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Summary of Transcript:
In this YouTube video, Peter Etia interviews Alan Nordiskart about the flaws in the 10-year risk approach for preventing premature disease. Nordiskart explains that the 10-year risk approach does not consider the natural history of the disease, making it almost impossible to avoid early disease. He further explains that the 10-year risk approach is based on age and sex rather than factors like cholesterol and blood pressure and that the risk is low until age 55-60. He proposes the causal benefit model, which considers the risk over 20-30 years, as an alternative to the 10-year risk approach.
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Summary of Description:
Podcasts
In this episode of The Peter Attia Drive, Dr. Allan Sniderman discusses the many risk factors that predict atherosclerosis, including triglycerides, cholesterol, and lipoproteins. He also explains his research that led to his 30-year causal model of risk and the advantages of early intervention to prevent future disease. He makes a case for apoB as a superior metric that is currently underutilized.
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Podcasts
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Cardiovascular Disease (CVD): Exploring the Risk Factors with Allan Sniderman
Cardiovascular disease (CVD) is the leading cause of death in the world, and yet we are still struggling to assess and predict risk accurately. Professor Allan Sniderman, a highly acclaimed professor of cardiology and medicine at McGill University, is a foremost expert on CVD and has dedicated his career to understanding the risk factors associated with the disease. In this episode, he explains the many risk factors that predict atherosclerosis, including triglycerides, cholesterol, and lipoproteins. He makes a case for apoB as a superior metric that is currently underutilized.
Professor Sniderman explains that the current scientific climate is focused on consensus and unanimity over encouraging multiple viewpoints, holding back the advancement of metrics like apoB for assessing CVD risk, treatment, and prevention strategies. ApoB is a protein found in the lipoproteins that carry cholesterol and triglycerides through the bloodstream. It is a more accurate measure of CVD risk than traditional cholesterol and triglyceride tests, as it considers the number of particles in the blood rather than just the cholesterol concentration.
In addition to apoB, Professor Sniderman explains the importance of considering other risk factors, such as hypertension and family history, when assessing CVD risk. He also discusses the potential benefits of early intervention for preventing future diseases. He emphasizes the need for critical thinking when making clinical decisions in the face of uncertainty. He argues that the lack of critical thinking once a “consensus” is reached hinders medical advancement.
This episode of The Peter Attia Drive is a must-listen for anyone interested in understanding the risk factors associated with CVD and the potential benefits of early intervention to prevent future diseases. Professor Sniderman’s expertise and passion for advancing the science of CVD risk assessment are truly inspiring.
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Source Description
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Allan Sniderman is a highly acclaimed Professor of Cardiology and Medicine at McGill University and a foremost cardiovascular disease (CVD) expert. In this episode, Allan explains the many risk factors that predict atherosclerosis, including triglycerides, cholesterol, and lipoproteins. He makes a case for apoB as a superior metric 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 to prevent 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 the 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 the lack of critical thinking hinders medical advancement 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
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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 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 extensively deals with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease) while improving healthspan (quality of life).
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