Sniderman may well be onto something.
"APO-B is causal but it's necessary but not sufficient" So with my familiar dyslipidemia i can focus on the other factors, on which a life style's approach has more influence.. By the way another factor belonging to the category "necessary but not sufficient": insuline resistance? Prevention simpler then than trying to lower Apo-B with pills..
I would argue with the point of necessary as we know that many with heart attacks do not have high cholesterol. Multi factorial for sure but necessary, no.
Until I had accepted the immaturity of professional medical organizations, little surprised me more than the extent to which they were more about themselves; their agendas, their remuneration, their politics; than they were about the health and well-being of those they serve. They rigidities of US medicine is there for those without blinders to see! Whether it is the unhealthfulness of the Standard American Diet, the support of American agri-business by the cancer, diabetes and heart associations, recognition of patient rights or the primacy of ApoB in cardiac risk assessment, much work on physician’s personal emotional growth is needed. There is good reason here to see why it takes so long to get information that can save and enrich lives from the results of clinical trials to the doctor’s office and patients. Very useful podcast. Thank you!
I'm a 60 woman interested in this topic--So enjoyed the philosophical discussion of knowledge and also why ApoB is a better marker. Thanks for making the topic so accessible to us nonscientist/docs
Not discussed in the context of guidelines were the legal risk of departing from them, the demands of the health system employer to hew to the algo, the undisclosed pharma thumb on the guideline scale, the effect on younger, 9 to 5 physicians who bring up the guideline and apply it, and the looming monolith of CMS bean counters discouraging screening because in macro is saves real money while the micro might save two dozen lives over a physician’s career (eg the DRE). Thank you Peter for questioning any attempt to ignore ApoB based on aggregate lab cost.
I took a CAC test and the results came back 0. I've just learned about CT coronary angiography. CAC score may not detect uncalcified plaque, whereas CT coronary angiography will better detect thinning of arteries. What's your opinion on these two methods?
My so called Essential Hypertension is reducing dramatically since I switched to a very low carbohydrate diet. I was pre diabetic ( Now reversed ). I have never smoked. I am normal weight. I am 64 & have had very high blood pressure since my early 30’s. I also now have very low triglycerides. These used to be high. My HDL is high & always has been. My Non HDL is 50% higher than the maximum reference range. I have been referred to lipidology by the British NHS because the Dr suspects familial hypercholesterolemia. She didn’t know what pattern A or B or Apo B particle numbers are. I hope to God that lipidology test the subtractions. I am on a very long waiting list. Meanwhile I am frightened. I stopped taking Statins due to massive muscle loss. Anne
My bookmarks: 25:33 - Americans 10 years behind - my opinion 43:00 - Guest's opinion - Americans 2 years behind 26:00 - Non-HDL similar to Apo B test. 28:00 - Extra cash cost of Apo B test = $2.50 31:50 - VLDL-C is atherogenic 40:30 - Once on statins, typical values unlikely to normalize. If high triglycerides before, high triglycerides after treatment. But Apo B is a target for success.
A master piece podcast. One of your best, Peter. Dr Allan Sniderson was spectacular with information. Thank you both for teaching me so much, I took notes. Loved it!!!
The best comment IN THIS ENTIRE PODCAST!! 58::25 I learned a lot about what ask at my next physical but this brilliant comment completely sums up how we got to the disaster of COVID 😷. …
I noticed this too, that if I want to get a statin to lower my apob, I'd have to engage in bad health behavior (eat chicken skins, smoked, etc.) in order to better protect my future health. When I bring down my numbers through discipline and sacrifice (diet and exercise), I'm not given statins to bring me all the way down to where I need to be. I'm left in limbo/normal land until I begin to fall ill. It is stupid if the goal is disease prevention.
How on earth could the deposition of the "atherogenic partical" be the cause when there must be a cause for the ABILITY to be depositied in the first place? Namely, dysfunction of the arterial wall. Is systemic inflammation not solely the cause of this? The presence without which deposition couldnt even occur?
I think saying that number of ApoB partials is causal is confusing. It doesn't describe a mechanism just a strong association. Is there a mechanism or are you suggesting the everyone will develop some degree of atherosclerosis due to their relative amount of apoB particles over their lifetime?
But what can we do now for us who want to start prevention early and keep our hearts strong even when we are 100 years old ? What are the practical life style steps we can take ? I would really appreciate Peter could please discuss that
US mainstream medicine is valuable but waits until we are sick to intervene as they are a for profit machine. Prevention strategies are left to us. Read Dr. Mark Hyman. Dr. Jeffrey Bland, Dr. Perlmutter. Functional Medicine doctors are into prevention not disease but big Pharma and big health insurance companies inUSA don’t like them. Follow and read Lissa Rankin, MD also. Good luck.
An Md is trained to discuss prevention as little as possible, and, when he must, then to mention exactly the wrong things such as Don't eat salt but do eat plant and fish oils, and to NOT mention the right things, like test your Magnesium status. If you hypothesize that medical education was designed to turn out cogs in a killing machine, then the recommendations of our doctors make a lot more sense.
Hey young doctor here, absolute beginner. I kind of like the topic of prevention. This video is so very helpful. I can confirm that too much focus is on cholesterol. The scientific consensus is on LDL particles being the cause not cholesterol. Why does an 40 year old lean athletic men with a LDL cholesterol of 40, that’s under the lowest LDL-C target, get a MI and CAD?
As a practicing physician I am frustrated with the overall knowledge and training in lipidology. As you can notice, even very smart and well studied specialists are discordant in opinions! I hope that in the next 5-10 years we will get this down… Thank you for this podcast!
Never knew there was a medical specialty called "Lipidology" until yesterday when I was watching another channel. How does anyone go about finding one? Doubt that there are many of them in the U.S. Assume most of them work at teaching hospitals or at The Cleveland Clinic.Even finding an Endocrinologist, Diabetologist or CDE in a lot of areas is very hard and if you do, there is a long wait. I see a Hepatologist at University of Louisville for NAFLD (doing much better) because that's the ONLY place within a 100 mile radius that does Fibroscans. Even though I am an established patient, I still have to make my follow-up appts one year in advance and if I miss or can't make that appt because something came up, I risk having to wait another 6 months because the doctor is only in-clinic on Mondays and the rest of the time, he is teaching and seeing Hepatitis patients and I am considered low risk by my doctor because I am not diabetic and my NAFLD has been reversed. That's what I was told last year when I couldn't make my yearly appt because I had a car accident (no injuries thankfully) but my car was totaled and was trying to reschedule.
@@karimaogden3875 Usually an endocrinologist may have specialized in training as a lipidologist. My PCP sent me to one back in 2016 once he raised concerns about my cholesterol level and family history of heart disease. He's actually been running blood work for Apo B since early 2016 once or twice a year. Good luck.
@@karimaogden3875 it’s not yet an accredited specialty. But it is a science that needs to be addressed! So, a cardiologist, endocrinologist, internist and I think family medicine can take the boards and get accredited. There is no need for a paper saying that you are accredited, like Attia has noticed, even accredited lipidologists can also get stuck in the 1990’s.
33:22 - "high triglycerides, high cholesterol but low 'apo-B' in remnant type-3 dysliprotenemia: low LDL is for sure because the conversion of VLDL to LDL is low. Low apo-B makes sense with high chylomicron which contains apoB-48 that is excluded in the apo-B (100) test.
Don't sell yourself short! The fact that you are watching videos like this shows that you are an intelligent person and are seeking knowledge in order to educate yourself which a lot of people don't feel the need to do.
@@karimaogden3875 True! Thank you! (virtual hug) I have been watching and listening to podcasts and RUclips videos about health for the past year. I have learned so much from these and I share the info with my husband and sons. Now, we as a family have changed the way we eat and make our food, which has improved the way we all feel. Thanks again.
Yes, utube medical videos are very educational, everyone should be doing their own research. I've learned how to reverse my Calcium Score and come to a consensus of who should I believe and lately it's sure not Cardiologists that will reverse my heart disease!
