Cardiovascular disease & why we should change the way we assess risk | The Peter Attia Drive Podcast

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Allan Sniderman is a highly acclaimed Professor of Cardiology and Medicine at McGill University and a foremost expert in cardiovascular disease (CVD). In this episode, Allan explains the many risk factors used to predict atherosclerosis, including triglycerides, cholesterol, and lipoproteins, and he makes the case for apoB as a superior metric that is currently being underutilized. Allan expresses his frustration with the current scientific climate and its emphasis on consensus and unanimity over encouraging multiple viewpoints, thus holding back the advancement of metrics like apoB for assessing CVD risk, treatment, and prevention strategies. Finally, Allan illuminates his research that led to his 30-year causal model of risk and explains the potentially life-saving advantages of early intervention for the prevention of future disease.

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

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The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 35 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.

Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life).

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Видео Cardiovascular disease & why we should change the way we assess risk | The Peter Attia Drive Podcast канала Peter Attia MD