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How to lower your apoB — Whalespan

Content›Video›How to lower your apoB…

How to lower your apoB

Peter Attia11m · 2023-10-26

Claims Made

24

Claims Supported

12

Support Rate

50%

Support rate

12 of 24 claims supported

12 supported12 partial / not

Claims from this content

22

✓Well SupportedA combination of a statin and ezetimibe can provide the same ApoB reduction as maximizing statin therapy alone, and this combination has outcome evidence.✓Well SupportedAntisense oligonucleotides targeting the Lp(a) gene are promising for Lp(a) research.✕Not SupportedHigh-dose statins are generally not necessary today, as most ApoB lowering and LDL receptor upregulation occurs with the lowest effective doses.◐Partially SupportedBempedoic acid's prodrug is activated only in the liver, preventing muscle symptoms associated with statins and not increasing glucose levels like high-intensity statins.Well Supported

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Attia walks back the clinic protocol: too aggressive for healthy adults

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A. Volkovreader

4h

Bookmarking — the dossier-vs-overview split is the right call. Most of the time I want overview; sometimes I want receipts.

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2d

Would love a "what would change this verdict" RSS feed. Sign me up if it exists.

✓

Bempedoic acid inhibits cholesterol synthesis specifically in the liver, offering a similar mechanism to statins but with fewer side effects.

✓Well SupportedPeter Attia recommends keeping ApoB levels as low as possible without pharmacology.

◐Partially SupportedIt is possible to pharmacologically address high apoB levels even if diet contributes to other benefits.

◐Partially SupportedReducing carbohydrates can lower triglycerides, which in turn lowers ApoB burden by reducing the need to traffic fewer triglycerides with cholesterol.

◐Partially SupportedFor individuals unable to afford newer PCSK9 inhibitors or bempedoic acid, statins remain a viable option, with pitavastatin and rosuvastatin potentially preferred due to a better side effect profile.

◐Partially SupportedReducing saturated fat lowers cholesterol synthesis and reduces the liver's need to export fat by upregulating LDL receptors, thereby pulling more LDL out of circulation.

◐Partially SupportedAcetamide works by blocking the Niemann-Pick C1-like 1 (NPC1L1) transporter in hepatocytes and enterocytes, preventing the reabsorption of non-esterified cholesterol.

◐Partially SupportedApproval of an antisense oligonucleotide drug for Lp(a) depends on phase three trials demonstrating a reduction in major adverse cardiac events.

✕Not SupportedStatin side effects include muscle aches, elevated liver function tests, and insulin resistance.

◐Partially SupportedExercise has no meaningful impact on cardiovascular disease risk factors related to lipoproteins, although it impacts risk in other ways.

◐Partially SupportedA combination of PCSK9 inhibitor, bempedoic acid, and etam keeps my ApoB negligible and has no personal side effects.

◐Partially SupportedA diet very low in carbohydrates and saturated fat may lower ApoB but not to levels that eliminate cardiovascular disease risk.

◐Partially SupportedStatins achieve approximately 85% of their maximum ApoB reduction at 5-10 milligrams, with higher doses offering minimal additional efficacy and increased side effects.

◐Partially SupportedEtam is the least potent of the three drugs Peter Attia takes for ApoB reduction.

◐Partially SupportedPeter Attia's baseline ApoB is 90-100 mg/dL, which is considered too high for someone with a genetic predisposition to ASCVD or who aims to eliminate it as a risk factor.

◐Partially SupportedPeter Attia takes a PCSK9 inhibitor, bempedoic acid, and etam to lower his ApoB.

?Limited ResearchConcerns exist about taking lipid-lowering drugs like statins for extended periods, particularly for younger individuals (30s-50s).

◐Partially SupportedAn approved anti-sense oligonucleotide for Lp(a) might be used off-label for primary prevention, but insurance coverage is unlikely initially.