Assessing Your Risk of Cardiovascular Disease | Lipid Series Part 2 | Dr Thomas Dayspring | Ep 252 

@@TheProofWithSimonHill Yes, Simon! I saw that episode and loved it! Thank you so much! I just find it disappointing that experts like this man seem to completely ignore this important female-specific risk factor when instead they could use this platform to draw attention to it and educate listeners. Greetings from California! 😊

In this "man's" world, women still get overlooked (disrespected), what else is new.

​@@mt4973Oh please. Women are given precedence everywhere modern society. Life was and still is hard for both genders.

What is that window of opportunity???

@@blacina9036 It refers to a timeframe of roughly 10 years around the time and after menopause, during which a woman can potentially reduce her risk of important diseases, if she starts MHT (menopausal hormone therapy) during this “window of opportunity”, although the earlier, the better, for disease prevention. I recommend a thorough, evidence based education on menopause for all women. There are several here on RU-vid, such as Dr Heather Hirsch, Dr Haver, Dr Barbara Taylor, Dr Louise Newson (my favorite 😊). If you like it more “nerdy”, you could check out the 2020 scientific statement by the American Heart Association - “Menopausal Transition and Cardiovascular Risk: Implications for Timing of Early Prevention” Hope this helps!

@@TheProofWithSimonHill thabk you too Simon, as a person in the third world country with not the best healthcare, educating ourselves is the best way to be saved. Not one place offers the ApoB test, i really wish i got the safe range for the non HDL from the interview.

Yes that lab would be helpful

are you taking medicine to make it lower ?

@@Youssef-1911 no. The only “non food” things I take are creatine, B12 and amla. I think the amla is helping, but I did have my cholesterol this low previously without amla, but I was eating a lot better then, so I think the amla is helping.

@@grasmi thats great but i think as long as you are taking b12 you are following vegan diet,right ? you did great job

@@Youssef-1911 yes, mainly whole food plant based, but I do eat some fish and have the occasional steak / burger with friends.

@@grasmi thanks you were so helpful

Our pleasure!

Why do you care of your ApoB number if you have high LDL ?!? He thinks putting on statins is the solution and most doctors would do it to patients with high LDL anyway… and he said no downside from the drug… 🤔I thought I would get something new!!

Excellent results….working on mine…. but ma’am 50 definitely isn’t deserving of old lady status!! We are rocking 50!!!!! 🎉

@@trudywilson9634 Yeah, 50 will seem young when you reach 70 like me!

Great to hear!

80 percent of ldl are large puffy not to be worried about a long with your cholesterol. It's your Apoe B and Lpa you need checked. And perhaps your triglyceride/hdl ratio.

@@nancyevans5176 I actually did end up getting those checked (ApoB & Lp(a))! Both were moderately elevated as I suspected they might.

There is zero truth to the statement that you have nothing to worry about with large fluffy LDL. It is irrelevant that dense LDL may be more harmful when both types are atherogenic. Although you do see that sort of misinformation circulating on RU-vid.

Filtered coffee doesn't raise LDL...unfiltered does

​​​@@markgarcia5845 how much? Can you get an assay locally? Not me, but...I know my D levels are great. I take about 5500iu daily, 5'9, BMI 23, WHtR 43, 40yrs... "Vitamin D levels had linear relation with their Homocysteine levels (t = -2.40, df = 302, p = 0.017). For every 1 ng/mL increase in vitamin D, there was a 0.04277 uM decrease in homocysteine, on average."

WHAT IS AN ACCEPTABLE Adobe non hdl ratio?

If that's the ratio then why they keep saying that if apob is not available you can look at non hdl instead?

what statin are u taking? what is ezetimibe?

6 weeks might not be long enough for that intervention. If you get dissapointing results keep it up and test again in 6 months.

Make sure you get plenty of fermented foods and probiotics in your diet. Lactobacilli seems to help.

If still high, what medication you will be in? Statins? Thanks

@@chiyerano Prebiotics > probiotics. It's the fiber that does the magic.

@@Joseph1NJ Just going by what was mentioned by the guest during the interview.

In addition my LDL is 109

What do you think he is doing now? This video can reach thousands where a classroom might be limited to fewer than a hundred.

The fiber thing surprises me. Most plant based sources suggest fiber does block absorption of cholesterol. So more on that would be great.

