On: A deep dive into heart disease.

Episode: 3

Date: July 2018

Key Subjects:

• See Cholesterol write-up.
• Importance of measuring LDL particle number vs LDL volume (which is what you get in a standard lipid test).
  • The LDL volume and LDL particle count may not always align.
• Combination of (i) elevated levels of LDL plus (ii) inflammation and (iii) arterial damage increases risk of CVD.
• Size of LDL particles – seems important, but not as important as number of particles.
• Statins:
  • Lower LDL by preventing LDL synthesis in the liver, as well as by upregulating LDL clearance through LDL receptors.
  • Don’t work well on Lp(a); specifically, they doesn’t activate the LDL receptors that clear Lp(a).
  • Can have substantial side-effects.
• PCSK9 inhibitors upregulate LDL receptors and work well to lower Lp(a).
• Niacin lowers apoB/LDL, increases HDL and lowers Lp(a).
  • Trials, however, have not shown efficacy in reducing cardiovascular disease
  • Side-effect include raising insulin resistance.

Key Takeaways:

• Meausre LDL-P count and Lp(a).
• Supplement brand recommendation: Jarrow.

Worth Listening:

• 7/10