Cardiovascular disease, the number one killer: development, biomarkers, apoB, cholesterol, brain health, and more | Tom Dayspring, M.D.
Peter Attia
3 feb 2025
Mindsip insights from this episode:
Recognize atherosclerosis starts in childhood for early intervention
Autopsy studies reveal that the process of atherosclerosis, the deposition of cholesterol in artery walls, begins as early as childhood and even in the fetal stage.
Identify desmosterol biomarker to address statin brain fog
Cognitive 'brain fog' from statins may be linked to the over-suppression of a brain cholesterol synthesis marker called desmosterol, which can be measured in the blood.
Understand brain's unique cholesterol synthesis for optimal health
The brain synthesizes 100% of its own cholesterol, which has a half-life of five years, and it cannot be supplied by cholesterol from the rest of the body.
Address APOE4 gene impact on brain cholesterol transport
The APOE4 gene, a major risk factor for Alzheimer's, creates a protein that is less efficient at transporting essential cholesterol between brain cells.
Rethink HDL cholesterol levels as potential dysfunction markers
A high HDL cholesterol level does not guarantee protection and can even be a marker of dysfunctional HDL particles that fail to clear cholesterol effectively.
Monitor triglyceride levels below 100 mg/dL to assess cardiovascular risk
The pathological process linking triglycerides to increased cardiovascular risk begins at a level of 100 mg/dL, far below the standard 'high' cutoff of 150 mg/dL.
Reduce triglycerides to lower atherogenic APOB particles
High triglycerides cause LDL particles to become small and dense, which impairs their clearance by the liver and increases the total number of atherogenic APOB particles.
Prioritize APOB measurement over LDL cholesterol for cardiovascular risk assessment
Measuring the concentration of APOB particles is more important for assessing cardiovascular risk than standard LDL cholesterol, as it's the number of particles that drives atherosclerosis.
Recognize LP(a) as a major heart disease risk factor
The genetic lipoprotein(a), or LP(a), is seven to eight times more atherogenic per particle than a normal LDL particle and is a major risk factor for heart disease.
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