I think I have the same thinking as you, eating plant food grains no fats as Not helped everyone, He says he would fight insulin resistance if he new he had it , I think sugars are the problem. Cholesterol is vital. dr sten Eckberg videos I think a healthy level of all markers is my target not just cholesterol

That is nonsense. LDL has been proven causal, you can read the ESC consensus paper with the overwhelming evidence of it. Just because the rate of insulin resistance is rising and thus we of course have a bigger comorbidity with cardiovascular disease then in the past, does not mean that insulin resistance directly causes cardiovascular disease. The existance of people with familial hypercholesteremia, while being metabolically healthy, still having heart attacks at a very young age. Also if abnormal blood clotting would be the main problem - not saying it does not play a part, you would see abnormal values in blood tests, which would be acted upon - pulmonary embolism, deep vein thrombosis is no fun - we would have solved the problem long ago. We have a pleithra of anticoagulants to choose from, and there has been primary prevention with aspirin. Studies showed only a small benefit in a certain age group. It might very well be that people on statins get CVD is funny, because people on statins already have CVD. We actually might use them far to late. The disease starts when you are young, so Dr. Dayspring is advocating to test people when they are young to actually prevent disease from happening. Prescribing statins for prevention is still debated if LDL-C is not astronomically high hinting at familial hypercholestemia. You can find that in the guidlines. If you watched the video, you would know, that there is a difference between LDL- the particles and the marker LDL-C - the cholesterol. Dr Dayspring agrees that LDL-C is not the best marker and proposes to rather meassure LDL by meassuring the protein on each particle called ApoB. I agree that LDL-C is not that great, but it is what is currently available to most. It unfortunatley underestimates the risk - not overestimates it. It can happen that LDL-C is low, but LDL particles are high -they just are small and do not carry much cholesterol. That happens in genetic mutations for example. You would see that with ApoB as the marker - so we are missing those. And as he explaided we are also missing people with high Lipoprotein a, an other genetic variant, if we don't test for it. LDL-C does not overestimate risk though. high LDL-C means a higher number of particles. It might vary from person to person how much the risk increase is, but there is one. If you want to see a debate between a pro LDL-C MD and researcher and Dr. Ovadia, head over to Nutrition made simple! Dr. Gil Carvalho debated him, maybe it answers some questions for you. Nutrition made simple is pretty neutral, I have no idea what Dr. Carvalho is eating or prefering as a diet. As far as Dr. Diamond goes, he unfortunatley has a habit of misquoting studies, books or people. I invite you to check his references. He claimed Dr. Ancel Keys had no education to conduct the studies he did. A quick check of the wikipedia article or google search will show you otherwise. He was a biologist with a degree in physiology. Would be easy to debate him for any real expert, if he is doing such things during a debate. It is really infuriating how much misinformation is out there on the web - for money, for fame - that you don't detect if you are a layperson.

@@kevinbrannan8347 Huh? Then you got the wrong message. The diet reccomended as a heart healthy diet is in no way low fat. It is the one keys advocated for - the mediteranean diet with arround 40% fat. There is also a low carb and keto version if that suits you better. And then there are general reccomendations if that is not what works for you. Whole food diet, high in fiber, low in refined carbs, low in saturated fat, high in omega 3 and polyunsaturated fat. I think Dr Eckberg talks about refined vs. complex carbs and fiber too. Sugars are part of the problem - they are refined carbs, make you hungry and overeat. If you can handle eating sugar in moderation and not eat more calories then you should, it is not that big of a problem. The same is to be said about saturated fat. There are studies hinting at that. Did you notice junk foods are often a combination of saturated fat and refined carbs? Fat tends to be the least satiating macronutrient, while protein is the most and carbs come in between. For me foods like beans, lentils and chickpeas fill me up very quickly, they are starches combined with protein and fiber. I think Dr. Eckberg might be right in many things - but I disagree with him in others. Mainly seed oils and saturated fat. saturated fat might be no problem short term, but certainly long term. Not for all, some people have genetics that does not make them react to saturated fat by raising LDL-C. I am not so lucky, I do react. You should watch the first part of the series, Dr. Dayspring agrees with you that cholesterol is vital, and that's why every cell has the ability to make their own. What is circulating in the blood stream is just additional cholesterol manufactured in the liver to mostly keep the lipoproteins (LDL, HDL VLDL etc...) stable, in order to transport the fat you ate from the intestines to the cells for energy production. But you don't really need that for cell walls, hormone productions etc, since the cells just produce it when they need it. But of course it is important to stay healthy overall, not just focus on one thing.

