Understanding cardiovascular disease risk, cholesterol, and apoB

By the time you're in your late 30s or early 40s, if you have any measure of apoB that's even north of the 20th percentile, that should be completely lowered. So, in some ways, I would view an apoB ceiling of 60 as the limit, and that's probably at about the 5th percentile. You sort of want everybody to be below the 5th percentile.

And while it's true that, on average, higher HDL cholesterol is associated with and traffics with metabolic health in a way that low HDL cholesterol tends to traffic with bad metabolic health, you can absolutely not tell by looking at an individual based on how high their HDL cholesterol is if they're in good shape or not.

Pharmacologically, lower ApoB to somewhere in the 20-30 mg/dL range for everybody in the population while someone is in their 20s, can you eliminate ASCVD? And I think the answer is probably yes.

Atherosclerosis is really the only inevitable disease of our species. Cancer, while prevalent with aging, and dementia, while prevalent with aging, do not appear inevitable the way atherosclerosis does. So, not everybody dies from atherosclerosis, but I think, to my knowledge, everybody dies with it, assuming they live long enough.

Everybody knows, for example, eating eggs means eating cholesterol. And a natural question is what is the relationship between the food that I eat that contains cholesterol and cholesterol you're measuring in my bloodstream? And the short answer is very little.

Over 50% of men who are going to have a cardiac event in their life will have it before the age of 65. And, for women, you do the same exercise; you can see that it's one-third of women.

So, it's important to understand that, if we didn't have cholesterol, we wouldn't have cells. If we didn't have cells, I wouldn't be making this video, and you wouldn't be here to watch this video. No cholesterol equals no life.

Over 50% of people's first heart attack is fatal.

What is cholesterol? So, cholesterol is a lipid. It is synthesized by every cell in our body. That means every cell in our body makes cholesterol. Okay, so why do we make this stuff? Well, this stuff is super important for every cell or our body wouldn't make it.

The ApoB concentration, to me, is the most important number you want to understand to predict, from a biomarker standpoint, your cardiometabolic risk, ASCVD risk, because it captures all of the atherogenic particles.

I haven't seen any solid evidence that triglyceride itself is pro-atherogenic. What's atherogenic is the cholesterol inside the vLDL particles. It's the number of those particles that get into the wall.

Two of the biggest risk factors for cardiovascular disease are smoking and hypertension. I don't think there is any ambiguity that cigarette smoking and high blood pressure increase the risk of cardiovascular disease...

There's no question that the number of LDL particles is a more accurate index of risk than the LDL cholesterol.

The evidence is overwhelming that infantile levels of ApoB are not deleterious in any way.