230 ‒ Cardiovascular disease in women: prevention, risk factors, lipids, and more
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- Опубліковано 26 лип 2024
- Watch the full episode & view show notes here: bit.ly/3Ub4La1
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Erin Michos is an internationally-known leader in preventive cardiology and women’s cardiovascular health. In this episode, Erin discusses current trends in cardiovascular disease (CVD) through the lens of female biology and the observation that major adverse cardiac events in both sexes are on the rise. She walks through risk factors including LDL-cholesterol, apoB, and Lp(a) and makes the case for the importance of early preventative measures. She explains various interventions for reducing risk including a discussion of statins, GLP-1 agonists, PCSK9-inhibitors, and drugs that lower Lp(a). She goes in-depth on female-specific factors that contribute to CVD risk such as pregnancy, grand multiparity (having five or more children), oral contraceptives, menopause, and polycystic ovary syndrome (PCOS). Additionally, she explains her approach with patients as it relates to the use of hormone replacement therapy and provides advice for people wanting to lower risk both through lifestyle changes & medications.
0:00:00 - Intro
0:02:30 - Erin’s background in preventive cardiology
0:05:15 - Recent trends in cardiovascular disease in women, mortality data, & how it compares to cancer
0:13:15 - Why early preventative measures are critical for CVD risk
0:19:45 - ApoB as a causal agent of CVD, & why high apoB levels are not being aggressively treated
0:27:00 - The rising trend of metabolic syndrome & other factors contributing to the regression in progress of reducing cardiac events
0:33:30 - GLP-1 agonists-Promising drugs for diabetes & obesity
0:37:15 - Female-specific risk factors for ASCVD
0:47:00 - Polycystic ovary syndrome (PCOS): prevalence, etiology, & impact on metabolic health, lipids & fertility
0:52:30 - The effect of grand multiparity (having 5+ children) on cardiovascular disease risk for women
0:55:00 - The impact of oral contraceptives on cardiovascular disease risk
0:58:45 - The effect of pregnancy on lipids & other metabolic parameters
1:02:00 - The undertreatment of women with familial hypercholesterolemia (FH) & how it increases lifetime risk of ASCVD
1:09:45 - How concerns around statins have contributed to undertreatment, & whether women should stop statins during pregnancy
1:16:00 - How Erin approaches the prescription of statins to patients
1:21:15 - PCSK9 inhibitors & other non-statin drugs
1:28:30 - Advice for the low- and high-risk individual
1:31:00 - The impact of nutrition, stress, & lifestyle on lipids & CVD risk
1:41:15 - Lp(a) as a risk enhancer for cardiovascular disease
1:50:30 - The effect of menopause on cardiovascular disease risk
1:55:30 - How Erin approaches decisions regarding hormone replacement therapy (HRT) for her patients
2:03:30 - The urgent need for more data on women’s health
2:09:45 - Erin’s goal of running a marathon in every state
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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 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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In this episode, we discuss:
0:02:30 - Erin’s background in preventive cardiology
0:05:15 - Recent trends in cardiovascular disease in women, mortality data, & how it compares to cancer
0:13:15 - Why early preventative measures are critical for CVD risk
0:19:45 - ApoB as a causal agent of CVD, & why high apoB levels are not being aggressively treated
0:27:00 - The rising trend of metabolic syndrome & other factors contributing to the regression in progress of reducing cardiac events
0:33:30 - GLP-1 agonists-Promising drugs for diabetes & obesity
0:37:15 - Female-specific risk factors for ASCVD
0:47:00 - Polycystic ovary syndrome (PCOS): prevalence, etiology, & impact on metabolic health, lipids & fertility
0:52:30 - The effect of grand multiparity (having 5+ children) on cardiovascular disease risk for women
0:55:00 - The impact of oral contraceptives on cardiovascular disease risk
0:58:45 - The effect of pregnancy on lipids & other metabolic parameters
1:02:00 - The undertreatment of women with familial hypercholesterolemia (FH) & how it increases lifetime risk of ASCVD
1:09:45 - How concerns around statins have contributed to undertreatment, & whether women should stop statins during pregnancy
1:16:00 - How Erin approaches the prescription of statins to patients
1:21:15 - PCSK9 inhibitors & other non-statin drugs
1:28:30 - Advice for the low- and high-risk individual
1:31:00 - The impact of nutrition, stress, & lifestyle on lipids & CVD risk
1:41:15 - Lp(a) as a risk enhancer for cardiovascular disease
1:50:30 - The effect of menopause on cardiovascular disease risk
1:55:30 - How Erin approaches decisions regarding hormone replacement therapy (HRT) for her patients
2:03:30 - The urgent need for more data on women’s health
2:09:45 - Erin’s goal of running a marathon in every state
Thank you for the free content! As a 75 year old on a small fixed income I really appreciate this.
