Why LDL is Not Enough: The Tests Your Doctor is Missing to Assess Your Risk of Heart Disease | Know Your Numbers

Mark Hyman

Feb 16, 2024

Episode description

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Heart disease is the world's leading cause of death. For years, the diet-heart hypothesis, which centers on high cholesterol as the primary culprit, has dominated the medical discourse. But now, we're beginning to appreciate the complexity and nuance of how the outer workings of our environment influence the inner workings of our physiology and risk for heart disease.

In today’s episode of a new series I’m calling Know Your Numbers, I deep dive into the Functional Medicine approach to assessing cardiovascular risk and why this is key to preventing and, in some cases, reversing cardiovascular disease.

You can test your cardiovascular risk with Function Health, a company I co-founded. It has been a lifelong dream for me. Function is the first-ever membership that includes 100+ lab tests and personalized insights from globally renowned doctors based on your results. Join Function at FunctionHealth.com.

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Here are more details from the episode (audio version / Apple Subscriber version):

Prevalence of cardiovascular disease and heart attacks (9:38 / 8:08)
Why conventional medicine misses the mark in assessing and treating cardiovascular disease risk and “high” cholesterol (10:50 / 9:20)
The testing you should be getting to assess cardiovascular risk (28:23 / 26:53)
The major root causes of heart disease (46:38 / 44:10)
Cholesterol: What is it and how is it related to heart disease? (47:20 / 44:52)
Insulin resistance and heart disea

Mindsip insights from this episode:

Address insulin resistance to combat heart disease

The major root cause for heart disease today, aside from some genetic disorders, is insulin resistance from a diet high in starch and sugar.

#heart

#insulin

Monitor triglyceride-to-HDL ratio to assess heart disease risk

A triglyceride-to-HDL ratio greater than two-to-one is a highly predictive marker for insulin resistance and heart disease risk.

#heart

#risk

Utilize AI-enabled coronary CT angiogram to detect dangerous plaque

An AI-enabled coronary CT angiogram, like the one from the company Clearly, is the new gold standard for identifying dangerous, soft, non-calcified plaque.

#AI

#plaque

Eliminate alcohol to reduce heart disease risk

A 2022 study of 370,000 people found that no amount of alcohol is protective, and all levels were associated with an increased risk of heart disease.

#alcohol

#heart

Reevaluate LDL cholesterol as a heart attack predictor

In a study of 136,000 patients hospitalized with heart attacks, 75% had a 'normal' LDL cholesterol level.

#heart

#LDL

Reassess statin use for primary prevention of heart attacks

For primary prevention, you have to treat 217 people with a statin for five years to prevent just one non-fatal heart attack.

#heart

#statin

Identify lean mass hyper-responders on high-saturated-fat ketogenic diets

Some thin, fit people are 'lean mass hyper-responders' who experience a dramatic, unhealthy spike in LDL particles on a high-saturated-fat ketogenic diet.

#keto

#LDL

Track ApoB to assess cardiovascular risk effectively

Of all the cholesterol biomarkers, Apolipoprotein B (ApoB) is the most important one to track for assessing cardiovascular risk, not LDL.

#APOB

#cholesterol

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