How to lower your apoB
Peter Attia MD
10 min, 40 sec
The speaker discusses the evolution of lipid management over the past 20 years, the impact of diet and exercise, and the pharmacological tools available for managing lipoproteins.
Summary
- Discusses the outdated use of mega doses of statins for managing apob levels and introduces more recent, diverse pharmacological tools.
- Emphasizes that exercise has minimal impact on ascvd risk factors through lipoproteins, highlighting pharmacology as the most effective approach.
- Explains dietary approaches to lowering apob, such as reducing carbohydrates and saturated fats, and their limitations without pharmacology.
- Details personal lipid management regimen using three drugs: pcsk9 inhibitor, NEX lazette, and bempedoic acid, explaining their mechanisms and benefits.
- Addresses concerns about long-term use of statins and their side effects, advocating for the use of the lowest effective doses and exploring alternatives.
Chapter 1
The speaker reflects on how lipid management has significantly improved with new tools compared to 20 years ago when mega doses of statins were the only option.
- 20 years ago, mega doses of statins were the sole method to manage apob levels.
- Today's advancements provide multiple pharmacological tools, eliminating the need for mega statin doses.
Chapter 2
The speaker explains that while exercise does not significantly impact ascvd risk factors through lipoproteins, it has other health benefits.
- Exercise offers other health advantages but does not significantly affect ascvd risk factors in the context of managing lipoprotein risk.
Chapter 3
The discussion covers how reducing carbohydrates and saturated fats can lower apob, but pharmacology is often needed for significant reductions.
- Reducing carbohydrates can lower triglycerides and, consequently, apob.
- Cutting saturated fat reduces cholesterol synthesis and prompts the liver to upregulate LDL receptors, drawing more LDL out of circulation.
Chapter 4
The speaker shares their personal lipid management regimen using a combination of drugs and discusses their specific targets for apob levels.
- Uses a combination of three drugs: pcsk9 inhibitor, NEX lazette, and bempedoic acid to maintain apob levels between 30 to 40 milligrams per deciliter.
- The drugs are chosen for their efficacy and absence of side effects for the speaker.
Chapter 5
The mechanisms of action for bempedoic acid and its advantages over traditional statins are detailed, including liver-targeted cholesterol synthesis inhibition.
- Bempedoic acid is a prodrug activated in the liver, selectively inhibiting cholesterol synthesis there.
- Unlike statins, which inhibit cholesterol synthesis throughout the body, bempedoic acid's liver selectivity reduces potential side effects.
Chapter 6
The speaker discusses the considerations for using statins, including side effects and dosage optimization to prevent unnecessary adverse effects.
- Statins' efficacy and side effects are dose-dependent, with maximum efficacy often achieved at lower doses.
- Side effects like muscle aches, liver function test elevations, and insulin resistance are acknowledged, emphasizing the need for personalized dosing.
Chapter 7
The speaker anticipates the increased availability and reduced cost of pcsk9 inhibitors and other lipid-lowering drugs in the future.
- PCSK9 inhibitors' costs have significantly decreased, and newer, more convenient administration methods are on the horizon.
- The speaker anticipates continued price reductions as more drugs enter the market.
Chapter 8
The speaker remains optimistic about a new drug targeting LP little a, which is currently in phase three trials to test its clinical efficacy.
- An antisense oligonucleotide drug in development shows promise in reducing LP little a levels without side effects in phase two trials.
- Phase three trials are crucial for determining the drug's impact on reducing cardiovascular events.
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