Diane, doing broth at home with bones or chicken feets add a bunch if vegetables and having great content on prot/fat, having eggs, that gives you the chance to buy meat also. And that's it. Food exercise is the key to survive. Greetings!
Hello Peter. Thank you for the free content. I am a 50 year old woman and for the past 20 years I've had elevated levels of LDL. Always high HDL and low triglycerides. We have moved around Canada and in the rest of the world and every doctor I saw about my cholesterol levels either have said, no problem as I am a non smoker not over weight. Others insisted on putting me on statins right away. I am sooo very frustrated by this. I have no idea what to do. Not only this but when I mention Apo B to some of the doctors (family doctor and or GP), (one didn't even know what it was) and the others were not wanting to do the test given my "low risk factors". I am here to tell that the biggest hurdle is the GP (the gate keepers to all other medical specialists and tests). The GPS I've come across are not informed about ApoB or are so reluctant to do a test as if the cost was coming out of their own pockets. I am looking into a private lab now to get my Apo B levels tested but then that still leaves me without a knowledgable expert to interpret my results. GPS / Family physicians are the ones who must be educated in this subject, that is where a meaningful change will happen for the everyday person like myself.
I’m in the same boat as you, as are many older Canadian women I’m sure. I may pay to have my APOB tested too. I’ve watched a few UA-cam videos that have helped explain what to look for in results. It would be useful if Peter or some other experts could go into more depth on this to help us out.
Thankfully, ApoB is a pretty cheap test.. normally less than $20.
Shocked me since I was told they were way too expensive to order. 🙄
GPs are worthless mostly
Thank you for this podcast, Dr Attia. In case you’re monitoring these comments, I’d like to suggest an interview/podcast with Dr Howard N. Hodis, MD, who is an expert in women’s heart health and HRT! I think he would be able to go into more detail and answer some of the questions you were not getting answers to (regarding estrogen and ASCVD) in this podcast.
Dr Howard Hodis is professor of medicine/cardiology at USC Keck school of medicine in Los Angeles. He has published extensively with a major focus and special interest in women’s health. He and colleagues have conducted two of the earliest RCTs of hormone therapy and atherosclerosis intervention, the results of which contributed to formation of the menopausal hormone therapy timing hypothesis.
Thank you for your interest in women’s health, Dr Attia! 😊
Osteoarthritis can severely limit a person's mobility and subsequent cardiovascular heath. It seems that there has been little changes in treatment or prevention for so long. I would like to see insight into any new research in this area. I feel like it's a death sentence.
They're nothing but drug pushers
This was an awesome pod, loved it. I was so hoping that she would have addressed statins, dementia, and women. Isn’t that a consideration?
Nope, it's bad. He won't talk about the real culprits.
It was a pathetic discussion
...well, yah - I would think so!
I'm only 1/4 of the way in, and I guess I assumed - since Peter did indicate (I thought) they would discuss treatment options(?) Nothing on statins?...hmmm🙄
get his book Outlive - it is discussed there
As a clinician this is sooooo helpful!!
I’ve been fasting for some time, I normally do 16-18hr fast and one day 24-36hr fast two days no fast. I had pre diabetes level blood glucose and was the reason for fasting. Ive lost weight and have a normal weight level, I had my first blood test the other day, my sugar levels were normal (yeah) but my vit D was low and even worse my cholesterol was so high the doctor told me to double my statins 😢 why is my cholesterol so high from fasting? I did the test after a long fast, I’m wondering if it skewed the results and I should have stuck with the standard 8-12hr before a fasting blood test. I’m Now searching for answers because everyone says fasting lowers cholesterol but it doesn’t seem to have in my case 😢.
Remarkably, one-quarter of the centenarians had high Lp(a) serum levels even though they never suffered from atherosclerosis-related diseases. 1998 G. Baggio.
