230 ‒ Cardiovascular disease in women: prevention, risk factors, lipids, and more

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Erin Michos is an internationally-known leader in preventive cardiology and women’s cardiovascular health. In this episode, Erin discusses current trends in cardiovascular disease (CVD) through the lens of female biology and the observation that major adverse cardiac events in both sexes are on the rise. She walks through risk factors including LDL-cholesterol, apoB, and Lp(a) and makes the case for the importance of early preventative measures. She explains various interventions for reducing risk including a discussion of statins, GLP-1 agonists, PCSK9-inhibitors, and drugs that lower Lp(a). She goes in-depth on female-specific factors that contribute to CVD risk such as pregnancy, grand multiparity (having five or more children), oral contraceptives, menopause, and polycystic ovary syndrome (PCOS). Additionally, she explains her approach with patients as it relates to the use of hormone replacement therapy and provides advice for people wanting to lower risk both through lifestyle changes & medications.

0:00:00 - Intro
0:02:30 - Erin’s background in preventive cardiology
0:05:15 - Recent trends in cardiovascular disease in women, mortality data, & how it compares to cancer
0:13:15 - Why early preventative measures are critical for CVD risk
0:19:45 - ApoB as a causal agent of CVD, & why high apoB levels are not being aggressively treated
0:27:00 - The rising trend of metabolic syndrome & other factors contributing to the regression in progress of reducing cardiac events
0:33:30 - GLP-1 agonists—Promising drugs for diabetes & obesity
0:37:15 - Female-specific risk factors for ASCVD
0:47:00 - Polycystic ovary syndrome (PCOS): prevalence, etiology, & impact on metabolic health, lipids & fertility
0:52:30 - The effect of grand multiparity (having 5+ children) on cardiovascular disease risk for women
0:55:00 - The impact of oral contraceptives on cardiovascular disease risk
0:58:45 - The effect of pregnancy on lipids & other metabolic parameters
1:02:00 - The undertreatment of women with familial hypercholesterolemia (FH) & how it increases lifetime risk of ASCVD
1:09:45 - How concerns around statins have contributed to undertreatment, & whether women should stop statins during pregnancy
1:16:00 - How Erin approaches the prescription of statins to patients
1:21:15 - PCSK9 inhibitors & other non-statin drugs
1:28:30 - Advice for the low- and high-risk individual
1:31:00 - The impact of nutrition, stress, & lifestyle on lipids & CVD risk
1:41:15 - Lp(a) as a risk enhancer for cardiovascular disease
1:50:30 - The effect of menopause on cardiovascular disease risk
1:55:30 - How Erin approaches decisions regarding hormone replacement therapy (HRT) for her patients
2:03:30 - The urgent need for more data on women’s health
2:09:45 - Erin’s goal of running a marathon in every state

The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 45 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.

Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life).

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