ApoB, LDL-C, Lp(a), and insulin as risk factors for cardiovascular disease [AMA 43 sneak peek]

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In this “Ask Me Anything” (AMA) episode, Peter answers questions related to the leading cause of death in both men and women—atherosclerotic cardiovascular disease (ASCVD). He highlights the most important risk factors for ASCVD, such as apoB, LDL, hyperinsulinemia, and Lp(a), and explains the mechanism by which they confer risk and how these factors are interrelated. Peter also dives deep into the data around apoB to try to answer the question of how much residual risk is conferred for ASCVD through metabolic dysfunction once you correct for apoB. He also looks at the data around lifetime risk reduction of ASCVD in the context of low apoB.

In this sneak peek, we discuss:
00:00 - Intro
00:08 - A racecar analogy for understanding atherosclerotic cardiovascular disease
09:15 - Defining and differentiating apoB and LDL-C
12:36 - The interrelated nature of insulin levels, apoB, triglycerides, and ASCVD parameters
18:17 - Another way that hyperinsulinemia plays a role in endothelial dysfunction

In the full episode, we also discuss:
-Why Peter uses the oral glucose tolerance test (OGTT) with all patients;
-Is there any evidence that hyperinsulinemia is an independent contributor to ASCVD?;
-Thinking through risk in the context of high-fat diets resulting in improved metabolic metrics but with an elevation of apoB/LDL-C;
-Thinking through risk in the context of low apoB but higher than normal triglyceride levels;
-The importance of lowering apoB for reducing ASCVD risk;
-Data on men and women with familial hypercholesterolemia that demonstrates the direct impact of high apoB and LDL-C on ASCVD risk;
-Importance of starting prevention early, calcium scores, and explaining causality;
-Defining Lp(a), its impact on ASCVD risk, and what you should know if you have high Lp(a);
-Lp(a) and ethnic differences in risk;
-Why someone with elevated Lp(a) should consider being more aggressive with apoB lowering strategies;
-Addressing the common feeling of hesitancy to taking a pharmacologic approach to lower ASCVD risk;
-Peter’s take on the 2022 Formula 1 season and thoughts on 2023; and
-More.

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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 45 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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