Thank you so much for sharing your knowledge with us. Please kindly, would help us tremendously if you have podcast on hypertension. God bless you all.
I may have missed it but I didn't hear any discussion about inflammation damaging artery walls leading to calcification of cholesterol as a primary way of causing atherosclerosis. Also do high blood glucose, a1c, etc influence atherosclerosis? What is causing the damage to the lining of the artery leading to the build up of calcium? Thanks
I was wondering the same thing. No mention of diet in prevention. From what I've read, inflammation is not a necessary component for lipids to enter the artery walls. There is an inflammatory response to lipid entry into the artery walls (foaming/macrophages, calcium) but you don't need inflammation prior. That said, inflammation does create an environment whereby even more lipids can embed themselves in the artery wall, so if you don't want soft or hard plaques to accumulate any more than they may already accumulate, then you definitely want to keep your inflammation under control.
I'll tell you! It's all in Dr Thomas Levy's book "Stop America's #1 Killer " Proof that the Origin of All Coronary Heart Disease is Clearly Reversible Arterial Scurvy. He's not kidding because I am reversing my CAC Score which is down to 458 from 660 in 20 months.
I was born with two rare intron variants of the ApoB gene that are found in centenrians that results in a partial truncation of the protein. The most dramatic results in a thymine substitution of a guanine base that makes the protein lose about 40% of it's binding ability. This seems to drmatically alter the function of the protein in a way that dramatically lowers ApoB and VLDL cholesterol and favors longevity, at the cost of higher triglycerides and jaundice when fat is ingested. There are 4 male centenarians in my family. If YT allowed, I would post stills of my DNA proving it, but posts with external links don't appear. Anyway, my LDL cholesterol is always below 40, and my VLDL is non-detecxtable, as well as C-reactive prtein. But the problem is that I get really sick and nauseated when I eat fat. I experience severe nausea and jaundice. My body doesn't handle fat very well, even though I enjoy it so much that I eat it anyway even though I know that it willl make me sick. When I was a little boy, I was called the "yellow boy", even though I am Caucasian, because I suffered from chronic jaundice and my skin wss always this dull yellow color all over. People would say "sick boy is sick again."
Do you want to exchange genes? I have youthful appearance - it runs in my family. It is a connective tissue disorder though that comes with varicose veins. On the other hand, I can‘t promise you will be able to digest all the fat you want. I have a bit of a problem there too, without the longevity gene.
@@stellasternchen I know you were jocking. I responded that literal way because I didn't appreciate your sarcasm, which implied that the problems that I have with these mutations is minor compared to the benefit, and that I should lucky and stop whining about it. Also, NO, you cannot "exchange" genes with gene therapy., You can edit genes with CRIPR and you can add genes with gene therapy. But "swap" genes between two people? No.
I had a lipid test that included apob. Glad I did because statins caused me to become prediabetic and get muscle cramps. My copay was 10 bucks for a wide range of lipid tests!
Enjoyed that - Thanks for saying yes Allan - I have several of your papers and share your perspectives with students and colleagues to provoke discussion around the causes of ASCVD
If you go to Labcorp, the Apolipoprotein B Blood Test is $79 and Quest Diagnostics is $65, not $2.95 😏 maybe for doctors or insurance, not individuals. High cholesterol is runs in my family. Every year my doctor wants to put me on Statin drug and refuses to get me an advanced LipoProfile test, even my triglyceride is never high and my TG/ HDL ratio is less than 1. Finally, I did Cardio IQ at Quest paid myself more than Dr. Hyman said. I think the labs charge more to individual than insurance. Unfortunately, I don’t know how to read. All I know is I have big fluffy pattern A LDL and very high.
The assays to run the test only cost Quest or LabCorp $2.95. However, they charge you or the insurance company the dollars you quoted. There is a huge mark up.
Thank You for the content and superlative interview. Reminds me of Atul Gawande's Better: A Surgeon's Notes on Performance, which candidly touched on shortcomings in medical care. Also, Moneyball by Mike Lewis - group think and entrenched consensus leading to glaring inefficiency. Such a good conversation! Thanks again.
Mendelian randomization is a method of using measured variation in genes of known function to examine the causal effect of a modifiable exposure on disease in observational studies.
How do we know that ldl isn’t pr Protective. That is comes to the rescue when there is abnormalities in the arterial lining. So the calcium we see that accumulates in the arteries is a protective patch to prevent further damage?
@@J_P3 private. I think, labs work and one can make a difference following professional advices. I feel more or less the same as 20 years ago because of my healthy lifestyle
When you talk about triglycerides being elevated, you never say elevated to what? My cardiologists keep talking about my high LDL, but it is 50. As I see my research, docs would like to get ldl down to 70. I also see research that ldl scores below 50 have 159% more homographic? Strokes. Also older people with low cholesterol have the highest risk of death, and women who take statins have a 50% increased risk of developing diabetes, and statins increase calcium in the heart. I’m worried that cardiologists want me on statins. Also side effects are highest in older women with arthritis and hypothyroidism which describes me. What resources should I look at to help make my decision ?
Following the discussion, I just calculated my apoB number that's lower than ADA/ACC goal and used the app as well. Thank you. I'm waiting for your book to come out and getting ready for it by walking 2 miles (3 times a week) at 20 mins./mile rate. Just can't do the level 5 yet.
Great show Dr Attia. CVD has shown itself to be a highly complex disease, and there's too many in the sci/med community perpetuating out dated models of CVD. Bottom line is lower the LDL-C/apoB the longer the better. That along with mitigating systemic inflammation - finally starting to get the traction and attention it should - are key to prevention of CVD.
Here are two highly skilled intelligent scientists searching for truth within a highly restricted system of central planning. As Dr. Sniderman expressed acurately, "We can only understand as individuals. There is no such thing as a group understanding." I completely agree. But the question is how do we find truth? I think this podcast is excellent in determing the limitations of group think imposed upon them but the solution I believe is having the freedom to take risks toward challenges in order to discover more truth. The limitations on ingenuism and discovery are far more strict in todays world of extreme regulation of central planned government medicine and lack of freedom to pursue new risk in challenges outside the systems. It is kind of like censorship. If you limit free speech, new ideas never have a chance to infiltrate and be challenged. I believe the only answer is to get government out of Health care completely and let the free markets find solutions which could never be found by bureaucrats alone.
Great interview. Thank you so much Dr. Sniderman and Dr. Attia! I'd love to know which lab does ApoB for $2.50 as discussed. Quest and Labcorp each charge about $ 60.
Cost of the Apob test? So the Doctor tells the patient that a better test is available for under $10 and insurance will not cover it. I would think almost everyone would choose to pay the cost. why not let the patient decide?
based on the repatha studies with an relative risk decrease of 1.5% from statin alone with an ldl of 90 lowering it to 40-50. I think we can see that lowering lipids is gives us asymptotic benefits. We are still missing another side of the story.
Great episode Peter! I would love to hear your input on why people with anorexia typically present with high cholesterol? And if this can cause the potential dangers down the road?
I had no idea. Is it the LDL-C that's high? That disorder must cause absolute mayhem to multiple systems though. I know that people struggling with that have a very rough go of it. Unlike alcohol and drugs, we can't abstain from food... or societal BS inputs.
It would make sense as LDL-C rises significantly in a fasted state, or whenever the body shifts dramatically to rely on fat oxydation rather than glucose. Eating hardly anything would be very close to fasting IMO.
@@zealous.y The difference is the shift from fat metabolism to catabolism of protein that happens with anorexia nervosa as fat stores are depleted that doesn’t occur with healthy fasting.
He is very discreet and careful iNOT to say exactly what he is thinking or who he is talking about but we can read between the lines. People aren’t interested in APOb because it isn’t a billion dollar profit.