Thanks for sharing!🧠💥💪🏽👍🏾
The Lp(a) levels were inversely correlated with the CIMT in this population, suggesting that subjects with a low Lp(a) level may have a predisposition to carotid atherosclerosis. This finding was preliminary and should be investigated further in larger studies and in additional settings. 2012 article CIMT thickness in asymptomatic subject with low Lp(a).
18:6; 20:4 Intermittent Faster and 24plus hrs once or twice a month (did Extended Fasting before Type 2 reversed & HBP normalized once a week). HDL went over 90, Triglycerides under 70 but Total Cholesterol & LDL- over 309 & 200 respectively. I'm not concerned.
Good for you, understanding maybe better than this gal.
@@mrbigsdaddy what I didn't say: I'm Female, 70yrs, 20plus yrs type 2; 30plus yrs HBP; Exerciser since 2007, Certified Fitness Instructor 2018; but reversals happened after Pandemuc, Lockdowns when I began working out Fasted on a Low Carb High Fat Diet.
@@anomarnamloh7444 lchf wins, every time it is properly tried. Despite the dietary SF/cholesterol.
@@mrbigsdaddy I'm going over my lipid panels to see when my LDL-C and Total-C began rising up and my HDL went up and my Triglycerides began dropping. I think it was before I even knew what IF & LCHF was. I began exercising Fasted in the A.M. right after Lockdown began at home. I, March/April 2020. A year later I learned about Fasting & IF and in June I added LCHF in my diet. I'm on the Facebook group, Private, LMHR
@@anomarnamloh7444 Feldmans group. Going to see if they let me in. Idk if I am a lmhr, but … Ima member at world carnivore tribe.
No Peter, Dr N.Ali says that the statins have real consequences and he gives the research to prove it
Can you have moderately high LDL but low amount of APOB?
Yes, assuming you're referring to LDL-C. ApoB is the sum total of LDL, VLDL, IDL, and Chylomicron (assuming you're measuring both ApoB-100 and ApoB-48) particles. You could totally have a high amount of LDL-C but low ApoB, namely if your triglyercides, LDL-P, etc are low.
@@kkurt5 thanks that is helpful. I conclude that one should not agree to take statins solely based on LDL-C test. You should know by testing that you have high APOB before going on statins. However the APOB test is not part of regular blood work in Canada.
@@sherrygaley4675 if your doctor refuses to order it, you can order it yourself. I suspect for less than 50 CAD
My heart health regime is Carnivore and exercise. I do sardines in AM and 🥩 about 10. I run 4 miles then do 4 -6 more steps/ day. I do upper body resistance. No prescription. 80 years. I don’t do fruits/ vegetables ever… Never smoked. I sub everyday retired teacher. I do Fast 72 hrs/ week. I do not have the ring of cholesterol around my eye that is common in cohorts my age so my optometrist reports. A Lark awaken happy….. Family male stroke or heart attack late 80s females stroke late 90s if no smoking then heart.
Dude, that write up was brutal lmao.
Well done. Nutrition! Not this lady’s pills!
Pp]pppppppp]p]ppppppppppppppppppppppppppppppppppppppppppppp
It's the death regime, not a health regime.
The absolute risk reduction of using statins on all cause mortality has been shown to be very small. Why is it that this highly educated and prestigious cardiologist is still recommending aggressive statin use to lower LDL when there is little to no benefit to doing so?
I am starting to change my negative opinion about statin because of Peter and his guests.
@@metemad I have not heard any compelling evidence to change my opinion.
I have had similar doubts regarding statins, Rachel, yet, top cardiologists insist on lowering LDL in elderly, at risk patients down to 40s... I keep my mind open...
That is because people like you don't comprehend absolute risk over time. I am not interested in short term prevention. Statins prevent my heart attack in 15 or 20 years. I plan to go at least 20 more after that. Also, by combining it with ezetimibe you can go very low dose with max effect and minimal side effects.
Further more, the meta analysis this "absolute risk low tho!" nonsense is based on concludes with this: "An important finding from the analysis was the high level of statistically heterogeneity in the studies, ranging from 27% to 82%, which suggested that pooling of results could make the findings unreliable." Yeah let's go with that then. No thanks, I'll keep my rosuvastatin / ezetimibe combo.
She should know the NNTs!
Exactly they won't be honest about that. they never are!
