334 - Cardiovascular disease, the number one killer: development, biomarkers, apoB, and more

Tom Dayspring is a world-renowned expert in clinical lipidology & a previous guest on The Drive. In this episode, Tom explores the foundations of atherosclerosis & why atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide for both men & women. He examines how the disease develops from a pathological perspective & discusses key risk factors, including often-overlooked contributors such as insulin resistance & chronic kidney disease. He breaks down the complexities of cholesterol & lipoproteins with an in-depth discussion on the critical role of apolipoprotein B (apoB) in the development of atherosclerosis. He covers the importance of testing various biomarkers, the impact of nutrition on lipid levels, & the vital role of cholesterol in brain health, including how cholesterol is synthesized & managed in the brain, how it differs from cholesterol regulation in the rest of the body, & how pharmacological interventions can influence brain cholesterol metabolism. View show notes here: https://bit.ly/3WFZURi Become a member to receive exclusive content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ We discuss: 0:00:00-Intro 0:01:07-Defining atherosclerotic cardiovascular disease (ASCVD) 0:09:52-The pathogenesis of ASCVD: the silent development over decades 0:16:52-Risk factors versus risk markers, & how insulin resistance & chronic kidney disease contribute to atherosclerosis 0:24:19-How hyperinsulinemia elevates cardiovascular risk 0:30:30-How apoB-containing lipoproteins contribute to atherosclerosis, & why measuring apoB is the superior indicator of cardiovascular risk 0:48:08-Challenges of detecting early-stage atherosclerosis before calcification appears 0:57:50-Lp(a): structure, genetic basis, & significant risks associated with elevated Lp(a) 1:02:30-How aging & lifestyle factors contribute to rising apoB & LDL cholesterol levels, & the lifestyle changes that can lower it 1:11:32-How elevated triglycerides, driven by insulin resistance, increase apoB particle concentration & promote atherosclerosis 1:25:59-How LDL particle size, remnant lipoproteins, Lp(a), & non-HDL cholesterol contribute to cardiovascular risk beyond apoB levels 1:33:25-Limitations of using HDL cholesterol as a marker for heart health 1:41:35-Critical role of cholesterol in brain function & how the brain manages its cholesterol supply 1:51:40-Impact of ApoE genotype on brain health & Alzheimer's disease risk 1:56:18-How the brain manages cholesterol through specialized pathways, & biomarkers to track cholesterol health of the brain 2:03:43-How statins might affect brain cholesterol synthesis & cognitive function, & alternative lipid-lowering strategies for high-risk individuals 2:16:20-Exciting advancements in therapeutics, diagnostics, & biomarkers coming in the next few years 2:19:33-Recent consensus statements on apoB & Lp(a) from the National Lipid Association (NLA) -------- About: The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 90 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more. Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan. Learn more: https://peterattiamd.com Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Podcasts: http://bit.ly/TheDriveGoogle Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit my website where I keep an up-to-date and active list of such companies. For a full list of our registered and unregistered trademarks, trade names, and service marks, please review our Terms of Use: https://peterattiamd.com/terms-of-use/