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Summary of Transcript:
Peter Etia welcomes Benoit Arsenault to the Drive Podcast to discuss Lipoprotein Lp(a). Benoit became interested in Lp(a) research during his postdoc years, and the genetic association studies published from 2009-2011 helped to resurrect the field. They discussed how Lp(a) is associated with cardiovascular events and how approximately 20% of the world population has an Lp(a) level that puts them in a higher risk category. Benoit explained that in the 70s and 80s, studies were published that showed that elevated Lp(a) was associated with cardiovascular events. Still, the assays used were inaccurate and overestimated the bigger isoform size and underestimated the small Lp(a) isoform size. Better assays have been developed, and the interest in Lp(a) has grown.
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Summary of Description:
In this episode of The Peter Attia Drive, research scientist Benoît Arsenault discusses Lp(a)—the most crucial genetically-inherited trait for atherosclerotic cardiovascular disease (ASCVD) risk. Benoît explains the biology of Lp(a), how it’s inherited, the importance of measuring Lp(a) levels, and the diseases most associated with high Lp(a). He also dives into data on the possible treatments for lowering Lp(a), such as niacin, statins, and PCSK9 inhibitors, as well as the most exciting new potential therapeutic—antisense oligonucleotides.
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Exploring Lp(a) and Its Role in Cardiovascular Disease Risk
Cardiovascular disease (CVD) is one of the leading causes of death worldwide. Researchers are looking into the role of genetic factors, such as Lp(a), to understand the risk factors for CVD better. Lp(a) is the most crucial genetically inherited trait regarding atherosclerotic cardiovascular disease (ASCVD) risk.
In this episode of The Peter Attia Drive, Benoît Arsenault, a research scientist focused on understanding how lifestyle and genetic factors contribute to CVD risk, explains the biology of Lp(a), how it’s inherited, the importance of measuring Lp(a) levels, and the diseases most associated with high Lp(a).
Benoît discusses the relationship between Lp(a) and CVD risk and the findings from genome-wide association studies (GWAS). He then dives into the biology of Lp(a), the structure of LDL-p and Lp(a), and how more significant numbers of Lp(a) particles are associated with an increased risk of disease.
Benoît then explains the genetics and inheritance of Lp(a) and how and when to measure Lp(a) levels. He discusses niacin and other proposed therapies to lower Lp(a), apoB, and CVD risk, as well as the most exciting new potential therapeutic—antisense oligonucleotides.
Finally, Benoît explains why awareness of Lp(a) among physicians remains low despite the importance of managing risk factors for ASCVD and why we need more research on individuals with high levels of Lp(a).
This episode is a must-listen for anyone looking to understand Lp(a) and its role in CVD risk. Please tune in to learn more about this vital marker and how to manage it.
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Source Description
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Benoît Arsenault is a research scientist focused on understanding how lifestyle and genetic factors contribute to cardiovascular disease risk. In this episode, the discussion casts a spotlight on Lp(a)—the most crucial genetically-inherited trait regarding atherosclerotic cardiovascular disease (ASCVD) risk. Benoît explains the biology of Lp(a), how it’s inherited, the importance of measuring Lp(a) levels, and the diseases most associated with high Lp(a). He dives into data on the possible treatments for lowering Lp(a), such as niacin, statins, and PCSK9 inhibitors, as well as the most exciting new potential therapeutic—antisense oligonucleotides.
We discuss:
0:00:00 – Intro
0:00:08 – How Benoît came to study Lp(a)—a new marker for cardiovascular risk
0:04:43 – The relationship between Lp(a) and CVD risk
0:15:08 – What genome-wide association studies (GWAS) revealed about Lp(a)
0:21:54 – Clinical tests to measure Lp(a)
0:26:11 – The biology of Lp(a)
0:29:52 – How statins lower LDL-cholesterol and why this doesn’t work for an Lp(a)
0:35:20 – The structure of LDL-p and Lp(a) and what makes Lp(a) more atherogenic than an equivalent LDL particle
0:46:00 – The role of Lp(a) in aortic valve disease
0:52:24 – How greater numbers of Lp(a) particles are associated with increased risk of disease
0:56:56 – The genetics and inheritance of Lp(a) and how and when to measure Lp(a) levels
1:07:30 – Niacin and other proposed therapies to lower Lp(a), apoB, and CVD risk
1:22:46 – Why awareness of Lp(a) among physicians remains low despite the importance of managing risk factors for ASCVD
1:28:36 – The variability of disease in patients with high Lp(a)
1:37:45 – Diseases most associated with high Lp(a)
1:48:05 – The biology of PCSK9 protein, familial hypercholesterolemia, and the case for inhibiting PCSK9
2:04:58 – The variability in PCSK9 inhibitors’ ability to lower Lp(a) and why we need more research on individuals with high levels of Lp(a)
2:10:38 – Peter’s approach to managing patients with high Lp(a), and Benoît’s personal approach to managing his risk
2:13:33 – Antisense oligonucleotides—a potential new therapeutic for Lp(a)
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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 40 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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