The Peter Attia Drive #229 ‒ Understanding cardiovascular disease risk, cholesterol, and apoB
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Oct 31, 2022 
Allan Sniderman, a leading expert in lipoprotein metabolism, and Tom Dayspring, a specialist in atherosclerotic cardiovascular disease (ASCVD), share their insights on cardiovascular health. They discuss the limitations of standard lipid metrics and highlight apoB as a superior risk assessment tool. The conversation dives into the importance of early intervention and challenges misconceptions around cholesterol, advocating for proactive measures against ASCVD. Discover how understanding these factors can significantly alter prevention strategies.
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Lipoprotein Categories
- Lipoproteins are categorized into ApoB (VLDL, IDL, LDL, Lp(a)) and ApoA (HDL) families.
- ApoB gives a total atherogenic burden and is the preferred risk assessment metric.
LDL-C Limitations
- Doctors often rely on calculated LDL-C, limiting their ability to address high triglycerides.
- Non-HDL-C is a more accurate risk indicator.
Cholesterol Calculation
- LDL cholesterol is usually calculated, not directly measured, with multiple calculation methods existing.
- VLDL cholesterol, carried in VLDL particles from the liver, is atherogenic.