Transcription
One of the things I wanted to speak to you about just because this is so common for women is that as we go through permenopause, you often quite start to see LDL cholesterol going up and some of that I think is with that interplay of estrogen reductions. My understanding is that LDL is important and the Apo is that extra marker for you to be able to really analyze uh in a bit more detail your LDL and whether you have kind of aeratic um kind of plaque building up and things like that. Um, can you just explain about LDR because it's actually quite a polarized situation on social with some people saying, "Oh, it doesn't matter." [clears throat] Um, can you explain your position on this from a longevity perspective?
>> Absolutely, Angela. And I do want to say something that will really empower your readers. Whenever something is polarized, whenever people are asked to take sides on something, whenever someone's chanting from the rooftops, LDL is bad, LDL is good, that should be every single person's indication that it is an endofone situation, which means yes, it could be bad for some people and good for others. It could be a problem that does not need to be treated in some people and it could be something that we actually might want to raise the levels in somebody or lower the levels in somebody else. is it's whenever you hear this kind of um I would say dogma being spouted out there or or strife in what people are saying it's because it's an NF1 situation which we really have to look at it in your individual biology.
Okay. So here's what I would tell people about LDL keeping that in context is that I see thousands of patients. We have 20 clinics all over the world now and I'm looking at hundreds and thousands of biomarkers and I get all the data on people and what I can tell you is I've seen LDL be a massive problem for people and I've also seen on the other end of the spectrum LDL is absolutely not an issue at all. And so when I look at a marker like LDL I'm trying to assess where on the bellshaped curve you are. So a bell-shaped curve is whenever you look at a statistical analysis of a group of people, most of them will fall somewhere in the middle of a bellshape and then you have what's called one and two standard deviations away and even three standard deviations away from the middle of the bell curve, meaning a particular intervention might work for the average and it might be harmful for some or super good for others, right? And so we're always trying to look at where does someone sit on the bell curve of LDL. And what I can tell you is that there are some people that if you have no inflammation and you have no high blood pressure and you have no genetic risk factors, having a high LDL will not matter at all. In fact, I just saw a guy at the gym. I just went to the gym, dropped off my kids, and I saw this guy and he was asking me about his LDL. This guy goes to the gym every single day. I've never not seen him at the gym. He's extremely healthy. His LDL is 150, and he's a little bit worried. And I know him very well because he also sees us as a patient and we check what's called a clearly cardiovascular scan on him. A clearly scan is a AI enhanced um visualization of all of his coronary blood vessels. He has zero plaque on his blood vessels. And so when I see that I'm like, "Oh, here's a guy that's living with an LDL that's in, you know, a normal doctor put him on a statin for and he has zero plaque. There's no reason for him to have um a statin."
Then I've seen other people who have a high LDL, but you know, they go they drive to work an hour here in LA every day. They don't get a chance to ever go to the gym, maybe just on the weekends. They go out to dinner and drinks every night after work, and their LDL might be 120, but they have a ton of plaque in their blood vessels, even plaque in their arteries going to your brain. And um the these are people that do need to be on a statin or a PCSK9 or inhibitor or something. So you can't look at LDL just by itself. Um you have to look at what is your level of inflammation in your body. What is um your metabolic health looking like? What is your genetic risk of heart attack? Do you have other compounding uh cholesterol issues such as LP little A um or small particle um dominance? Those are all factors that you have to take in account about LDL. So you know when people ask me this question about LDL, they're often frustrated because they think I'm not giving them an answer. And that's because there is no answer unless I see you as a patient and we determine for your individual biology what is the level of LDL that's going to be appropriate.
>> And so with the clearly scan, right, I don't think that's yet widely really available in the UK. We have some other kind of ultrasound style um testing that people can do. What would they be looking at then alongside on their blood work and speaking to their physician about? It would be the LPA, uh, the APOB, would it the L the VLDLDL and the inflammation markers to kind of get a fuller picture?
>> Yes, absolutely. So, if you're looking at specifically cardiac risk, remember, we know that these markers indicate a certain amount of risk of cardiac disease, right? So, risk is something that is developed as a concept when you have a massive group of individuals and you look at their LDL and you see how many of them have heart attacks, right? And we have much better biomarkers of risk now than LDL. LDL is like a biioarker of the 1970s and 80s. Now we've moved on from that. So as physicians that are really up on the science, we're looking more at apo. We're looking at particle sizes and we're looking at um LP little A. LP little A is not captured in your standard cholesterol panel. So those are the markers I would definitely look at as far as cholesterol markers. And then you also want to look at how much inflammation is going on. So, HSCP, homoyine levels, and you also want to look at your metabolic health, which is fasting insulin, uric acid levels, um, hemoglobin A1C is another one as well, and triglycerides. And so, you want to look at all of that in context.
Now, what I will say is the cardiac scanning is available in different forms in the UK and also all throughout Europe, all over the United States. And there's different forms of it. And what's good about cardiac scanning is now we know for N of one on you on your particular biology. We're not looking at risk. We're looking at what's actually going on at your blood vessels. So the first scan there is a coronary calcium CAC score or the the um you know the the CT scan that's 10 minutes long that we can see how much calcification is happening in your blood vessels. Even though calcification is a late sign of cardiac um um blockages at least we know. And then from there there's a CT angiogram that I know is available Angela there. And then the clearly scan you take that CT angiogram uh CD or um the data from it and you send it to a company called clearly and they have AI look at each blood vessel individually and see lay it out and see how much plaque is developing both calcified plaque and soft plaque. So you can still get it done um even if you're in the UK. It just might take a little bit of leg work.
>> Yeah. And then it can be uploaded. Interesting.