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

Read full show notes here: bit.ly/3r2hU9A Subscribe to receive exclusive subscriber-only content: bit.ly/3r7TUSg Sign up to receive Peter's email newsletter: bit.ly/3G1kr8n 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 -------- About: 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). Learn more: bit.ly/3rbsBXk Connect with Peter on: Facebook: bit.ly/PeterAttiaMDFB Twitter: bit.ly/PeterAttiaMDTW Instagram: bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: bit.ly/TheDriveApplePodcasts Overcast: bit.ly/TheDriveOvercast Spotify: bit.ly/TheDriveSpotify Google Podcasts: bit.ly/TheDriveGoogle

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