I am not a medical professional. I'm a cholesterol patient who has been told that he has a high risk for a heart event with no further explanation of why that risk exists. I am trying to educate myself about the factors that affect the significant concerns for my health and well being. As I watch this very interesting podcast video, one big question comes to mind. If this information started being available in the late 1950s and was clearly identified by the 1980s, why is it that 40+ years later the medical profession is still subjecting the patient population to the old 4 factor cholesterol panel and the BS AHA 10 year heart event risk calculator as the primary basis for determining a diagnosis and subjecting us to treatment regimens that may be effective for some people, but seems to be largely oversold and overhyped by the pharma companies and the AHA?
Some evidence suggests that endurance sports could contribute to calcification - I wonder if exercising for multiple hours at a time raises BP, as we’d expect, and therefore providing that driving force for Apo B to get trapped in the arteries… Of course, on the flip side exercise lowers BP at rest so one is walking around with overall lower BP thanks to exercise, but I wonder what’s the cost of prolonged exercise… is there a net benefit? Or should we keep it under 60 mins…
thank you! I wonder when boston heart panel will be available in other countries (europe, australia)? and how we can possibly approach precise diagnostics without it?
Wow, one of the most informative videos I’ve ever seen on the subject of LDL. Using the ApoBApp, I am normal with ApoB:100, TC:225, TG:55, but with LDL of 138, most physicians would put me on a statin! Thank you Peter!
I'm 65 F, started low carb 1 year ago, LDL went up a lot, CAC of zero and cardiologist (who is head of dept in a major hospital) recommended a low dose of statin. I told him that even if my CAC was not zero I would not take it. I've remitted my diabetes and my Trig have gone down and my HDL have increased. My liver function numbers have come down a lot and my moderate fatty liver is now only mild. I've lost 20% of my body weight and waist has gone from 44" to 38" without even trying.
@@jobrown8146 Saying ApoB is bad is not much different from the original LDL hypothesis. Triglyceride is the elephant in the room that people in this LDL camp refuse to recognize. Triglycerides to HDL ratio is the proper indicator. Raising HDL is extremely easy. There is nothing helpful in this video.
HELP😅😅😅😢😢😢. IS EZETIMBINE good to treat higher Apo B? Nicotine causes depletion of vitamin C = inflammation = weakening of the arterial walls . Correct?
Tons of studies have shown indirectly that parasympathetic activity is decreased in patients with hypertension. PSNS causes the relaxation of blood vessels, decreasing total peripheral resistance. It also decreases heart rate. The sympathetic nervous system regulates arterial blood pressure (ABP) by functionally influencing the vasculature, kidney, and heart. The increase in sympathetic activity is a mechanism for both initiating and sustaining the blood pressure elevation. If an improvement in parasympathetic tone is associated with a successful reduction in blood pressure ... through things like fasting, deep breathing, and better vagus nerve function ... why is the health of a person's autonomic nervous system not ever mentioned or a focal point ??? Animal and human studies show the same pattern. Even when some people eat well (tons of greens ... veggies, quality meats, nuts, seeds, low sugar to no added sugar ... processed food, etc.) sleep well, don't drink, have great relationships, exercise, etc. sometimes interventions like a fasting regimen works to improve blood pressure without meds
I'm 55. At 42 I had a 0 CAC Score. At 50 I was put on a statin for 6 months. Stopped as it was elevating my ALT liver enzymes. At 50 my CAC Score was 47. I went back on to a statin for a year and stopped again. Liver enzymes were high. At 53 had another CAC Scan score was 106. Went on keto carnivore for 3 years. LDL went to 167 doctor again put me on statin. I stayed on the statin for 3 years...now I'm 55 had another CAC Scan score was 226. This is a 45% annual increase in calcium. Before the statin I had a 25% annual increase on my calcium score. Do statins stabilize plaque by CALCIFING MY ARTERIES? I think the statins are accelerating the calcification of my arteries!!
@Tim Yurek Ask your doctor two things. 1. How do statins lower LDL? 2. How do statins stabilize plaque? Maybe the third question is why are you subscribing me a statin to stabilize plaque when you don't know or even tested me for plaque.
@@KevinSmith-4Liberty I will ask those questions. I am going to get a CTA. That can see and distinguish soft and hard plaque. I just started complying with the Dr Esselstyn diet. I lost 16 lbs in 10 weeks.
Statins calcify your plaque which stabilizes them. At age 55 you most definitely have plaque unless you kept your LDL below 80 for your entire life, which most people don’t. Exercise also increases calcification. One way that exercise helps with ASCVD.
@@timyurek9036 I was on his diet for several years, didn't get the results I'm getting on the Linus Pauling Heart Protocol. Reversing my heart disease!
In this episode, we discuss:
00:00:00 - Intro
00:00:10 - Problems with the current 10-year risk assessment of cardiovascular disease (CVD) and the implications for prevention
00:14:32 - A primer on cholesterol, apoB, and plasma lipoproteins
00:22:07 - Pathophysiology of CVD and the impact of particle cholesterol concentration vs. number of particles
00:28:45 - Limitations of standard blood panels
00:33:10 - Remnant type III hyperlipoproteinemia-high cholesterol, low Apo B, high triglyceride
00:39:26 - Using apoB to estimate risk of CVD
00:42:57 - How Mendelian randomization is bolstering the case for ApoB as the superior metric for risk prediction
00:53:47 - Hypertension and CVD risk
01:05:49 - Factors influencing the decision to begin preventative intervention for CVD
01:11:37 - Using the coronary artery calcium (CAC) score as a predictive tool
01:23:27 - The challenge of motivating individuals to take early interventions
01:26:30 - How medical advancement is hindered by the lack of critical thinking once a “consensus” is reached
01:33:24 - PSK9 inhibitors and familial hypercholesterolemia: two examples of complex topics with differing interpretations of the science
01:39:49 - Defining risk and uncertainty in the guidelines
01:46:07 - Making clinical decisions in the face of uncertainty
01:51:58 - How the emphasis on consensus and unanimity has become a crucial weakness for science and medicine
01:59:58 - Factors holding back the advancement of apoB for assessing CVD risk, treatment, and prevention strategies
02:11:44 - Advantages of a 30-year risk assessment and early intervention
Allan, oh my. I could listen to him for 2 hours and 25 minutes!
And I always forget that Peter is a great interviewer among all the other things he does so well.
I like to hear about particle size, and wish Allan would have taken us deeper through his thoughts on that.
Grateful to get stuff like this. What a gift.
Hi Peter , There have been a number of replies referencing Dr Malcolm Kendricks latest book "The clot thickens" which gives a more plausible hypothesis to CVD causation than just "APoB particles get stuck in the arterial walls" and infact does a great job of debunking this myth. Would be amazing if you and Alan could take a look into this , even better interview Malcolm so we can actually get to the truth of what is happening. I would love to hear your rebuttal to his hypothesis , so far he's just been ignored. Look forward to your reply.
@@davidblackford5193 excellent suggestion I agree 100%
Now let's talk about the significant increase of apoB in low/zero carb diets.. it's important to look at the context. Would be great if you can talk about it in the future. Thanks again for sharing.
Astounding that Magnesium is nowhere on the list.
I’m a cardiologist, MD, PhD; I didn’t go to Ivy League schools, but I felt I had very good training. This level of discussion is not found in medical school training. Thank you for the free CME. It’s the third time I hear this discussion and I am finishing his book to understand lipidology a little better.
I absolutely agree that the science was dumb down and that somehow we got stuck in the 1990s. But I feel that things are changing slowly.
How will you mow treat high APOB?
Your accuracy and honesty are refreshing. As a clinical pharmacist/drug info devotee, I've worked with residents who have a huge STATIC knowledge of general medicine. As they progress (especially into subspecialties) they don't really have the time to take a deep dive into many subjects, so they rely on associations to steer them. Personally I like following top notch resources (e.g. Allan Sniderman, Peter Attia, Tom Dayspring, Gil Carvalho) in specific areas.
