1: Ever heard of 3-hydroxyisobutyric aciduria?
Probably not.
“That’s because there have been only thirteen reported cases. Ever,” Dr. Peter Attia writes in his powerful book Outlive.
It’s an “orphan disease,” a rare disease that doesn’t impact many people.
Why does Peter share this anecdote? Because he believes heart disease, our #1 killer in the United States, should not even be among the ten causes of death.
If we treated it more aggressively.
“Instead, we have over eighteen million cases of fatal atherosclerotic disease per year globally,” he notes.
2: So, how do we reduce our risk of heart disease and heart attack?
Yesterday, we looked at Peter’s recommendation to start fighting heart disease much earlier.
Peter believes we should be much more aggressive about lowering our “bad cholesterol,” the concentration of LDL-C and apoB particles in our blood.
“Our first order of business is to reduce the burden of apoB particles, primarily LDLs but also VLDLs, which can be dangerous in their own right,” he writes.
“And do so dramatically, not marginally or incrementally. We want it as low as possible, sooner rather than later,” he writes.
3: And there is good news, Peter notes: “Here we are fortunate because we have more preventive options in our armamentarium than we do for cancer or neurodegenerative disease.
“Statins are far and away the most prescribed class of drugs for lipid management, but there are several other options that might be right for a given individual, and often we need to combine classes of drugs, so it’s not uncommon for a patient to take two lipid-lowering drugs that operate via distinct mechanisms.
“These are typically thought of as ‘cholesterol-lowering’ medications, but I think we are better served to think about them in terms of increasing apoB clearance, enhancing the body’s ability to get apoBs out of circulation. That’s really our goal.
“Mostly this is done by amplifying the activity of LDL receptors (LDLR) in the liver, which absorbs cholesterol from the bloodstream. . .
“Not everyone can take statins comfortably; about 5 percent of patients experience deal-breaking side effects, most notably statin-related muscle pain.
“Also, a smaller but nonzero subset of patients taking statins experience a disruption in glucose homeostasis, which may explain why statins are associated with a small increase in the risk for type 2 diabetes.
“Another fraction of patients experience an asymptomatic rise in liver enzymes, which is even more common in patients also taking the drug ezetimibe.
“All these side effects are completely and rapidly reversible when the drug is discontinued,” Peter writes. “But for those who can tolerate them (i.e. most people), I deploy them early and often.”
More tomorrow.
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Reflection: Do I know my “bad cholesterol” levels, the concentration of LDL-C and apoB particles in my blood?
Action: Talk to my Primary Care Physician about Peter’s work.
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