Ok, your podcasts are top, nearly higher than my mind( vocabulary) is at some moments reaching. I mix it up, I am the one with the focus on vaccination. I have a colleague going right away into menopause after vaccination, another getting her period suddenly twice a month. I gained some knowledge past months, I still stick to vaccination, even though I feel healthy now, I was badly sick and this has happened right away being vaccinated and it went for months. A doctor and my friends lied 4 and half months a comma after a second bioNtech vaccine, a son a my another friend was shortly after being vaccinated dead with 40 before that having no health issues, and and and..... I am at the airport and I know stories from bleeding out of ears, a young passenger lying in a hospital with a sudden heart operation( all shortly after a vaccine), passenger falling down death, me myself seeing and dealing with 5 sick passengers within a short time, my colleagues also, it repeats itself. I understand the insulin resistance( as a doctor explained to me using an insulin, of course it depends), Lufthansa flies with medical services on board. See I might get killed eventually, but no one will fool me. Thank you. I know I walk away from the topics, but in fact not too far. My English is not good enough, but I think you get the sense. THANK YOU.
...well, no - only 'sense' I got fm your wordy comment is that you tried to use this platform to vent your fear & loathing of Vax, and unleash it on a podcast completely unrelated to YOUR topic.
What's with that?
I'm really surprised on how little time was put on lifestyle changes, and how much time on pills. Really? Are you serious?
Of course, we are talking about experts in the pill-pharma system. Are you guys already taking yourselves your daily dosage of statins, pcsk9 inhibitors, glp1 receptor agonists, etc? (On top of Rapamycin)
I don't think so, or are you? Really?
I thought that, even if Peter has this arsenal of pills on hand, he was only using the longevity drugs orally and managing the rest of his health through diet, excersice, sleep and stress management. And doing the same for his patients. Really with a very strong emphasis on lifestyle, and not so pill-centered as her guest. Yes, I know, they talked a bit of lifestyle changes and diet (like 5 minutes of a 2 hours podcast)
I'm really surprised.
In the meantime, I'll stick with Dave Feldman, Paul Mason, Paul Saladino and Shawn Baker. No statins or other pills, by the way.
Paul Saladino shows up on Layne Norton's stream a lot.
Too many acronyms. Intelligence exercise! 😮
1:17:40
This very old message. ‘Give everyone a statin’ did not improve for the extra detail. And dietary advise that has failed for 50 years, didn’t improve either. How sad.
What I have written is not to criticize the vaccine etc.... there is no ideal Lufthansa uniform, as an example to some it suits other must fix the shape of their body. But I am not also exaggerating what I was told in the past months. As it is at an early age insulin resistance is also showing up by children etc. smart people might fix it with them in a natural way. In many cases it works, I have a colleague who is diabetic and through interval fasting she does not need insulin, but an adequate diet, etc. Last week I listened to Biden's speech on Pharma, mentioning insulin and it is a dumping price for families with children to afford it. It starts as you pit your daughter in a camp having no smart phone. All this can work if smart people like this lady or you tell others how. Thank you.
The Industry standard.
Pass
yeeeees
Guess i will skip this one.
Nothing of value here.
About 31:30. I am constantly disappointed by experts. She correctly Identifies highly processed food as a contributor to obesity. She Fails when identifying its dangerous components as SATURATED FAT and additives. HPF is not full of saturated fat. It is full of high o6 PUFA, LA. Also full of refined sugar/grains. There is your metabolic disfunction, guaranteed by the food supply… but fortunately we have pills comming on to treat it.
BS, HPF is full of SFA.
@@erastvandoren yes, I believe it is, also.
Certainly SFA's in HPF cannot be ruled out as a contributor to MD due to consuming a diet high in HPF.
SFA may not be as high, overall, in HPf's
as other 'culprits' but it is definitively, a player.
To try splitting hairs over all the crap in HPF, to let SFA's off the hook as a contributing factor to ill health from
HPF-forward consumption
- is ludicrous, imo.
The whole cholesterol/lipoprotein hypothesis is such bullshit. It is embarrassing that this is still being seriously adressed or just very corrupt.
Thank you!
💯%
It's sad indeed they keep following junk science just to push statins. Attia is pathetic
It is proven beyond doubts. Read “The Cholesterol Wars”.
@@erastvandoren *Beyond your doubt. Read ''Something that will maybe falsify your current understanding''.
Still I'm curious what makes the story of Steinberg appealing to you? Is the mechanism of atherosclerosis convincing and logic on its own? Is it because of some of the clinical statin trials?