@@stellasternchen From my perspective…LDL has not been proven to cause atherosclerosis. So we can agree to disagree on this point. I’m glad you do agree LDL-C is not a good biomarker for Heart Disease. Dr Lustig argues that the ratio of TG/HDL is a much better predictor of future Heart Attacks or Stroke. And you have to know that most people with Hypercholesterolemia (heterozygous) live a normal healthy life. Which begs the question….what is different about the small percentage of them that experience Heart Attacks or Stroke at a young age. Perhaps it is that they also have the Lpa snip, or one of the other clotting issues. This would be an interesting study…to figure this out. Ancel Keyes found two factors correlated to Heart Disease…cholesterol and insulin resistance or Type 2 Diabetes. David Diamond and his team removed insulin resistance as a factor, and found there was no correlation between LDL cholesterol and Heart disease. What many of us are suggesting is that it was never cholesterol…and our maniacal focus on it driven by STATIN profits have prevented us from better understanding what actually causes CVD. Plus the side effects of STATINs have been downplayed (for obvious reasons), but they are significant. Patients must understand the true risk-benefit before they take any medications…including STATINs. I appreciated the fact that Dr. Dayspring was not quick to prescribe a STATIN …rather considered a broader patient history.

@@DrJK-wm9ec I don‘t know the study of David Diamond, do you have the DOI of it? I’d like to take a look. As far as I know Keys only measured cholesterol, not LDL cholesterol, and we know now that HDL particles are not harmful in physiological amounts. They basically transport fatty acids to tissues in order for them to burn them. So using total cholesterol including HDL cholesterol is inaccurate. It is kind of strange though to stratify for insulin resistance, it is not an independent factor, it increases LDL-C and LDL particles as well. They are connected, not independent. That‘s the problem with correlation. You can‘t say if there is an other factor causing the correlation. Keys study findings showed basically that not all fat is bad, like many colleagues believed, but there is nuance. Some fats do increase the risk some decrease it. He advocated for a diet with 35-40% of fat, not a low fat diet because of that, the Mediterranean diet. It might be anecdotal, but he lived longer then most people - he diet at 100. I know that the Framingham heart study is a perfect example, why relying only on correlations is not always a good idea. LDL-C had only shown a weak correlation with cardiovascular events, but a strong with HDL-C. Drugs have been developed to increase HDL-C, but showed no cardiovascular risk reduction at all, so trying to increase HDL-C for example with a low carb diet, does not reduce your risk either of heart disease. For LDL-C lowering drugs, we see a risk reduction. Don‘t be fooled by the small absolute risk. Absolute risk does not tell you anything. I‘ll explain. Let‘s say we have the hypothesis that driving with a seat belt on Leads to less chance of injury during a car crash. So we have an intervention group of 100 people with seat belt and an control group with no seat belt. Let‘s say for convenience sake we had 3 car accidents in each group. 1 injured person in the intervention group, 2 in the control group. So we have 1% risk of injury in the intervention group and 2% risk in the control group, meaning we have an absolute risk reduction of 1%. So in this example seat belts would be pretty useless, right? I mean most of the time you drive you won‘t have a car accident anyways. Not if you look at relative risk. Relative risk in this example would be the risk of injury in case of an accident. If we calculate that we get a risk reduction of 50% So yeah, in 99% of the times you drive in this scenario, you would not really need a seat belt, but do you know when you need it. But if you have it on in the case of an accident, there is a 50% risk reduction of injury. Would you put it on? The same principle applies to relative risk and absolute risk with statins. We can not predict 100% wether somebody is going to have a heart attack or not, so we have to depend on risk calculation who should get medication or not. The downside of this method is that we only can calculate 10 year risk of cardiovascular risk, not 30 or 40. Disease development of arteriosclerosis takes decades, thus at the moment we just treat it, not preventing it from even developing. For prevention guidelines set focus on lifestyle interventions and treating other risk factors like high blood pressure, diabetes, obesity, tell the patient to stop smoking and exercise regularly and reduce LDL-C. Despite the lack of exercise, all those risk factors are damaging vessel walls. Including LDL-Particles. The higher the blood pressure, those LDL spheres are shooting like bullets through the arteries and sometimes crash full speed into the vessel walls for example at bifurcations like in the coronaries. The weaker the vessel wall, the higher the risk that this might happen, the more particles there are, the more frequent are the crashes. If they get stuck, the