5th Percentile ApoB
Hi Peter, I recently switched doctors after the previous laughed at the causal nature of ApoB. Upon getting my results back, I discovered I'm at 61, the upper echelon of the desired 5th percentile. I'm a 35 year old male with a keen interest in being proactive and follow through daily with the pillars of health you espouse to. I'm up to date through the most recent podcast, #238 the AMA on ApoB from January 16th. How hard would you suggest someone like this to push on this lever? Looking at your bold statement from episode #202, would you recommend being bullish and taking a PCSK9 inhibitor/statin to bring the numbers in the 20-30 range for a mid thirties male with a score at the ceiling of the 5th percentile? Or would you continue to pull on the levers of the five pillars and continue to monitor? Thanks for all that you do!
Lowering ASCVD risk starting in 20s
In one of the episodes, you mentioned a thought experiment that if you were to lower someone's APOb to 5th percentile in their 20s and keep it there for all of their life, the chance of them developing ASCVD would be close to zero. I am wondering if you were dealing with a patient in your practice who is in mid 20s who has a family history of ASCVD, type 2 diabetes, and also has 1 variant of EPOE4 gene, would you try to lower their APOb with lipid lowering medications in their 20s or wait until 30s? If you started in 20s, which tactics would you use to minimize their risk (e.g. statins, PCSK9, ...)?
If Peter were 25 again with current knowledge
Dear Peter, if you could rewind your life to when you were 25, knowing everything you know, how would you design your life to maximize longevity? In other words, if you were to design a perfect life regimen starting in 20s (pharmaceuticals, screening, exercise, supplements, fasting), what would it be, and how would it change going into 30s, 40s, 50s. If you could please focus on which pharmaceuticals and supplements would you start taking at each decade, what would the strength / zone 2 / VO2 max training split look like through each decade, etc.
Addressing inflammation and endothelial dysfunction
Can you describe in more detail your strategies for addressing elevated uric acid and homocysteine levels? Is this secondary to bringing apoB to a desirable level or of equal/similar importance? Do you find hs-CRP, Lp-PLA2, and oxidized LDL useful? If so, how do you address them?