#129 - Tom Dayspring, M.D.: The latest insights into cardiovascular disease and lipidology

A major cardiovascular biomarker laboratory that may still use older generation NMR technology for LDL-P measurement.

Pharmaceutical company that acquired Epanova, a free omega-3 fatty acid combination of EPA and DHA, whose trial was stopped due to futility.

The company that manufactures Vascepa, the branded EPA medication used in the REDUCE-IT trial.

A pharmaceutical company that has acquired a product for Lp(a) synthesis modulation and is initiating a Phase 3 trial.

A major cardiovascular biomarker laboratory that uses ion mobility transfer for particle number techniques, which is not directly comparable to other methods.

A company that makes an assay for LDL triglyceride levels.

A lipid expert mentioned in earlier podcasts, whose work, along with Allan Sniderman's, heavily influenced Peter Attia's practice.

A New York Times writer who wrote a story about Lp(a), disclosing his own elevated levels.

A person with whom Peter Attia recorded a podcast, mentioned in the context of generic vs. branded drug efficacy.

An expert on omega-3 fatty acids, known for advocating serious doses for triglyceride lowering and for his insights into the REDUCE-IT trial.

Guest on The Drive podcast, a clinical lipidologist and internal medicine physician, and chief scientific officer at cardiovascular biomarker laboratories. He works with Peter Attia on cardiovascular cases.

Researcher who, in the 1990s, identified what would later be called metabolic syndrome (Sydnermax), contributing to the understanding of cardiovascular risk factors beyond LDL cholesterol.

Host of The Drive podcast and a physician focused on longevity; discusses cardiovascular disease and lipidology with Dr. Dayspring.

A scientist who, in the late 1950s and early 1960s, identified a relationship between serum cholesterol and coronary artery disease, leading to early discussions of cholesterol fractionation.

A figure in lipidology known for emphasizing the importance of ApoB, whose work strongly influences the practice of Peter Attia and Tom Dayspring.

A researcher who described HDLs as fire engines part of the innate immune system, carrying various molecules for inflammatory responses.

Cited as one of the world's leading experts on Lp(a), whose dedicated work is anticipated for future podcast episodes.

A newer statin that is hepatoselective and has a very clean drug interaction profile, making it a safer option for sensitive patients or those on polypharmacy.

The first statin introduced; compared to pravastatin, it had more drug interactions and was less safe.

A potent statin, though less potent than rosuvastatin on a milligram basis, with more drug interactions due to its lipophilic nature.

An older statin mentioned as one that Peter Attia rarely prescribes due to its safety profile compared to newer alternatives.

A new selective p-par alpha receptor modulator (SPPARM) fibrate currently undergoing large outcome clinical trials.

A class of drugs that inhibit HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis, primarily in the liver, leading to increased LDL receptor expression and ApoB lowering. Noted for their widespread use and ongoing role in lipid-lowering therapy.

A free omega-3 fatty acid product containing both EPA and DHA, acquired by AstraZeneca, which failed to show efficacy in a clinical trial and was subsequently stopped.

The brand name for Bempedoic Acid, also available in a combo product with Ezetimibe for broad lipid-lowering therapy.

A potent, hydrophilic statin, effective at lowering LDL cholesterol and ApoB.

A statin with a safer drug interaction profile compared to simvastatin or lovastatin, also hydrophilic.

A class of drugs used to lower triglycerides, still considered underutilized for patients with triglyceride-rich lipoproteins and insulin resistance, with potential microvascular benefits.

A major clinical trial in which Amarin's branded EPA medication (Vascepa) at a high dose (4 grams/day) showed a nearly 30% reduction in residual cardiovascular risk in high-risk patients already on statins with elevated triglycerides.

Multi-Ethnic Study of Atherosclerosis, another key observational study providing data on cardiovascular risk factors and lipid discordance.

A long-running observational study that provides data on cardiovascular disease risk factors, used to predict discordance in lipid metrics.

Lipids that contribute to the atherogenicity of ApoB particles and impact lipoprotein concentration and quality, increasingly central to understanding cardiovascular disease.

High-Density Lipoprotein Cholesterol, a metric historically associated with cardiovascular health but now considered less relevant in risk assessment due to lack of evidence for raising its levels and its poor correlation with functionality.

Apolipoprotein B, the main structural protein that wraps lipids in the body, forming water-soluble lipid transportation vehicles. Its concentration is a key metric for assessing atherogenic lipoproteins.

LDL particle number, a measurement used historically by Peter Attia's practice before switching to ApoB due to technological inconsistencies and lack of guideline support.

Antisense oligonucleotide therapy, a genetic approach in early trials that stops the liver from making apoprotein(a), thereby reducing Lp(a) levels.

A medical journal that published a recent study and editorial on the combination of terrible family history of heart disease and Lp(a) issues.

Historically used for triglyceride lowering, but now considered a 'dead drug' and out of every major guideline due to lack of proven cardiovascular benefit.

A type of omega-3 fatty acid, shown in trials like REDUCE-IT to significantly reduce residual cardiovascular risk at high doses, particularly when used alone.

A recently introduced drug that inhibits cholesterol synthesis by targeting ATP citrate lyase, offering an additional ApoB-lowering option, especially for statin-intolerant patients.

A non-statin lipid-lowering drug that blocks intestinal absorption of cholesterol, further depleting hepatic cholesterol pools and increasing LDL receptor expression.

Another type of omega-3 fatty acid, often combined with EPA, believed to be important for cell membranes and brain function, but its combined efficacy with EPA for cardiovascular events is still under debate.

A class of drugs that lower LDL cholesterol and ApoB by increasing the number of LDL receptors on liver cells, also effective in lowering Lp(a) levels.

Discussed for their role in triglyceride reduction, with specific focus on the controversy between EPA alone versus EPA and DHA for cardiovascular benefit.

Another brand name for a PCSK9 inhibitor, also mentioned for its variable effect on Lp(a) reduction.

A branded fibric acid (fenofibric acid), which is a pro-drug, considered the purest fibric acid and the one to use if a fibrate is necessary.

Branded EPA medication (icosapent ethyl) manufactured by Amarin, proven to reduce macrovascular outcomes in the REDUCE-IT trial.

Referenced for an article by Anahad O'Connor about Lp(a) and personal discovery of elevated levels.

Nuclear Magnetic Resonance Lipoprotein Particle testing, a technology for measuring LDL particle count, which has seen several generations of unreliable or non-comparable results leading to a shift towards ApoB.