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Summary of Transcript:
In this podcast episode, host Peter Attia interviews Dr. Ethan Weiss about the value of calcium scans and CT angiograms to assess cardiovascular health. Dr. Weiss explains that calcium in the coronary arteries is strongly related to the risk of adverse outcomes and that calcium scans are a low-risk, low-cost tool for assessing this risk. He also notes that while a calcium score of zero may be meaningful, it is most valuable in older patients with risk factors. In contrast, a calcium score of zero in a younger patient may not provide useful information. The conversation also touches on Dr. Weiss’s midlife career change to work on creating a new biotech company.
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Summary of Description:
Dr. Ethan Weiss, a preventative cardiologist at UCSF, discusses the use of diagnostic imaging tools to image plaque and how they inform our understanding of ASCVD risk and guide clinical decision-making. He compares the diagnostic imaging tools, CAC (coronary artery calcium score) and CTA (CT angiography), used to image plaque, discusses the types of plaque that cause events, and explains why high blood pressure is problematic. He also talks about the best way to measure blood pressure, why we shouldn’t accept that blood pressure rises with age, and how he uses different drugs to treat hypertension. In addition, he explains our current, but limited, understanding of the role of metabolic health in ASCVD and discusses the impact of fat storage capacity/location on metabolic health and CAD.
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Understanding ASCVD Risk and How Diagnostic Imaging Tools Can Help Guide Clinical Decision-Making
In this episode of the Peter Attia Drive podcast, Ethan Weiss, a preventative cardiologist at UCSF, provides insights into the diagnostic imaging tools used to image plaque and how these tools inform clinical decision-making. He also shares his expertise on metabolic health in ASCVD and the impact of fat storage capacity and location on CAD.
Comparing and Contrasting Diagnostic Imaging Tools
Weiss compares and contrasts the diagnostic imaging tools, CAC (coronary artery calcium score) and CTA (CT angiography), used to image plaque and explains how these tools inform our understanding of ASCVD risk and guide clinical decision-making. He also describes how improved methods of CTA have helped to grade plaque lesions and shape medical decisions such as stenting.
Optimal Medical Therapy vs. Stenting
Weiss favors optimal medical therapy over stenting outside of particular situations and explains why, citing data that make a case for optimal medical treatment. He also discusses the need for FFR CTA and the potential for medical therapy to eliminate ASCVD.
The Role of Metabolic Health in ASCVD
Weiss discusses our current, but limited, understanding of the role of metabolic health in ASCVD. He explains how fat storage capacity and location significantly affect metabolic health and CAD. He also shares insights on the fat attenuation index (FAI) and other ways to measure inflammation in a plaque.
Importance of Blood Pressure Management
Weiss emphasizes keeping blood pressure in check and defining what’s normal. He explains why we shouldn’t accept higher blood pressure with age and discusses blood pressure variability, the best way to measure it, and data suggesting the enormous impact of keeping it down. He also talks about the drugs recommended by the ALLHAT trial for treating high blood pressure and shares insights from the SPRINT trial on the aggressive treatment of hypertension and the risks of such treatment.
Statin Hesitation and Risks
Weiss also addresses the root cause of statin hesitation and discusses the risks of statins and exercise that may increase the risk of calcification. He also explains what this means for the chance.
Final Thoughts
In this episode, Weiss shares valuable insights into the diagnostic imaging tools used to image plaque and how these tools inform clinical decision-making. He offers his expertise on metabolic health in ASCVD, the impact of fat storage capacity and location on CAD, and the importance of blood pressure management. He emphasizes the need for optimal medical therapy.
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In this episode, Ethan Weiss, a preventative cardiologist at UCSF, compares & contrasts the diagnostic imaging tools, CAC (coronary artery calcium score) & CTA (CT angiography), used to image plaque & how these tools inform our understanding of ASCVD risk & guide clinical decision-making. He discusses the types of plaque that cause events & the data that make a case for optimal medical therapy over stenting outside of particular circumstances. He explains why high blood pressure is problematic & walks through the data from clinical trials testing aggressive treatment. He talks about the best way to measure blood pressure, why we shouldn’t simply accept that blood pressure rises with age, & how he uses different drugs to treat hypertension. Additionally, he explains our current, but limited, understanding of the role of metabolic health in ASCVD. He discusses the impact of fat storage capacity/location & explains how & why there is still a residual risk, even in people with normal lipids and blood pressure.
We discuss:
0:00:00 – Intro
0:00:08 – Ethan’s entrepreneurial work in the cardiometabolic disease space
0:02:03 – Calcium scans (CAC scores) & CT angiography (CTA), & how it informs us about ASCVD risk
0:07:15 – Peter’s historical CAC scores, CTA results, & how one can be misled
0:12:07 – How Peter’s CTA results prompted him to lower his apoB
0:19:39 – Calcium scans vs. CT angiogram (CTA)
0:28:07 – How Ethan makes clinical decisions based on CTA results & plaque burden, & the importance of starting treatment early to prevent ASCVD
0:34:12 – Improved methods of CTA to grade plaque lesions & how it’s shaped medical decisions such as stenting
0:43:31 – Why Ethan favors optimal medical therapy over stenting outside of particular situations
0:57:23 – The need for FFR CTA, & the potential for medical therapy to eliminate ASCVD
1:01:31 – The fat attenuation index (FAI) & other ways to measure inflammation in a plaque
1:04:00 – Statins & exercise may increase the risk of calcification, but what does this mean for risk?
1:10:54 – The root cause of statin hesitation
1:17:07 – Importance of keeping blood pressure in check, defining what’s normal, & whether we should accept higher blood pressure with age
1:28:59 – Blood pressure variability, how to best measure it, & data suggesting the enormous impact of keeping blood pressure down
1:45:05 – Drugs for treating high blood pressure recommended by the ALLHAT trial
1:48:27 – What the SPRINT trial says about the aggressive treatment of hypertension, & the risks of such treatment
1:54:04 – Confirmatory results in the STEP trial for blood pressure, & how Ethan uses the various drugs to lower blood pressure in patients
2:03:06 – The role of metabolic health in ASCVD
2:08:50 – The impact of fat storage capacity & location on metabolic health & CAD
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About:
The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…& a few other things. With over 45 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, & 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 & mental health, & pharmacology to increase lifespan (delay the onset of chronic disease) while improving healthspan (quality of life).
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