May I ask the book you are reading ? I enjoy these conversations. I am a FNP . In family medicine these convos do not happen . I try to stay on the cutting edge of medicine. Thank you for your contribution
@@brucefranken4615😊
@@tammyglaude7266low carb and no saturated fat
Dr. Sniderman, I am a clinical pharmacist and I did a presentation for our patient centered medical home which houses approx 30 primary care doctors - the physicians and providers are likely going to make apoB standard of care within our institution and it’s due to your amazing work. We commend you! Knowledge is power and it’s helpful to step out of the echo chamber of the AHA/ACC guidelines and into the primary literature to critically evaluate the evidence and optimize care. Thank you for all you do!!!
Please apply this same rigor to HCQ, sir. Big Pharma has managed to demonize this PROVEN PROPHYLACTIC & CURE ( per American Frontline Doctors). They provide 2 examples : 1900 & 2300 patients- one hospitalization 0 deaths !
I requested a Lipoa and a Apob test be added to my blood tests. United Health Care would not cover the tests and the total of the two came to $118. My Apo b is high. My primary said she doesn’t really know what that means. I am going to try and get a consult from a cardiac care center. I appreciate the information this video provides! Keep fighting the fight!
This talk single handedly shows the problems with science acceptance in the US but also the reasons why we must to a better job of showing the power of science. What an amazing human being, Allan Sniderman. Wow. Privileged to have the opportunity to have listened to him talk and the medical community needs more of what he's done. Thanks Peter Attia for what you do and your thoughts in this arena. Spectacular talk.
agreed. even though there definitely are flaws, it's important it's also the scientific community and science itself that is the best tool to overcome those flaws in scientific acceptance.
I think it shows the power of consensus and how individuals outsource their cognition. A one-page executive summary is the final word for almost all doctors? The selection process for papers and conclusions drawn are committee decisions with an almost forced/DeFacto unanimity?
I feel that this conversation between these 2 brilliant men gives me the knowledge and credibility to advocate for myself with my own doctor. And I'll share the information with family and friends. Don't downplay the impact you have made. Thank you so much for this
I’m a first year med student and we just wrapped up our lipo protein lectures and my professor was adamant LDL-C is the gold standard…. Despite the explanation that the apoB value gives a count of the atherogenic particles… it’s a bit defeating as a student I must admit.
I love how this conversation began with a thoughtful discussion of ApoB and migrated into a philosophical exploration of the systematic weaknesses of our current clinical guideline process and a rumination on the nature of uncertainty
Everything ends up in philosophy if the participants have adequate curiosity - start with the saltiness of salt and you could end up at epistemology! lol!
What a great discussion. I was on statins for 30 years. I am 64. I became pre-diabetic and in 2019 stepped into diabetes with an A1C of 6.6. I started a low carb diet and by late 2020 reversed my diabetes. Lowest A1C became 5.8 and all my liver and kidney values came back to normal after years of out of range. I wanted to stop the statins so doc ordered a CAC. My score was 1.something. Now my LDL and total cholesterol were high (trig. very low and HDL high) so doc ordered another CAC and now that score is 26. In only 3 years. I see my doc this week and after a TON of research on my part (both pre-treatment like this discussion and anti-statin) I think I will choose to go back on a statin (per my doc's recommendation). I will also ask about an APOb test. I have to convince myself that I can control my previous diabetes through diet, which I did. I may not want to live to 85 but 75 is certainly a goal.
Consult a physician and dietician who’s well versed in the whole food plant based nutrition.
Wow! To be so lucky! Most people would not have a CAC that low after 30yrs of being on a statin! I think I would just be on Linus Paulings Heart Protocol and a few other supplements and call it a day! My last CAC was 458 down from 660 which is a 30% reduction achieved in 20 months...think about that!
Are you still eating the low-carb diet?
Any gum issues ??,
@denzaharo9326 your right about gum issues. That would set off calcification for sure. It's very odd all those years, and a near zero CAC score doesn't make sense.
FASCINATING! I've listened to this discussion twice - Drs Sniderman and Attia are refreshing voices. Both are deep thinkers, but what I like the most, they don't guess. Instead of curing or masking symptoms, they research and search for root cause.
Root cause is often gum disease
New grad NP here and I ordered my first ApoB today. I am just going to start ordering ApoB on every lipid panel from now on.
Shocking that this has only 246 thousand views given its significance. Profoundly helpful Peter. Thank you. I had an environmental exposure due to the stealth use of a diesel generator by a Crystal Geyser Bottling plant a block away over a 12 month period during lockdown that pushed me into dyslipidimia with adverse neurovascular outcomes that were only documented after admission for a TIA to Adventist Hospital in St. Helena I have not yet been properly diagnosed.at Stanford Medical after 12 months. I am on atoravastin and have begun to shift my dietary and supplemental intake based on watching your videos over time. Deeply appreciative to you.
lol, I'm used to hearing Peter's voice a LOT more on these podcasts. But he just lets Dr. Sniderman talk, because what he's saying is pure gold.
I got my doctor to start testing me for ApoB.. I've refused statins, and managed to lower my ApoB from 186 (on a strict keto diet) to 83 by adding 2 cans (~600 g) of legumes per day, cutting red meat and SFA and exercising even more. And by incorporating 50-50 salt (half potassium chloride, half NaCl), I've dropped BP to 110/69 in my early 60s.
That is great news you could do that with diet because my apo B ia over 232 mg/dL and I am on a keto diet eating SFA.
This is interesting. I feel like my lpa and apoB have only deteriorated since starting keto and low carb in 2017 to address elevated A1C. My A1C never got better. Lots of stress and I don't exercise, so I get that s perhaps a supercritical missing link at least on A1C, but I have been told by a cardiologist at Cornell studying lpa is that lpa is genetic and nothing can really be done to improve it (not diet or exercise). I am taking niacin on and off. Not a fan. Maybe I need to go back to my old life just lowish grain, lots of beans and cut back on dairy and finally commit to regular exercise.
@@nathalierey7663Yes to everything you say. But as to your last point, there's no "maybe" about it. The human body is designed to be active, every day. 10,000 steps is a good target. Exercise always bored me, until I realized I could binge watch all the shows while on my elliptical or spin bike. So now that's what I do. Every damn day.
Thank you! I have enjoyed this podcast tremendously. I've learned so much. what a pleasure it is to listen to two brilliant scholars who are offering pure knowledge, decency and common sense and serving it with so much humility. so rare. so desired. so appreciated.
Cash price for calcium heart test is $125 here in Las Vegas. APoB is $25 at Quest Diagnostic.
Given Peter's enthusiasm for rapamycin, it would have been nice if he discussed how risk for cardiovascular disease is impacted by rapamycin use. We know that three independent studies have shown that 6-10 weeks of rapamycin treatment is enough to cause a reversal of some of the key measures of heart function (EF, FS and E/A) in old mice back to about halfway to that of the young mice (that is, it takes a 60-65-year-old back to about a 30-year-old in a human equivalent approximation). Does it lower CVD risk also?
I doubt the guest would know anything about it.
Amazing. Would like to learn more. Do you publish videos about this?
Will rapamycin reverse insulin resistance?
Remove animal products from your diet, and you will get the same effect without drugs.
I hope he asks his plumber for advice on his race cars aero too
My guess on blood pressure being a mechanical engineer I’m not a doctor or a medical person is that it’s as simple as the total resistance of the circulatory system. And the resistance of the circulatory system would be a function of the resistance of all the individual parts. And I’m guessing that this resistance increases with a variety of factors including athroscrelosis, inflammation, kidney function, sodium levels, hydration regulation, and the ability of blood vessels in general to allow blood flow. So we see that blood pressure goes down with BMI probably because a smaller body has less resistance. Muscle tone would be a big factor I’m guessing assuming higher muscle tone has better blood flow.
It seems to me that the only way to change the way risk is assessed (which will never happen but should) is that for one week out of the year, doctors should go to a conference led by the leading scientists doing studies in their specialty to discuss the latest results and to figure out the best possible way to diagnose and treat diseases. Instead, we have doctors who are following what they learned in med school, their residency or read in a New England Journal of Medicine article years ago, along with whatever the pharmacological industry is currently pushing. Not the best recipe to prevent disease.
