AMA #34: What Causes Heart Disease?

**Peter Attia** (0:11)
Hey, everyone, welcome to a sneak peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.
Welcome to Ask Me Anything episode number 34 I'm once again joined by Nick Stenson. In today's episode, we do a super deep dive answering a lot of questions that have been accumulating around atherosclerotic cardiovascular disease. Now atherosclerosis, of course, is the number one killer in the developed world.
It affects basically everybody. So you undoubtedly know somebody who's affected by this, if not you.
So we thought it was really time to kind of focus deep on this. So for this reason, we combined a lot of previous questions that have come in into this episode. And so we discuss a lot of things here. We discuss why everybody should care about atherosclerosis. We talk about exactly what it is and try to explain how it comes about. Now it's important to spend a lot of time on this because if you want to understand how to prevent it, you really need to understand how it's caused. And then that'll give you some sense of what the markers are and what the markers don't tell you and what they do tell you. So we look at why it's not a disease that only affects old people, but why it really takes hold at an early age and you need to be aware of this if of course you want to present it. We talk about cholesterol, blood work, what these numbers mean, what's typically run, what's not run, what metrics I like to look at and what you should be concerned over. We also get into a question that comes up a lot, which is can cholesterol levels be too low? So if you're taking medications to lower cholesterol, what happens if your cholesterol levels get really low? What are the risks of that? From there, we answer questions around coronary artery calcium scores or CACS, CIMT, CT angiogram, and a whole bunch of other things along that. So if you're a subscriber and you want to watch the full episode of this in video, you can do so on the show notes page. And of course, we'll have the show notes that include a whole bunch of details.
Worth pointing out here before I start, this is an episode where I probably have more figures than any other episode I've done. So even if you're not someone who likes to look at the graphics, I think this is the one time you probably want to make an exception and watch the video. If you're not a subscriber, you can still catch a sneak peek of this on our YouTube page. So without further delay, hope you enjoy AMA number 34
Hey Nick, how you doing?

**Nick Stenson** (2:39)
I'm not doing too bad. How are you doing?

**Peter Attia** (2:41)
I'm good. We got a doozy today.

**Nick Stenson** (2:43)
More so than usual.

**Peter Attia** (2:44)
I know, embracing myself for the intensity of this discussion.
We've accumulated, I don't know, almost an endless supply of questions on heart disease in one format or another, the specifics around lipids, atherosclerosis in general, these things like that. And so as is often the case, I think we've accumulated a critical mass of questions that we can now organize them into a coherent and thoughtful discussion around all things related to atherosclerosis. So I know you've done an amazing job taking these questions and organizing them in a way that makes for hopefully a logical discussion. So let's take it away.

**Nick Stenson** (3:21)
The hope is a lot of this stuff we're gonna talk about today, we could dive in so deep. So many of these questions could be their own AMA, but what we thought as a team was it'd be just much better to touch on all these aspects so people who listen top to bottom can just get a really good understanding of what this is, why they should care about it, how they should think about it. On that note, what we thought would be important is just answering the first question, which is why should someone care about this? It's such a complex topic.
Why is it important for people to put the time in to really think through and understand it?

**Peter Attia** (3:55)
It really starts with the ubiquity of this disease, and its assault on human longevity. People have probably heard me say this before, but 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. So you have a condition that, as I said, is inevitable, is ubiquitous. Also, I think based on what you're going to hear me talk about today, we know a lot about this condition, and we really have tools to mitigate it. To me, that's the reason you want to really understand this.