In Episode #253, Dr Thomas Dayspring joins me to round out our three-part masterclass on blood lipids and atherosclerotic heart disease. In Episode #251, we covered what blood lipids are and what happens when things go wrong within the lipid transportation system, and in Episode #252 we looked towards how to test and understand your blood lipids as an individual. Make sure to listen to those episodes first.

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In this episode, Part Three of the lipid series, we discuss interventions to lower risk of atherosclerotic cardiovascular disease (ASCVD). Both Dr Dayspring and I believe in a lifestyle-first approach to lipid optimisation. As discussed in previous episodes with the likes of Dr Gil Carvalho and Dr David Jenkins, there is no doubt that nutrition is the most powerful lifestyle tool we have to dramatically lower ApoB. In some cases, certain people will be able to lower their ApoB by around 30% through diet alone.

This conversation is designed to help you better understand the treatment options available if you do require a pharmaceutical approach. As Dr Dayspring says: you need to be your own advocate, which means developing some level of understanding to gain more autonomy over your health.

Given Dr Dayspring’s expertise in both research and practice, this episode focuses almost exclusively on the available pharmaceutical drugs to lower ApoB, an elevation of which is essential for developing atherosclerosis. We walk through four main drug classes – ezetimibe, statins, bempedoic acid, and PCSK9 inhibitors – discussing their mechanism of action, effectiveness, and safety profile.

If you are currently struggling with ASCVD or are at risk, I hope you found this episode and series empowering. Even if this does not appear to be a concern for you in the foreseeable future, it’s important to be equipped with this knowledge on one of the Western world’s biggest killers. Dr Dayspring offered extremely well-informed insight into this topic over the course of this series, and I am grateful to have had a field leader on the show to embark on this deep dive.

00:00 - Intro
03:42 - Evolution of cardiovascular disease treatments
07:30 - Are we becoming a drug-dependent society?
13:54 - Bile acid sequestrants, statins, and more
35:12 - Cholesterol-lowering drugs and cognition
47:39 - Is Bempedoic acid a good statin alternative?
55:46 - Ezetimibe and nuances you should know
1:03:52 - PCSK9 inhibitors
1:15:18 - Do statins increase the risk of diabetes?
1:19:40 - Gene therapy targeting PCSK9
1:24:08 - Pelacarsen for lowering Lp(a)
1:26:58 - Can we take drugs that raise HDL to lower cardiovascular disease risk?
1:35:19 - HDL and atherosclerosis
1:47:08 - Elevated triglycerides and atherosclerosis
2:05:32 - Takeaways
2:08:51 - Outro

Connect with Dr Thomas Dayspring on Twitter @DrLipid.

If you have any additional questions you would like answered in the future, let me know in the comments.

We are also currently working on a summary PDF highlighting the key learnings from each part of the series. To receive a copy of this simply submit your email at theproof.com/lipidseries. We are also working on transcripts for these episodes, with the release date to be advised soon.

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Enjoy, friends.

Simon
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