Does it bother anyone else when she talks about, in effect, luring statin-reluctant women to take them by giving them one that sounds lower in dose, thereby getting better “buy-in”?
Baribrooks - NO, not really. She's obviously using this tactic in the interest of the well-being of a patient that has bought into all the negative hype around the evils of statins.
....What??! Do you think she's doing this for 'the money'? Maybe she gets a pharma $$$ 'kickback' for prescribing statins??? (I'm being completely facetious here ;))
But, no, to answer your question - does not make me uncomfortable at all. IMO, whatever works; works (even a bit of trickery).
I took a statin in my 40s and developed prediabetes and muscle pain. No dose levels would not lure me.
I'm sorry but this was really hard to listen to
Totally out of character for a Peter Attia podcast.
Seemed more like a pharmaceutical advertisement for statins.
Additionally, Attia never stepped in when she was referencing HRT studies he himself has questioned in multiple prior podcasts as poorly designed with dubious results.
As a fanboy of great science and those that can intelligently interpret it - this was disappointing.
Indeed it was pathetic and Attia is nothing but a narcissist
Yes, they really lost credibility there… especially her. Citing a study that has virtually been debunked … makes her appear like some of her biases and knowledge is outdated. Which is scary.
I wondered the same thing.
I agree. I was shocked that Peter didn’t call her out for maligning HRT.
Anyone who continues to push statins is not worth my time. Peddling life destroying substances that have shown no demonstrable benefit for women - EVER ANYWHERE - in any independent non-pharma sponsored studies is so shameful.
She's absolutely pathetic
Attia: Take statins! There are no side effects. Even though there is no mortality benefit. And only a 1 percent decrease in events. And muscle wasting, congestive heart failure, T2D, cognitive decline, destruction of CoQ10 are all made up. Increase in Lp(a) which is a serious heart disease risk (unlike Lp(a)) doesn't matter because I found a way to manipulate the data. Besides, Dayspring says to take statins even though he doesn't do so, and could not run a mile if his life depended on it.
I have no faith respect for either of them
Yeah until you had a few friends barely surviving the widowmaker in their mid 50s and then dragging around an oxygen bottle around in their last few years. I'm sticking with super low dose rosuvastatin and ezetimibe for best of all worlds. Zero side effects.
@@robertusga Good for you. Except your plan doesn't work.
@@danielmccarthyy annnd you base your comment on exactly what outcome based data from quality studies in humans? Go!
@@robertusga Start with a look at the publications by David Diamond, PhD. But I doubt you will wish to leave the comforting blanket of your own ignorance.
A fruit and vegetable based diet drastically reduces cardiovascular risk
Actually adding veg, particularly fruit, is more likely counter productive in improving metabolic health. It is a profitable scam that plant based is useful to health.
You are what you eat. Your diet impacts your health.
Lower stress, reduce obesity and more exercise are key to a healthy life.
Obesity in children and adults is rising across the world.
Fast food and sugary drinks are contributing to the problem of poor health and obesity.
Eat a healthy plant based diet and exercise regularly.
Reduce or ELIMINATE cows milk, eggs, cheese and meat. Eat more salad greens, beans, fruit and vegetables. Eliminate fast food, snacks like cookies, cakes, chips, and sugary drinks and juices.
Every adult and child should own a bicycle and ride it regularly.
Regular exercise will help you sleep better. Yoga is a great stress reducer.
Obesity is all too common today. Get off the couch. Get off the phone, ipad or video game.
A variety of stretching and other exercises help with increased mobility.
Ride to work, ride to school, ride for fun.
Every city should be a bicycle city.
Speak up for bicycles in your community
Lol. That's absurd.
We need to get off the polarizing plant based diet narrative. Common ground is the easy fight that will help the most people. 93% of Americans are not metabolically healthy. The first step is eat real food. Minimally processed if at all. Fruit and vegetables are real food. Grains not so much. Meat yes. Dairy not so much. Eggs yes. Any thing that says low fat, no way.
Then once 80% of disease is gone we can argue about minor details. Chicken vs beef vs crickets vs soy.
@@KJSvitko An animal based while food lchf diet, with no seed oil, no highly processed plant food, looks like a path to a natural human diet. A chronic disease free diet. A definitionally nutrient deficient PB diet is wildly over rated. High carb is crushing for metabolic health.