You'd hope so!! It used to be called CPD (continuing professional development), but whose scrutinising in out low regulation world? When its all market forces the only rubric is how much money the doctors and pharma can screw out of the public. Patients dying is not much of a feedback loop.
doctors do attend such conferences
@@annettestevens2260 i attended such a conference recently. They talked about LDL and statins and plant based diets. It was myopic and unsatisfying. I will not attend such a conference again. Much more information on RUclips.
@@annettestevens2260 the conferences are more like sales pitches.
Pushing what the latest pharmacy rep is sellin
:) When you get to 74 you will become very interested in living to 84…and the ‘’work” you are doing now will very likely give you good quality of life, even over 90.
I had a stent placed in 2019 at age 46. I had 99% blockage in my LAD artery. By God's grace it was discovered before I had a heart attack. No family history, never had cholesterol at or above 200, not obese or diabetic, never drink or smoke. I ask my cardiologist why, he doesn't have an answer, just tells me to exercise, eat a plant based diet and take my cholesterol meds. For some reason I'm just not satisfied with that answer.
Also no high blood pressure. But as I listen to this I did have low gel numbers and higher triglicerides, so maybe that was the cause. I had never heard of the apob
@@tg3728 What are "gel" numbers? By the way, your high triglycerides would suggest your diet was too high in sugar and carbs, thereby provoking high insulin, thereby provoking arterial damage, thereby leading to a 99% blocked LAD. Ask your cardiologist whether he thinks it's possible that years of hyperinsulinemia may have had something to do with your heart disease and see what he says.
@@Malcolm-Achtman I'm not sure what you mean by 'gel numbers, but I will research it. Thank you for the info, I will do that! The main thing now I is to prevent it from happening again.
@@tg3728 you said low gel, did you mean low HDL? Inferring from context
@@thefisherking78 Yes lower HDL than LDL at the time. Numbers are much better now.
Listening to this for the second time.
I lowered my blood pressure by going low carb. Also, at the same time, I ditched all industrial oils.
Hopefully, an anti inflammatory diet will extend my life. Most of my relatives on my dad's side (Scotch-Irish) died young of heart attacks.😢
This conversation should have millions of views. Thankfully this brilliant men are advocating for awareness on intelligent preventive medicine.
Bottom line question. Do I understand that if ApoB is even slightly elevated, starting treatment with something like a statin, will slow the atherosclerosis process thereby reduce time to onset of Events?
Gentlemen, I don’t have the words to thank you for this wonderful episode. Great to see Peter in such awe of his guest (also a great show of respect). Beyond the specifics, there was just so much wisdom packed in this interaction (worth listening to multiple times). Again a huge thank you to both of you and teams behind the scenes who made this happen
I haven't finished the video yet, but it seems to me that this discussion should include in-depth mention of D3 activation by K2 .....if you are talking about calcification.
Never gonna happen. Vitamins and minerals have nothing to do with heart health 🙏
YES! Doctors don’t want to talk about K2. They say stop it, go on aspirin.
@@wizardatmathyour loss my gain CAC Score 660 down to 458.
Dear Peter, I’m a fellow MD (with at least an above average knowledge of lipidology). I usually enjoy your podcast…. But this?!.
Myopic, pro-statin (“great therapy”? Really? show me a study with more than a absolute minimal effect) apoB/cholesterol-centric lecture, with next to nothing on metabolic health, micronutrient status, inflammation, type A and B lipoprotein pattern, oxidation, insulin resistance and so on, and I know you know a lot about this stuff. I know particle count is important, but I my opinion you left so many other important points. Cardiovascular disease (atherosclerosis) is an inflammatory condition (or so I’ve let myself convince), you dont mention the condition of either the Apo-B/cholesterol (healthy vs oxidized/rancid) or the state of the artery (healthy vs inflammed) as something of grave importance for the risk? Just that Apo-B get stuck in there and that’s the cause of AS. I simply don’t agree.
And the short part on hypertension was at best laughable. When you can reverse HT in patient after patient with almost the same therapy (NOT drugs, but with good sleep and overall lifestyle changes).. it gives you quite a good hint on what is at least a part of the pathophysiology (although of course multifactorial). I my opinion. When you reverse insulin resistance, optimize micronutrients, lower kortisol and catecholamines and lower chronic inflammatory most hypertension resolve itself. It’s absolutely not just “age”.
Maybe I’m suffering from a bit of cognitive dissonance here. But I was disappointed.
I can help I think! More than absolutely minimal effect: one example (there are many more) is 4S with which the NNT for all cause mortality was 30 and NNT to prevent major coronary event was 15 over 5.2 years? Idk about you but that is a great therapy - absolutely amazing! Especially in the era where apoB levels were not targeted, probably would have seen better outcomes if they were (based on Johanneson 2021)
It is never a good idea to "meet your heroes". Sometimes a lot of respect for a person restricts you...
I agree 100%. I am not a doctor, but a patient with high Total Cholesterol,(familial) and high LDL. But healthy-high HDL levels, Triglyceride: HDL ratio is .76, normal Homocysteine, HBA1C, CPR markers etc. My ApoB : APOA1 ratio is 0.7. The first thing my GP said: "Gotta get you on statins now!" I said: " And you want to kill off my mitochondrial functioning, and give me a very high risk for Alzheimer's, in the 'hopes' that this drug will lower my chances of a heart attack ( and it has statistically shown to NOT in any significant way), never!" How many cardiologists are even aware that when taking a statin, you MUST also take enzyme Co Q 10, to save your mitochondria? It is insanity....Willful ignorance and big-pharma pay-backs that are bordering on criminal negligence...The motto "Do No Harm", is a big joke.
I agree, it is disappointing not to consider the lack of good evidence for statins. If statins are so amazing, why haven’t we seen miraculous improvements in CVD?
@@scoggme0 Exactly!
Thank you Dr Attia for the guests and sharing the knowledge. My “KickAss100YrOld” self appreciates the information!
Thank you so much for this. So courageous and so truthful. I first recognized that I had to do my own research and sometimes push back against what doctors advised when I was diagnosed with luminal a breast cancer. It is so frightening to stand on your own and choose your path based on your best assessment of all the information and your individual case. Now I learned that I have HDL of 125 mg/dl-- very high, very rare, and potentially dangerous and once again I am trying to figure out what to do on my own, in the face of clinicians who persist in telling me that high HDL is good, certainly nothing to worry about. I feel cursed by the lousy genetics but blessed to have the information in presentations like these. And, though my individual case details are rare, I feel now like I am not rare or alone in trying to figure out things myself, in the face of harried and uninformed clinicians.
I don't get how you can have a conversation that includes cholesterol and not mention that a higher cholesterol provides a survival advantage for older folks. Wish I could provide sources, but I only remember the data.
I think it is in the Framingham data
I've heard that also, but it's hard to grasp since it is not uncommon for cholesterol to drop in elderly people and very sick people, thus making it appear that those with high cholesterol live the longest. The whole correlation is not causation thing. So much we don't understand about this makes it so frustrating.
He's an Md. You're welcome 🙏
ruclips.net/video/BzTjPuikhQE/видео.html
When I was first diagnosed with cancer my cholesterol , iron and vitamin D was really low … now that I’m in remission all those numbers are within normal range or higher
Best guest ever best medical researcher w superior thinking and humility
What treatment? Not statins. Not manipulating HDL. my husband was on statins 12 years when he had a heart attack at 68. He required 4 stents, so damage was still happening.
Did you know that Statins are banned in Europe?
ApoB "sufficiency" is a wrong term. Modifiable is a better term. There are several factors that can modify the rate of transcytosis of ApoB particles. TNF-alpha. Estrogens. Genetic mutations. Blood glucose. What has to be done - is to quantify the modifiers. Then we will know the safe level of ApoB for a given person.
agreed, that's the kind of nuance missed in this talk
56:00 pathogenesis of Systemic Hypertension:(SHT) We believe tbe loss of elasticity in the aorta to be causative for SHT in cats. I am in veterinary cardiology and we often see SHT in older cats, and a interesting feature of thus is what we call colloquially the "lazy aorta". On a lateral radiograph we can see the aorta displaced ventrally in the descending thoracic portion. Histopathologically, these aorta demonstrate more fibrous tissue than a younger aorta. Dr. Sniderman may well be onto something.
