Cardiovascular disease, the number one killer: development, biomarkers, apoB, cholesterol, brain health, and more | Tom Dayspring, M.D.

**Peter Attia, MD** (0:11)
Hey everyone, welcome to the Drive podcast. I'm your host, Peter Attia. This podcast, my website and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of a subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com/subscribe. My guest this week is Tom Dayspring. This may be a familiar name to you, as Tom has been a guest on the podcast several times already. Tom is a fellow of both the American College of Physicians and the National Lipid Association, and he is certified in Internal Medicine and Clinical Lipidology. He was the recipient of the 2011 National Lipid Association, President's Award for Services to Clinical Lipidology, and the 2023 Foundation of NLA Clinician Educator Award. Boy, have I known Tom for a while. Tom and I met back in 2011 At the time, I had a budding interest in cardiovascular disease and lipids. Tom took me under his wing and has been one of the more important mentors I have had in the field of clinical lipidology. In this episode with Tom, we talk about the foundations of atherosclerosis, why it is the number one killer in the US and abroad, both for males and females, and how the disease works from a pathologic perspective. We talk about the various risk factors for cardiovascular disease and the role of insulin resistance and chronic kidney disease, which are two things that don't get talked about quite as much as high blood pressure, smoking and lipids. We then do a bit of a dive into cholesterol and lipoproteins, discussing the role of ApoB, the development of atherosclerosis and also talking about other particles that make up ApoB, so LDL, VLDL, IDL, in addition to HDL and their associations on cardiovascular risk. Talk about testing the various biomarkers as well as the impact of nutrition, particularly saturated fat and fat consumption on lipid levels. We can talk about the impact of cholesterol in the brain, where cholesterol in the brain comes from, how it's synthesized there, how that differs from the periphery and the role of pharmacology in that. So without further delay, I hope you enjoy my conversation with Tom Dayspring.
Hey, Tom, thank you so much for joining me. It's actually probably been a while since we've done an actual podcast together. Though, of course, we speak so frequently that it almost feels a little strange to be talking in this way. But anyway, thank you for joining us.

**Tom Dayspring** (3:12)
Now, it's a thrill to be back on the podcast series. It has been a while and there's always stuff to talk about lipids as you and I know too well.

**Peter Attia, MD** (3:22)
So Tom, we're obviously going to talk about cars today because that's, no, I'm just kidding. Everybody knows what we're here to talk about. We're here to talk about ASCVD, cardiovascular disease. I think in part, I'd like to do this because there aren't many people who probably heard our first podcast series together. I think that was a five, seven part series, something of that effect. I still obviously get many notes from people who are just discovering that or who listened to it way back. But I also think if I could be critical of that discussion, as much as you and I enjoyed speaking for what I think amounted to eight or nine hours, it's a little bit intimidating for someone who's trying to understand this topic. And so the two things I would like to accomplish today would be to bring a little bit of brevity to what we discussed then. And of course, also to update people on all the things that have changed since then, because that's the beauty of this field is that a lot has changed in the probably six years since that discussion. But maybe we should at least start by letting you define for people what is meant by atherosclerotic cardiovascular disease.

**Tom Dayspring** (4:33)
That's a very specific type of a vascular disease, and that means arteries throughout your body acquire a pathology. And that pathology is simply the deposition of cholesterol in the artery wall. I always joke there's like one sine qua non for atherosclerosis, and it says, do you have cholesterol in your artery wall, or do you not? If you don't, you don't have atherosclerotic heart disease. And of course, we have many, many arteries in our body, and some are much more afflicted than others. And the ones of most concern are typically the smaller ones that are supplying our heart and our brain, because those are sort of essential organs that need a profuse blood flow with all the nutrients and oxygen in the blood.