Summary
The Drive podcast episode hosted by Peter Attia features an interview with Dr. Aaron Mikos, an expert in preventative cardiology and women's cardiovascular health. The discussion focuses on atherosclerotic cardiovascular disease (ASCV) in females, the importance of early interventions, and the risk of ASCV over a lifetime. The episode also delves into the impact of various factors on ASCV risk, including polycystic ovarian syndrome, contraceptives, nutrition, metabolic health, familial hypercholesterolemia, statins, stress, and hormone replacement therapy. The episode highlights the need for increased awareness of ASCV as the leading cause of death in women and the importance of preventive efforts, especially in younger women, to combat the rising mortality rates.
The discussion emphasizes the importance of prevention and the role of lifestyle changes, particularly in younger adults and women of reproductive age. The lack of clinical trial data for younger and lower-risk individuals is a challenge, but the focus should be on treating the causal agent, APO B, as we do with smoking and blood pressure. The context also discusses the use of new agents for weight management and type 2 diabetes, including Traceptivide and Magnetite.
The speaker discusses the impact of PCOS, parity, and oral contraceptives on a woman's risk of cardiovascular disease. The context concludes with the offset of ASCVD risk in women and the importance of individualized care. During pregnancy, there are changes in a woman's lipid panel, and women with familial hypercholesterolemia (FH) have the same relative increases, but the magnitude of elevation is even greater. Women benefit from statins in both primary and secondary prevention without interaction by sex.
The context discusses the benefits of Statins in both men and women, but despite the evidence showing that women benefit from Statins, they are less likely to be offered them. The speaker discusses various options for lowering LDL cholesterol levels in high-risk patients. Monoclonal antibodies, such as PCSK9 inhibitors, have been shown to lower LDL by 50-60% and reduce major adverse cardiovascular events. The new drug, inclisiran, which inhibits PCSK9 through a different mechanism, is given every six months and has shown similar reductions in LDL.
The speaker emphasizes the importance of measuring LP little a, as it can contribute to residual risk even in individuals with low LDL levels. Finally, they mention the importance of addressing mental health and social determinants of health in delivering effective preventive interventions. The impact of therapies and lowering electrical a on reducing cardiovascular risk in women is uncertain. Menopause is an accelerator of risk for cardiovascular disease in women. Hormone therapy is not recommended for the sole purpose of cardiovascular disease prevention, but may be considered for symptomatic women who are under the age of 60 or within 10 years of menopause. The speaker also highlights the underrepresentation of women in clinical trials for cardiovascular medicine and the importance of diversifying study teams and investigators to improve enrollment of women participants in trials.