"APO-B is causal but it's necessary but not sufficient"
So with my familiar dyslipidemia i can focus on the other factors, on which a life style's approach has more influence..
By the way another factor belonging to the category "necessary but not sufficient": insuline resistance? Prevention simpler then than trying to lower Apo-B with pills..
I would argue with the point of necessary as we know that many with heart attacks do not have high cholesterol. Multi factorial for sure but necessary, no.
After all is said . You got to reduce your carb intake. It's better than medicine.
Until I had accepted the immaturity of professional medical organizations, little surprised me more than the extent to which they were more about themselves; their agendas, their remuneration, their politics; than they were about the health and well-being of those they serve.
They rigidities of US medicine is there for those without blinders to see! Whether it is the unhealthfulness of the Standard American Diet, the support of American agri-business by the cancer, diabetes and heart associations, recognition of patient rights or the primacy of ApoB in cardiac risk assessment, much work on physician’s personal emotional growth is needed.
There is good reason here to see why it takes so long to get information that can save and enrich lives from the results of clinical trials to the doctor’s office and patients. Very useful podcast. Thank you!
I'm a 60 woman interested in this topic--So enjoyed the philosophical discussion of knowledge and also why ApoB is a better marker. Thanks for making the topic so accessible to us nonscientist/docs
Snidermam has a wonderful philosophy on life and humanity
Not discussed in the context of guidelines were the legal risk of departing from them, the demands of the health system employer to hew to the algo, the undisclosed pharma thumb on the guideline scale, the effect on younger, 9 to 5 physicians who bring up the guideline and apply it, and the looming monolith of CMS bean counters discouraging screening because in macro is saves real money while the micro might save two dozen lives over a physician’s career (eg the DRE). Thank you Peter for questioning any attempt to ignore ApoB based on aggregate lab cost.
I took a CAC test and the results came back 0. I've just learned about CT coronary angiography. CAC score may not detect uncalcified plaque, whereas CT coronary angiography will better detect thinning of arteries. What's your opinion on these two methods?
My so called Essential Hypertension is reducing dramatically since I switched to a very low carbohydrate diet. I was pre diabetic ( Now reversed ). I have never smoked. I am normal weight. I am 64 & have had very high blood pressure since my early 30’s. I also now have very low triglycerides. These used to be high. My HDL is high & always has been. My Non HDL is 50% higher than the maximum reference range. I have been referred to lipidology by the British NHS because the Dr suspects familial hypercholesterolemia. She didn’t know what pattern A or B or Apo B particle numbers are. I hope to God that lipidology test the subtractions. I am on a very long waiting list. Meanwhile I am frightened. I stopped taking Statins due to massive muscle loss. Anne
To say that he is brilliant is an understatement! He is not only brilliant but wise!
My bookmarks:
25:33 - Americans 10 years behind - my opinion
43:00 - Guest's opinion - Americans 2 years behind
26:00 - Non-HDL similar to Apo B test.
28:00 - Extra cash cost of Apo B test = $2.50
31:50 - VLDL-C is atherogenic
40:30 - Once on statins, typical values unlikely to normalize. If high triglycerides before, high triglycerides after treatment. But Apo B is a target for success.
This is pure gold. Thank you for sharing this with the world.
A master piece podcast. One of your best, Peter. Dr Allan Sniderson was spectacular with information. Thank you both for teaching me so much, I took notes. Loved it!!!
The best comment IN THIS ENTIRE PODCAST!! 58::25
I learned a lot about what ask at my next physical but this brilliant comment completely sums up how we got to the disaster of COVID 😷. …
I noticed this too, that if I want to get a statin to lower my apob, I'd have to engage in bad health behavior (eat chicken skins, smoked, etc.) in order to better protect my future health. When I bring down my numbers through discipline and sacrifice (diet and exercise), I'm not given statins to bring me all the way down to where I need to be. I'm left in limbo/normal land until I begin to fall ill. It is stupid if the goal is disease prevention.
How on earth could the deposition of the "atherogenic partical" be the cause when there must be a cause for the ABILITY to be depositied in the first place? Namely, dysfunction of the arterial wall. Is systemic inflammation not solely the cause of this? The presence without which deposition couldnt even occur?
You nailed it
I think saying that number of ApoB partials is causal is confusing. It doesn't describe a mechanism just a strong association. Is there a mechanism or are you suggesting the everyone will develop some degree of atherosclerosis due to their relative amount of apoB particles over their lifetime?
Best conversation on RUclips in 10 years !! Thank you!! My lpa is 267.😕
Man these guys are scaring the living shit outta me !! I better start taking care of myself !
But what can we do now for us who want to start prevention early and keep our hearts strong even when we are 100 years old ? What are the practical life style steps we can take ? I would really appreciate Peter could please discuss that
US mainstream medicine is valuable but waits until we are sick to intervene as they are a for profit machine. Prevention strategies are left to us. Read Dr. Mark Hyman. Dr. Jeffrey Bland, Dr. Perlmutter. Functional Medicine doctors are into prevention not disease but big Pharma and big health insurance companies inUSA don’t like them. Follow and read Lissa Rankin, MD also. Good luck.
An Md is trained to discuss prevention as little as possible, and, when he must, then to mention exactly the wrong things such as Don't eat salt but do eat plant and fish oils, and to NOT mention the right things, like test your Magnesium status. If you hypothesize that medical education was designed to turn out cogs in a killing machine, then the recommendations of our doctors make a lot more sense.
He’s 80 ??? Wow. Glad he agreed to do the podcast with you ! Thanks for the video Dr. Attia
Hey young doctor here, absolute beginner. I kind of like the topic of prevention. This video is so very helpful. I can confirm that too much focus is on cholesterol. The scientific consensus is on LDL particles being the cause not cholesterol. Why does an 40 year old lean athletic men with a LDL cholesterol of 40, that’s under the lowest LDL-C target, get a MI and CAD?
As a practicing physician I am frustrated with the overall knowledge and training in lipidology. As you can notice, even very smart and well studied specialists are discordant in opinions! I hope that in the next 5-10 years we will get this down…
Thank you for this podcast!
Never knew there was a medical specialty called "Lipidology" until yesterday when I was watching another channel. How does anyone go about finding one? Doubt that there are many of them in the U.S. Assume most of them work at teaching hospitals or at The Cleveland Clinic.Even finding an Endocrinologist, Diabetologist or CDE in a lot of areas is very hard and if you do, there is a long wait. I see a Hepatologist at University of Louisville for NAFLD (doing much better) because that's the ONLY place within a 100 mile radius that does Fibroscans. Even though I am an established patient, I still have to make my follow-up appts one year in advance and if I miss or can't make that appt because something came up, I risk having to wait another 6 months because the doctor is only in-clinic on Mondays and the rest of the time, he is teaching and seeing Hepatitis patients and I am considered low risk by my doctor because I am not diabetic and my NAFLD has been reversed. That's what I was told last year when I couldn't make my yearly appt because I had a car accident (no injuries thankfully) but my car was totaled and was trying to reschedule.
@@karimaogden3875 Usually an endocrinologist may have specialized in training as a lipidologist. My PCP sent me to one back in 2016 once he raised concerns about my cholesterol level and family history of heart disease. He's actually been running blood work for Apo B since early 2016 once or twice a year. Good luck.
@@karimaogden3875 it’s not yet an accredited specialty. But it is a science that needs to be addressed! So, a cardiologist, endocrinologist, internist and I think family medicine can take the boards and get accredited. There is no need for a paper saying that you are accredited, like Attia has noticed, even accredited lipidologists can also get stuck in the 1990’s.
33:22 - "high triglycerides, high cholesterol but low 'apo-B' in remnant type-3 dysliprotenemia: low LDL is for sure because the conversion of VLDL to LDL is low. Low apo-B makes sense with high chylomicron which contains apoB-48 that is excluded in the apo-B (100) test.
