#129 - Tom Dayspring, M.D.: The latest insights into cardiovascular disease and lipidology

Summary

The Drive podcast, hosted by Peter Etia, features a team of analysts who translate the science of longevity into accessible content for everyone. In this episode, Dr. Tom Dayspring, a diplomat of both the American Board of Internal Medicine and the American Board of Clinical Lipidology, joins the podcast to discuss changes in the field of lipidology since his previous appearance on the show. The conversation covers atherogenic lipoproteins, the importance of triglycerides, the limitations of HDL cholesterol as a metric, and the significance of lipoprotein little a. The episode emphasizes the importance of understanding apob, the primary structural protein that transports lipids throughout the body, and its role in cardiovascular disease.

The conversation discusses the complexity of atherosclerosis and the role of lipoproteins in contributing to it. The focus is on the importance of particle quality, not just particle concentration, and the need to examine other components of lipoproteins, such as complex lipidome and other proteins. The conversation also touches on the benefits of reducing apob and the potential risks of reducing cholesterol too much. The conversation also highlights the importance of understanding the different pools of cholesterol in the body and how reducing lipids through lifestyle or drugs does not necessarily mean that cells are being deprived of cholesterol.

The context discusses the limitations of current testing for HDL functionality and the need for a more comprehensive approach to understanding the role of HDL in cardiovascular health. The speaker suggests that current panels attempting to subdivide HDL particles are not useful and that focusing on metabolic factors such as VLDL cholesterol, glucose, insulin, homocysteine, and uric acid is more important. The speaker also discusses the importance of LP little a as a genetic driver of atherosclerosis and the need for more serious evaluation of this marker.

In this podcast, the speakers discuss various metrics and markers used in lipid testing and therapy. They emphasize that LP little a is not an acceptable goal of therapy, and that LDL triglyceride concentration is a simple metric that can provide useful information about a patient's lipid profile. They also discuss the limitations of statins as a lipid-lowering therapy and the need to consider other factors such as family history, blood pressure, and concomitant risk factors when determining whether or not to prescribe statins.

The context discusses various therapies for reducing cholesterol and triglycerides, including statins and omega-3 fatty acids. The focus is on the effectiveness of EPA and DHA in reducing triglycerides and residual risk in high-risk individuals. The recommendation is to use EPA at a dose of four grams per day for individuals at high risk. The importance of measuring omega-3 levels is also highlighted. Overall, the episode emphasizes the complexity of atherosclerosis and the need for a multifactorial approach to treating it.