Paul Saladino· MD
There is a LARGE amount of evidence to suggest that being insulin sensitive massively attenuates the increase in cardiovascular risk seen with higher ApoB levels.
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The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
There is a LARGE amount of evidence to suggest that being insulin sensitive massively attenuates the increase in cardiovascular risk seen with higher ApoB levels.
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this is what i'm talking about when you stratify ischemic heart disease risk by any variable whether it's hdl triglycerides to hdl or it's fasting insulin which is a study that i wish more people would do you see that ldl becomes a piss poor predictor apob containing the proteins as a piss poor predictor all of these track the same
I think there's not much good evidence at all to say that an isolated rise of APO b or LDL in someone that is insulin sensitive carries any increased risk of cardiovascular disease
there's not much good evidence at all to say that an isolated rise of APO b or LDL in someone that is insulin sensitive carries any increased risk of cardiovascular disease
it is all about the context which you can understand by knowing how insulin sensitive you are that was why I started this podcast with the very first metric of a fasting insulin
if you take able B people with an elevated apob and throw on smoking and insulin resistance and hypertension and social determinants of Health lack of exercise you know obesity especially abdominal obesity you tag on all that stuff absolutely their risk goes way way up
I do not think you need an NMR lipid panel if you want want to get an NMR or a Lipa protein lipop panel that's more sophisticated you can do that I've shown my blood work with that in the past I think getting a basic lipid panel with an apob is fine again interpret that in the context of insulin sensitivity know what your fasting insulin is
given that you have a normal level of thyroid function given that you don't have a genetic predisposition to hyper lipidemia like we talked about the FH genotype versus phenotype aside and you know become insulin resistant and I think that significantly lowers your risk of cardiovascular disease
I happen to believe that Apo B containing lipoproteins are not aogenic in of themselves. And I think that anytime you look at studies that qualify or contextualize atherosclerosis risk on the basis of insulin sensitivity, you see the relationship between APOB and cardiovascular disease either massively attenuated or you see it kind of vanish.
IR is so often accompanied by high apoB, that there is overlap.
In addition to ApoB, other drivers of cardiovascular disease include insulin resistance, hypertension, and smoking.
Lower your triglycerides as much as possible (this is a proxy for insulin sensitivity — in general, the more insulin sensitive you are, the lower your triglycerides).
step number one is lower the triglyceride as much as possible and the triglyceride being low is an enormous proxy for insulin sensitivity