The Peter Attia Drive #185 - Allan Sniderman, M.D.: Cardiovascular disease and why we should change the way we assess risk
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Nov 29, 2021 
Allan Sniderman, a leading Professor of Cardiology at McGill University, discusses the merits of using apoB as a more reliable metric for assessing cardiovascular disease risk. He critiques the conventional risk assessment models and their limitations, especially for younger individuals. The conversation covers the complexities of cholesterol, the significance of particle counts, and the importance of nuanced risk evaluations. Allan also emphasizes early intervention and raises concerns about the lack of innovation in current medical practices surrounding cardiovascular health.
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Early ApoB Research
- In 1980, Dr. Sniderman's research showed ApoB's stronger link to coronary disease than cholesterol levels.
- Despite decades of evidence, the medical community resists adopting ApoB over standard cholesterol metrics.
LDL Calculation and Triglycerides
- Calculated LDL cholesterol, not directly measured, is standard but has multiple calculation methods.
- High triglycerides indicate higher CVD risk, but it's the ApoB particle number that matters, not just triglyceride levels.
Remnant Type III Hyperlipoproteinemia
- Remnant type III hyperlipoproteinemia features high cholesterol and triglycerides, but low ApoB.
- This condition, more common than familial hypercholesterolemia, is easily treatable but often missed without ApoB testing.