Kraft Insulin Survey, Dr. Kraft was a pioneer in what actually leads to Heart Attack/Stroke
I loved this interview. I am not an educated person but he made it very understandable. He’s so real.
Don't sell yourself short! The fact that you are watching videos like this shows that you are an intelligent person and are seeking knowledge in order to educate yourself which a lot of people don't feel the need to do.
@@karimaogden3875 True! Thank you! (virtual hug) I have been watching and listening to podcasts and RUclips videos about health for the past year. I have learned so much from these and I share the info with my husband and sons. Now, we as a family have changed the way we eat and make our food, which has improved the way we all feel. Thanks again.
Yes, utube medical videos are very educational, everyone should be doing their own research. I've learned how to reverse my Calcium Score and come to a consensus of who should I believe and lately it's sure not Cardiologists that will reverse my heart disease!
Thank you so much for sharing your knowledge with us.
Please kindly, would help us tremendously if you have podcast on hypertension.
God bless you all.
I may have missed it but I didn't hear any discussion about inflammation damaging artery walls leading to calcification of cholesterol as a primary way of causing atherosclerosis. Also do high blood glucose, a1c, etc influence atherosclerosis? What is causing the damage to the lining of the artery leading to the build up of calcium? Thanks
I was wondering the same thing. No mention of diet in prevention. From what I've read, inflammation is not a necessary component for lipids to enter the artery walls. There is an inflammatory response to lipid entry into the artery walls (foaming/macrophages, calcium) but you don't need inflammation prior. That said, inflammation does create an environment whereby even more lipids can embed themselves in the artery wall, so if you don't want soft or hard plaques to accumulate any more than they may already accumulate, then you definitely want to keep your inflammation under control.
I'll tell you! It's all in Dr Thomas Levy's book "Stop America's #1 Killer " Proof that the Origin of All Coronary Heart Disease is Clearly Reversible Arterial Scurvy. He's not kidding because I am reversing my CAC Score which is down to 458 from 660 in 20 months.
What are optimum ApoB scores, also cholesterol, blood pressure….
This was amazing. Very practical to patient care and decision making.
What a wonderful person and intellect
I was born with two rare intron variants of the ApoB gene that are found in centenrians that results in a partial truncation of the protein. The most dramatic results in a thymine substitution of a guanine base that makes the protein lose about 40% of it's binding ability. This seems to drmatically alter the function of the protein in a way that dramatically lowers ApoB and VLDL cholesterol and favors longevity, at the cost of higher triglycerides and jaundice when fat is ingested. There are 4 male centenarians in my family. If YT allowed, I would post stills of my DNA proving it, but posts with external links don't appear. Anyway, my LDL cholesterol is always below 40, and my VLDL is non-detecxtable, as well as C-reactive prtein. But the problem is that I get really sick and nauseated when I eat fat. I experience severe nausea and jaundice. My body doesn't handle fat very well, even though I enjoy it so much that I eat it anyway even though I know that it willl make me sick. When I was a little boy, I was called the "yellow boy", even though I am Caucasian, because I suffered from chronic jaundice and my skin wss always this dull yellow color all over. People would say "sick boy is sick again."
very interesting thanks for sharing
Do you want to exchange genes? I have youthful appearance - it runs in my family. It is a connective tissue disorder though that comes with varicose veins.
On the other hand, I can‘t promise you will be able to digest all the fat you want. I have a bit of a problem there too, without the longevity gene.
@@stellasternchen Exchaging genes is not possible.
@@petercoderch589 Not necessarily.
Gene therapy exists.
But yeah, I meant that rather jokingly.
@@stellasternchen I know you were jocking. I responded that literal way because I didn't appreciate your sarcasm, which implied that the problems that I have with these mutations is minor compared to the benefit, and that I should lucky and stop whining about it.
Also, NO, you cannot "exchange" genes with gene therapy., You can edit genes with CRIPR and you can add genes with gene therapy. But "swap" genes between two people? No.
My apo b never budged with a Staten. Until I started taking a psk9 inhibitor dropped to 81 from 134. Lp(a) still hugh.
Take niacin and that may help with LPa
I had a lipid test that included apob. Glad I did because statins caused me to become prediabetic and get muscle cramps. My copay was 10 bucks for a wide range of lipid tests!
What were your results?
Enjoyed that - Thanks for saying yes Allan - I have several of your papers and share your perspectives with students and colleagues to provoke discussion around the causes of ASCVD
I thought I understood this issue. I was wrong. Thanks for clarifying many points of my misunderstanding. Excellent discussion.
If you go to Labcorp, the Apolipoprotein B Blood Test is $79 and Quest Diagnostics is $65, not $2.95 😏 maybe for doctors or insurance, not individuals.
High cholesterol is runs in my family. Every year my doctor wants to put me on Statin drug and refuses to get me an advanced LipoProfile test, even my triglyceride is never high and my TG/ HDL ratio is less than 1. Finally, I did Cardio IQ at Quest paid myself more than Dr. Hyman said. I think the labs charge more to individual than insurance. Unfortunately, I don’t know how to read. All I know is I have big fluffy pattern A LDL and very high.
The assays to run the test only cost Quest or LabCorp $2.95. However, they charge you or the insurance company the dollars you quoted. There is a huge mark up.
Thank You for the content and superlative interview. Reminds me of Atul Gawande's Better: A Surgeon's Notes on Performance, which candidly touched on shortcomings in medical care. Also, Moneyball by Mike Lewis - group think and entrenched consensus leading to glaring inefficiency. Such a good conversation! Thanks again.
What about checking MPO (Myeloperoxidase) and LP-PLA2 (Lipoprotein-associated Phospholipase A2) and, or the CIMT Test?
Mendelian randomization is a method of using measured variation in genes of known function to examine the causal effect of a modifiable exposure on disease in observational studies.
It's a tragedy that I had to wait until I'd had an MI & CABG before I took an active interest in this.
How do we know that ldl isn’t pr Protective. That is comes to the rescue when there is abnormalities in the arterial lining. So the calcium we see that accumulates in the arteries is a protective patch to prevent further damage?
This theory is verboten.
The Calcium is a cover up of the real issue "arterial scurvy " Dr Thomas Levy. Reversing my Calcium score.
I checked my apo b after this podcast and it's 97 whereas normal range is upto 133. I feel it was worth checking .
Did you go through pcp/insurance or a private company?
@@J_P3 private. I think, labs work and one can make a difference following professional advices. I feel more or less the same as 20 years ago because of my healthy lifestyle
My lab classifies high ApoB over 90…. Is that wrong?
When you talk about triglycerides being elevated, you never say elevated to what? My cardiologists keep talking about my high LDL, but it is 50. As I see my research, docs would like to get ldl down to 70. I also see research that ldl scores below 50 have 159% more homographic? Strokes. Also older people with low cholesterol have the highest risk of death, and women who take statins have a 50% increased risk of developing diabetes, and statins increase calcium in the heart. I’m worried that cardiologists want me on statins. Also side effects are highest in older women with arthritis and hypothyroidism which describes me. What resources should I look at to help make my decision ?
Following the discussion, I just calculated my apoB number that's lower than ADA/ACC goal and used the app as well. Thank you. I'm waiting for your book to come out and getting ready for it by walking 2 miles (3 times a week) at 20 mins./mile rate. Just can't do the level 5 yet.
Amazing lecture! I have learned so much from this, a lot of information to digest, will watch this many times. Thank you.
Great show Dr Attia. CVD has shown itself to be a highly complex disease, and there's too many in the sci/med community perpetuating out dated models of CVD. Bottom line is lower the LDL-C/apoB the longer the better. That along with mitigating systemic inflammation - finally starting to get the traction and attention it should - are key to prevention of CVD.
