The Drive with Peter Attia — Tom Dayspring (4)

On: Part IV of V: statins, ezetimibe, PCSK9 inhibitors, niacin, cholesterol and the brain.

Episode: 23

Date: October 2018

Key Subjects:

  • Only drugs proven to reduce both cholesterol and CVD events are the ones that target increasing the clearance of cholesterol by upregulating LDL receptors.
    • Not focused on preventing cholesterol synthesis or absorption, but focused on taking it out of the bloodstream.
  • Statins most commonly used drug.
    • Lowers cholesterol synthesis, which in turn activates higher cholesterol clearance.
    • Statin’s impact on improving cholesterol clearance is more powerful than its impact on preventing synthesis.
  • Statins may lower synthesis too much (in the brain) in people that have lower cholesterol synthesis to being with.
    • Low cholesterol in the brain is associated with higher risk of neurodegenerative diseases.
    • Important to understand your level of cholesterol synthesis (measure desmosterol).
  • Depending on individual situation, may make sense to take low dose statin in combination with other drugs.
    • Ezetimibe (to lower cholesterol absorption).
    • PCSK9 inhibitors (to further increase cholesterol clearance).

Key Takeaways:

  • -/-.

Worth Listening:

  • 8/10

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