407 ‒ Preventing cardiovascular and Alzheimer’s disease: lowering LDL early, APOE4, and more
Peter Attia and Michael Davidson discuss why lowering LDL early in life prevents cardiovascular disease, and how a new drug class called CETP inhibitors may also protect against Alzheimer's.
The gist
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Attia and Davidson argue that starting LDL treatment in your 30s or 40s prevents plaque before it forms, rather than trying to reverse it later.
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The 8-gram rule says 200 mg/dL of LDL over 40 years equals enough lifetime exposure to drive heart disease, justifying early treatment.
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Davidson says statins deliver most of their benefit at around half the maximum dose, so high-dose regimens offer poor value on a risk-benefit basis.
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CETP inhibitors like obeticholic acid may reduce Alzheimer's risk for APOE4 carriers, who make up about 25% of the population and face up to 10 times baseline risk.
"I then went on to start medical school. I took niacin in med school. As soon as statins became available, I started taking a statin. My brother did not take statins until much later, and at age 44 has bypass surgery and very significant coronary disease. So I think that's a pr..."
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"I then went on to start medical school. I took niacin in med school. As soon as statins became available, I started taking a statin. My brother did not take statins until much l..."
"Zetimibe, which is now a well-known drug — we use it all the time for lowering LDL. We believe obicetrapib then becomes the go-to drug after statins, and then the combo pill wit..."
"If you're an APOE4, knowing you have it you can obviously do better lifestyle, exercise. I think taking some DHA, even though you may not get enough into the brain, is still wor..."
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