Cardiovascular disease in women: prevention, risk factors, lipids, and more | Erin Michos, M.D.

**Peter Attia** (0:11)
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My guest this week is Erin Michos. Erin is an internationally known leader in preventative cardiology, women's cardiovascular health and cardio obstetrics. She's an associate professor of medicine in the division of cardiology at Johns Hopkins School of Medicine, the joint appointment in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. She's also the director of women's cardiovascular health and the associate director of preventative cardiology with the Johns Hopkins Center of Prevention of Cardiovascular Disease. This is an episode that covers a topic that is obviously valuable to understand, given that atherosclerotic cardiovascular disease is the number one cause of death worldwide. And while it's a topic we've covered in detail in the podcast before, I think it's an important episode because we focus this conversation around cardiovascular disease and lipids specifically through the lens of female biology. We discuss the prevalence of ASCVD in females as they age, the importance of making interventions early in life, the risk of ASCVD over the course of lifetime as opposed to the traditional view, which is to only really consider 10-year risk.
We then probe the ins and outs of CVD, lipids and various lipid-lowering medications across a female's lifetime, including the premenopausal state, changes during the perimenopausal state, pregnancy and menopause and beyond. We also touch on a number of other subjects that affect a female's risk of ASCVD, specifically polycystic ovarian syndrome, contraceptives, GLP-1 agonists, nutrition, metabolic health, familial hypercholesterolemia, statins, stress, HRT and more.
So without further delay, please enjoy my conversation with Dr. Erin Michos.
Thanks so much for making time, Erin. Look forward to this discussion. We have a lot to talk about, but before we do it, there's one thing I wanted to just check. Going through your bio, I realize when did you do your residency in medicine? Because you also did that at Hopkins, correct?

**Erin Michos** (2:45)
Yes.
So I've been at Hopkins 22 years. I did residency from 2000 to 2003, and then stayed on for cardiology fellowship, and then joined the faculty. So I've been on faculty over 15 years now.

**Peter Attia** (3:00)
I did my general surgery there. I was there from 1 to 06, which made me realize the probability we haven't passed each other somewhere in the emergency room during residency is exceedingly low, right?

**Erin Michos** (3:14)
I'm sure we must have interacted, because I was there all during that time, overlapped with my residency and my fellowship.

**Peter Attia** (3:20)
I always am amazed when I run into people who I know I was there with. And there are certain medicine residents I remember very well, but just by coincidence, you're always in the ER together, but obviously it's a huge program. So when you went into medicine, did you know you wanted to do cardiology?

**Erin Michos** (3:34)
When I went into medicine, I did. In college, I actually didn't know that I was gonna go into medicine. You know, there's no doctors in my family, so I'm the first one. So I didn't really know what a career in medicine would be about. So I started out my undergrad studies at Northwestern as a molecular biology major. Through that, I interacted with so many pre-med students who were my classmates, and their enthusiasm about entering the field was really contagious. And I was doing a lot of bench science, which is really a good experience. I think anybody entering science and medicine should have some bench lab work experience. But I began to long for more direct clinical research with direct patient exposure. So kind of late, I switched to being pre-med kind of my last year of undergrad and applied actually to both the PhD and medical programs.
And then when I started medical school, I really fell in love with cardiology, even as a medical student before medicine residency. I have a real interest in diet and nutrition and exercise and lifestyle.
And we think that over 90% of cardiovascular disease is due to preventable, modifiable risk factors.