Tom Dayspring, M.D.: The latest insights into cardiovascular disease and lipidology

**Peter Attia, MD** (0:11)
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Now, without further delay, here's today's episode. My guest this week is Dr. Tom Dayspring. This name is probably familiar to some of you because back in October of 2018, we released a five-part series with Tom, and that set of episodes, despite being quite technical, are some of the most popular episodes we've released, especially amongst people who really like to get serious about their understanding of cardiovascular disease. So we wanted to have Tom back, basically to pick it up where we left off. And in this episode, we try to focus on things that have changed in the last couple of years, and that kind of loosely fell into three categories that we probed. The first is digging really deeper into the recognition of the importance of atherogenic lipoproteins. So kind of revisiting the idea of what ApoB is, why it matters, and both Tom and I discuss a little bit about how our views have changed with respect to the use of ApoB as a laboratory surrogate over LDL-P.
And we get into all of the nuance around that with respect to VLDLs, triglycerides, LP little a, et cetera.
We also get into why HDL cholesterol is a far less relevant metric, at least why we believe that to be the case.
We then pivot a little bit and talk about risk assessment. Basically, how do you understand these metrics? How do you use these metrics? This is a lot of the clinician-type stuff here around ApoB and triglyceride-rich lipoproteins. We again revisit the idea of LP little a. And then finally, we bring it home with some discussion around therapies. And in particular, we talk about the continued evolution of the PCSK9s, the evolving data around omega-3 fatty acids, in particular, some of the controversy between EPA alone versus EPA and DHA. And obviously, we talk about the most recent addition to the lipid drug story, which is a drug called bambandoic acid, which has not been around very long, and probably many people are not gonna be familiar with that, but Tom does a great job explaining that. Tom's a diplomat of both the American Board of Internal Medicine and the American Board of Clinical Lipidology. He practiced internal medicine in New Jersey for 37 years, the last 17 of which was devoted to consulting patients with lipid and cardiometabolic disorders. Between 2012 and 2019, he served as the chief scientific officer at two major cardiovascular biomarker laboratories. Since that time, he has been working with us in our practice, primarily on the research side of things, but also as a consultant advising on most of our cardiovascular cases. He's both a fellow of the American College of Physicians and the National Lipid Association, the NLA. And he's an associate editor at the Journal of Clinical Lipidology.
He was also the recipient of the National Lipid Association 2011 President's Service Award. He's authored and illustrated more manuscripts and book chapters related to lipids than I can count. And so without further delay, please enjoy my conversation with my mentor and friend, Tom Dayspring.

**Tom Dayspring, MD** (3:50)
Hey!

**Peter Attia, MD** (3:55)
Hey Tom, thanks so much for making time to sit down again and talk about lipids. It's been almost two years since we sat down for what still remains the longest podcast I've ever done, nearly eight hours, which I believe was divided into a five part series that is still a very popular podcast series. And don't take this the wrong way, but I'm kind of surprised at the popularity of that episode given that I thought it was really geared only towards people that were really, really diehard, lipid fanatics, but it's had a broad enough appeal that I think we've agreed neutrally that it makes sense to sit down again.

**Tom Dayspring, MD** (4:41)
That was amazing.
First of all, it's always great to sit down with you, Peter, and chat about my little lipid world. But yeah, I'm shocked every time somebody tells me we've listened to the whole series, and I've done it three times, and I just can't imagine that. But I'm glad it came across pretty good.