immune system reacts - they do not belong there after all- creating inflammation setting up a detrimental cascade of chronic inflammation. The body only can put out that fire, by sealing away that inflammation and reinforcing the seal when necessary. That is the calcification we see, and that calcification is actually a good thing, reducing the risk for strokes and heart attacks, but unfortunately can severely block the arteries, which in turn can increase the risk for heart attack and strokes by impairing perfusion. As I‘m trying to explain, the disease process is an interplay of all the risk factors. Statins have the additional effect of stabilizing unstable soft plaques by promoting their calcification. This protects from blood cults forming or parts of the still soft plaque getting ripped off. You can see the effect of statins probably - study is still going on- in an increased CAC. Sorry I hope you are not bored - it is easier to understand why those meds are used and when, and what else is taken into consideration. But drug trials can be biased - like you hint by pharmaceutical companies. So we have correlation and Pharma funded RCT‘s right? But we do have more, we have genetic evidence for high LDL causing CVD. Those trials are called Mendelian randomization studies. They do look at genetic mutations increasing HDL or decreasing LDL and the cardiovascular risk of those individuals. And the LDL lowering mutations showed risk reduction, while the HDL increasing mutations did not, which is in line with our drug trials. This method of studying eliminates almost every confounding factor and looks at the factor independently. The genes are there from birth - there is almost no outside factor able to change them, interference is very unlikely. If there are Mendelian randomization trials looking at diabetes and cardiovascular risk I honestly don‘t know, type 2 - in type 1 there is usually no insulin resistance - can also be genetic. And can there be cardiovascular disease without insulin resistance? I can tell you yes two times. Let‘s start with the anecdotal evidence. I have somebody in my extended family, who is lean, female, was an very active person, had no signs of being insulin resistant getting a stroke at 47 and a heart attack at 52. My second example is a sad condition called homozygote familial hypercholesteremia. Those young children have extremely high LDL due to genetic mutations and do get heart attacks sometimes already still in childhood. It is not really associated with insulin resistance, not even when statins are taken, there have been studies looking into that. If statin producers had so much influence on the guidelines, why don‘t they say to prescribe every patient with high LDL -C over the threshold a statin instead of calculating the individual risk to decide on a treatment plan. I don‘t quite get the logic behind the theory. Like I said statins are prescribed very late, when there are already signs of arteriosclerosis. Before that‘ it is debatable. Since they are not something you can take like candy and there are risks. It is still difficult to estimate if the risk reduction in low risk to intermediate risk is worth the risk of side effects. Although there are also a bit of fearmongering. Some people claim that statins do cause dementia - which has not been shown in studies from independent researchers. Kidney and Liver - problems are possible though and you have to pay attention to. I do need to take a medication, that unfortunately can harm the kidneys, I understand that people only want to take them when there is a benefit. There are alternatives to statins as well, but of course they come with their own risks. I‘m kind of in the situation where my LDL-C is not elevated yet but borderline. But I think in my situation, it might not be worth the risk to take something, since I‘m otherwise healthy - not that somebody told me to, but I had my own thoughts about it. But I agree with you on one thing - it would be great to know which people with high cholesterol are the ones getting heart attacks and which not, maybe we will find a yet unknown pattern in the future.

Things that make you go hmmmm....

Hard to be a consultant for big Pharma and discourage drug peddling...

​@@b.h.1205So let's try wooddoo.

So what. Dude knows his shit

Is he consulting for the companies that produce the tests that you, your doctor are requesting? It would be good to now.

That would be logical.

Just saw a Dr. Alo post on this. The answer is ‘yes’, but the efficacy is only a fraction of what a statin can provide, and that’s assuming the supplement is what is the label says it is.

It's in the episode: HDL is not a significant marker. In lay people's terms that means you can ignore your high level. It's as relevant to heart health as the color of your hair. It's really only measured because of tradition.

This was interesting to me as well, it seems that the supplement is very well studied and has been proven to lower cholesterol. I'm guessing he thinks the risks outweigh the benefits? He seemed very in favor of medicinal intervention versus supplements. I also didn't really hear the doctor speak at all in this episode about dietary and exercise intervention.