Here are two highly skilled intelligent scientists searching for truth within a highly restricted system of central planning. As Dr. Sniderman expressed acurately, "We can only understand as individuals. There is no such thing as a group understanding." I completely agree. But the question is how do we find truth? I think this podcast is excellent in determing the limitations of group think imposed upon them but the solution I believe is having the freedom to take risks toward challenges in order to discover more truth. The limitations on ingenuism and discovery are far more strict in todays world of extreme regulation of central planned government medicine and lack of freedom to pursue new risk in challenges outside the systems. It is kind of like censorship. If you limit free speech, new ideas never have a chance to infiltrate and be challenged. I believe the only answer is to get government out of Health care completely and let the free markets find solutions which could never be found by bureaucrats alone.
Can anyone explain why low carb diet is associated with high LDL? What is the mechanism? Thanks
Amazing podcast, the best I've seen so far. I have a new appreciation for the depth and complexity of the cardiovascular subject matter. WELL DONE !
Great interview. Thank you so much Dr. Sniderman and Dr. Attia!
I'd love to know which lab does ApoB for $2.50 as discussed. Quest and Labcorp each charge about $ 60.
I had the same question
$13 in Germany. But I don't agree with Peter at all. LDL-C, Non-HDL-C, ApoB - are all not so different regarding the prediction value.
that's the cost to the hospitals that order it was my understanding.
@@Sean2046 The $2.50 value mentioned was the cash price, not the medical insurance price
@@erastvandorenSee Dr. Carvalo's video on YT, in which he explains why LDL-C is not reliable 25% of the time
OMG what an incredibly insightful exposee! 👏 Thank you for this.
Cost of the Apob test?
So the Doctor tells the patient that a better test is available for under $10 and insurance will not cover it.
I would think almost everyone would choose to pay the cost.
why not let the patient decide?
based on the repatha studies with an relative risk decrease of 1.5% from statin alone with an ldl of 90 lowering it to 40-50. I think we can see that lowering lipids is gives us asymptotic benefits. We are still missing another side of the story.
Great episode Peter! I would love to hear your input on why people with anorexia typically present with high cholesterol? And if this can cause the potential dangers down the road?
I had no idea. Is it the LDL-C that's high?
That disorder must cause absolute mayhem to multiple systems though. I know that people struggling with that have a very rough go of it.
Unlike alcohol and drugs, we can't abstain from food... or societal BS inputs.
It would make sense as LDL-C rises significantly in a fasted state, or whenever the body shifts dramatically to rely on fat oxydation rather than glucose. Eating hardly anything would be very close to fasting IMO.
@@zealous.y The difference is the shift from fat metabolism to catabolism of protein that happens with anorexia nervosa as fat stores are depleted that doesn’t occur with healthy fasting.
I love the idea of being able to read guidelines with mixed opinions. As a well educated patient, it makes my rang of options open to me.
It seems to me they should be more aware of 'Noise ' as described by Kahneman when they try to make guidelines.
I need to study this far more to help advise correctly on the concerns many people often bring to conversation. This is really fascinating.
He is very discreet and careful iNOT to say exactly what he is thinking or who he is talking about but we can read between the lines. People aren’t interested in APOb because it isn’t a billion dollar profit.
I am not a medical professional. I'm a cholesterol patient who has been told that he has a high risk for a heart event with no further explanation of why that risk exists. I am trying to educate myself about the factors that affect the significant concerns for my health and well being.
As I watch this very interesting podcast video, one big question comes to mind.
If this information started being available in the late 1950s and was clearly identified by the 1980s, why is it that 40+ years later the medical profession is still subjecting the patient population to the old 4 factor cholesterol panel and the BS AHA 10 year heart event risk calculator as the primary basis for determining a diagnosis and subjecting us to treatment regimens that may be effective for some people, but seems to be largely oversold and overhyped by the pharma companies and the AHA?
Some evidence suggests that endurance sports could contribute to calcification - I wonder if exercising for multiple hours at a time raises BP, as we’d expect, and therefore providing that driving force for Apo B to get trapped in the arteries… Of course, on the flip side exercise lowers BP at rest so one is walking around with overall lower BP thanks to exercise, but I wonder what’s the cost of prolonged exercise… is there a net benefit? Or should we keep it under 60 mins…
Is there a high risk of plaque rupture during vigorous exercise?
Can we talk about this conversation when you’re here? Love this guy
Thanks for siccing me on Peter attia!!
thank you! I wonder when boston heart panel will be available in other countries (europe, australia)? and how we can possibly approach precise diagnostics without it?
Wow, one of the most informative videos I’ve ever seen on the subject of LDL. Using the ApoBApp, I am normal with ApoB:100, TC:225, TG:55, but with LDL of 138, most physicians would put me on a statin! Thank you Peter!
Peter would put you on a statin too. He wants to see ApoB in the 40s.
I'm 65 F, started low carb 1 year ago, LDL went up a lot, CAC of zero and cardiologist (who is head of dept in a major hospital) recommended a low dose of statin. I told him that even if my CAC was not zero I would not take it. I've remitted my diabetes and my Trig have gone down and my HDL have increased. My liver function numbers have come down a lot and my moderate fatty liver is now only mild. I've lost 20% of my body weight and waist has gone from 44" to 38" without even trying.
@@jobrown8146 Saying ApoB is bad is not much different from the original LDL hypothesis. Triglyceride is the elephant in the room that people in this LDL camp refuse to recognize. Triglycerides to HDL ratio is the proper indicator. Raising HDL is extremely easy. There is nothing helpful in this video.
HELP😅😅😅😢😢😢. IS EZETIMBINE good to treat higher Apo B?
Nicotine causes depletion of vitamin C = inflammation = weakening of the arterial walls . Correct?
Tons of studies have shown indirectly that parasympathetic activity is decreased in patients with hypertension. PSNS causes the relaxation of blood vessels, decreasing total peripheral resistance. It also decreases heart rate.
The sympathetic nervous system regulates arterial blood pressure (ABP) by functionally influencing the vasculature, kidney, and heart. The increase in sympathetic activity is a mechanism for both initiating and sustaining the blood pressure elevation.
If an improvement in parasympathetic tone is associated with a successful reduction in blood pressure ... through things like fasting, deep breathing, and better vagus nerve function ... why is the health of a person's autonomic nervous system not ever mentioned or a focal point ??? Animal and human studies show the same pattern. Even when some people eat well (tons of greens ... veggies, quality meats, nuts, seeds, low sugar to no added sugar ... processed food, etc.) sleep well, don't drink, have great relationships, exercise, etc. sometimes interventions like a fasting regimen works to improve blood pressure without meds
I'm 55. At 42 I had a 0 CAC Score. At 50 I was put on a statin for 6 months. Stopped as it was elevating my ALT liver enzymes. At 50 my CAC Score was 47. I went back on to a statin for a year and stopped again. Liver enzymes were high. At 53 had another CAC Scan score was 106. Went on keto carnivore for 3 years. LDL went to 167 doctor again put me on statin. I stayed on the statin for 3 years...now I'm 55 had another CAC Scan score was 226. This is a 45% annual increase in calcium. Before the statin I had a 25% annual increase on my calcium score. Do statins stabilize plaque by CALCIFING MY ARTERIES? I think the statins are accelerating the calcification of my arteries!!
I am 63. The same trajectory happened to me. 5 yesrs ago my CAC was 76. Now it's 270! I have been on atorvastatin.
@Tim Yurek Ask your doctor two things. 1. How do statins lower LDL? 2. How do statins stabilize plaque? Maybe the third question is why are you subscribing me a statin to stabilize plaque when you don't know or even tested me for plaque.
@@KevinSmith-4Liberty I will ask those questions. I am going to get a CTA. That can see and distinguish soft and hard plaque. I just started complying with the Dr Esselstyn diet. I lost 16 lbs in 10 weeks.
Statins calcify your plaque which stabilizes them. At age 55 you most definitely have plaque unless you kept your LDL below 80 for your entire life, which most people don’t. Exercise also increases calcification. One way that exercise helps with ASCVD.
@@timyurek9036 I was on his diet for several years, didn't get the results I'm getting on the Linus Pauling Heart Protocol.
Reversing my heart disease!
Apo-B test in Chopo Mexico is $588 mx ($31 US, £25)