Ep393 PETER ATTIA IS WRONG! BEST STRATEGY TO MANAGE HEART DISEASE

Summary

Dr. Rob Cis discusses cardiovascular risk assessment beyond traditional cholesterol and LDL measurements. He emphasizes the importance of a coronary artery calcium (CAC) score to evaluate plaque burden and the necessity of a nuclear medicine stress test for those at risk. Dr. Cis also advises on anti-inflammatory strategies, including diet and exercise, and the potential use of medications like aspirin and colchicine to manage inflammation and reduce heart attack or stroke risk.

Takeaways

• 🔍 Doctors often use a standard algorithm to assess cardiovascular risk based on total cholesterol and LDL levels.
• 🚫 High cholesterol and LDL are not the sole causes of cardiovascular disease, contrary to common medical belief.
• 📉 A coronary artery calcium (CAC) score is a more direct measure of plaque in the heart vessels and can indicate the risk of heart attack or stroke.
• 🏥 If a doctor is unwilling to order a CAC score, it can be obtained for around $100 in the US, and it's crucial for assessing heart health.
• 💓 A CAC score of zero or below 80 indicates a low risk of heart attack or stroke, even for those over 50.
• 🏋️‍♂️ If the CAC score is above 80, a nuclear medicine stress test can determine if plaque is affecting blood flow to the heart muscle.
• 🩺 Regular blood work should include tests for inflammation markers such as white cell count, lipids, triglycerides, uric acid, iron levels, and HS CRP.
• 🚭 Smoking cessation and adopting a low-carbohydrate, high-fat ketogenic diet can significantly reduce inflammation and cardiovascular risk.
• 🏃‍♂️ Regular physical activity is essential for reducing inflammation and should be incorporated into daily routines.
• 💊 Anti-inflammatory medications like aspirin and colchicine can be used to reduce inflammation and prevent clot formation.
• 🌾 Eliminating grain products from the diet can help reduce inflammation, which is a key factor in cardiovascular disease.

Q & A

What is the primary focus of Dr. Rob's video?

The primary focus of Dr. Rob's video is to discuss how to approach cardiovascular risk without panic, emphasizing that high cholesterol and LDL levels are not the sole causes of cardiovascular disease.

Why do doctors often prescribe statins to patients with high cholesterol?

Doctors often prescribe statins because they believe high cholesterol and LDL levels directly cause cardiovascular risk, which is the commonest cause of death, even though Dr. Rob argues this is not entirely accurate.

What is the first test Dr. Rob recommends for assessing cardiovascular risk?

The first test Dr. Rob recommends is a coronary artery calcium score (CAC score), which directly looks at the burden of plaque in the heart vessels.

What does a CAC score indicate?

A CAC score indicates the amount of plaque in the coronary arteries. A score of zero or below 80 suggests a negligible risk of heart attack or stroke, while a score above 80 indicates a risk.

What is the next recommended test if the CAC score is above 80?

If the CAC score is above 80, the next recommended test is a nuclear medicine stress test, which evaluates whether plaque is affecting blood flow to the heart muscle.

What lifestyle changes does Dr. Rob suggest to reduce cardiovascular risk?

Dr. Rob suggests adopting a low carbohydrate, high-fat ketogenic eating pattern, regular physical activity, and avoiding smoking as key strategies to reduce cardiovascular risk.

What is the significance of looking at white cell count and other blood markers?

Looking at white cell count and other blood markers like uric acid, lipids, triglycerides, and hs-CRP helps assess the level of inflammation in the body, which is a risk factor for cardiovascular disease.

Why does Dr. Rob emphasize the importance of reducing inflammation?

Dr. Rob emphasizes reducing inflammation because it can trigger preventive care and is a key factor in attracting clots to blood vessels, which can lead to heart attacks or strokes.

What are some anti-inflammatory medications mentioned by Dr. Rob?

Some anti-inflammatory medications mentioned by Dr. Rob include aspirin, colchicine, and non-steroidal anti-inflammatory drugs (NSAIDs) for significant inflammatory diseases.

What dietary advice does Dr. Rob give to reduce inflammation?

Dr. Rob advises reducing grain products in the diet, as they are significant inflammatory molecules, and suggests a carnivore or carnivore-based diet for those with significant autoimmune disease.

How can monitoring the CAC score over time help in managing cardiovascular risk?

Monitoring the CAC score over time can help in managing cardiovascular risk by indicating whether the plaque burden is stable (reducing the risk of heart attack or stroke to less than 1%) or increasing (indicating a higher risk).