Fidosterol?

"Larger fluffy" and "small dense" are not actual determenants of heart disease. See it explained in detail here and check the sources: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-NUTvzuDphmg.html

Average life expectancy was only in the high 40's at that time. Without detailed autopsies or the advanced scanning techniques we have today, there is no way of knowing what condition their arteries were in. They were also not eating animal protein from the commercial practices of today so it was much lower in saturated fat and they were far more active on a daily basis than 90% of the populations today. So early 20th century is not a relevant comparison to today.

@@garydublanko4098 Life expectancy is tied to infant mortality as well. Children died much more frequently during this time period. Most people do not know this. There were many people who lived long lives back then.

​@@scotterickson9091yeah I heard if they account for infant mortality life expectancy was similar to now

I'm sure they ate less meat and dairy. It's an upward curve throughout the 20th century. Remember: this is the time of the world wars and the economic crisis of the 30s. Most people could not afford all that many animal products. They ate the proverbial beans and rice.

Yes and that should make anyone cautious as to his motivations.

@@TheProofWithSimonHill thank you. I'm European and those guidelines are bible for me but those Apob values doesn't add up, if you look at most research papers where Apob and LDL are reported, LDL is always higher than Apob, so I don't see how an LDL of 70 can be equal to an Apob of 80.

@@TheProofWithSimonHill anyway I searched on my own. If you are interested the 80th percentile of LDL is 160, corresponding to an Apob of 120. So the whole discussion you made was on a very shaky ground. I have the sense that what's reported on esc guidelines is not a percentile but a target. Can't imagine them being wrong on this. Probably they simply use Apob as a secondary threshold in case of discordance and is not to be intended as a percentile. Not questioning the knowledge of the doctor, but this should be addressed more clearly and age adjusted as well. An LDL of 150 in a 60 yo woman have not the same importance in a 35 yo one.

You're young. Plaque buildup takes time.

@@k.h.6991 I’m 72.

My cardiologist's excuse for never offering any testing beyond the basis LDL Calc test is that it wouldn't change his recommendation for Statins. LDL was the shining object. I got a CAC and advanced bloodwork work on my own. I had been on statins years ago and for various reasons was deemed statin intolerant. My current regime is a pcsk9 inhibitor, very low dose crestor and niacin. They have taken my LDL down from 300 to 70. Docs want it lower. I'm not convinced that LDL/APOb are the risk factors docs like Dayspring make them out to be or that lowering them makes a hills beans of a difference but I'm playing along as I do more research. There are equally brilliant people on the other side of the argument. As for the CTA, my understanding is that it does show soft plaque as well as any obstructions irrespective of the presence of calcified plague. It's also my understanding that the CAC score represents only a small portion of overall plaque burden. If we have hard plaque, we surely have much more soft. Another test mentioned for soft plaque is the CIMT. If there's soft plaque in the carotid, it's also going to be present in the heart. Another thing to be aware of is that if you take statins, it will increase any subsequent CAC score. Researchers say they "think" this is a good thing but further research is needed.

I thought the lower the CAC score the better🤔 do you think Statins is beneficial for preventing heart disease?

N2daAIR I have heard this too. Very confusing, conflicting info out there.

@@TheProofWithSimonHill :) So ApoB is 70... not total cholesterol. Gotcha, when listening to this interview I thought it was total cholesterol. My husband and I are working on our lifestyle and making changes. Always learning. Thanks! We need to up our weight and strength training!

​@@TheProofWithSimonHill what do you think of ketogenic diet mostly in unsaturated fat, and fibre rich

Do you mean no butter no eggs no red meat …unsaturated fat keto diet?

There is scant evidence that "lean mass hyper responders" are an actual thing or that they have low risk of cardiovascular disease.

Atherosclerosis is a disease that takes decades to develop at most LDL levels. The lean mass hyper responders are generally young. They haven't had time yet to develop serious heart disease. We'll be seeing them develop disease in the coming years. In the meantime I would not recommend making decisions on your health today and in the coming decades based on the fact that those people seem healthy today. But yes, it helps their health that they're not diabetic. Since they're usually avoiding antioxidant rich foods, they're not otherwise doing very well. But that too won't show up in the short term. Eating your fruit and veggies is also a mostly long term health thing.