Last week, I sat down with Dr Thomas Dayspring to begin a three-part masterclass in atherosclerosis and blood lipids. In Episode #252, Dr Dayspring returns to continue this journey, this time shifting the focus from the causes of cardiovascular disease to more individualised applications. This episode is all about understanding where you lipids are now so you can then work out the best strategy to optimise them.
“Lipidologists are now understanding [what] we have to do: recognise the risk for the fire and get on it with whatever equipment you have to ASAP.”
There is so much noise online about the tests that matter, the ones that don’t, and which biomarkers to look out for. In this episode, Dr Dayspring clearly outlines the three lipid tests that you should take to best assess your risk of atherosclerotic cardiovascular disease – and importantly, the ones you don’t need.
Dr Thomas Dayspring is a Fellow of the American College of Physicians and the National Lipid Association. He is certified in internal medicine and clinical lipidology, and as we saw in last week’s episode, adept at communicating complex information in an accessible way. Make sure you watch or listen to Episode #251 first to get the background you need to better understand this conversation.
“If you have any cardiovascular risk, eating a good, healthy diet is good for your heart in the long run, no matter what it’s doing to any given biomarker.”
In this episode, you’ll learn about the lipid tests that matter and the ones that don’t. Dr Dayspring also explains the importance of early testing, including when to do your first lipid test and how often (if at all) you should retest. We discuss why ApoB is a superior test to LDL-C, whether LDL particle size matters, and if HDL-C is an important test.
We also cover the importance of measuring triglycerides; exactly how to request ApoB and LP(a) tests from your doctor; targeting ApoB levels for low- and high-risk patients; and how to test if someone is a hyper-producer of cholesterol and/or a hyper-absorber.
On top of all this, we walk through a few different avatars that many will find relevant and how Dr Dayspring would advise these people to proceed.
Specifically, we discuss:
- Intro (00:00)
- What is Lp(a), and why you need it checked? (02:05)
- Does diet influence Lp(a)? (20:36)
- The oxidized phospholipid test (29:00)
- Early intervention and atherosclerosis screening for children (31:24)
- The tests helpful in predicting cardiovascular disease risk (40:27)
- Discordance between ApoB and LDL-cholesterol (52:35)
- Normal range of ApoB levels for a healthy young person (1:03:14)
- Does atherosclerotic plaque ever disappear? (1:16:52)
- Triglyceride: HDL ratio vs ApoB test (1:22:15)
- Screening women in their 30s (1:29:31)
- Screening women in their 70s (1:37:23)
- What causes elevated ApoB (1:39:25)
- Do phytosterols help manage cholesterol? (1:58:55)
- Secondary prevention (2:07:08)
- The obviously misunderstood case of ApoB (2:20:45)
- Outro (2:22:35)
As we press forward with the blood lipid series, I hope you are finding value in this deep dive. This series is all about equipping you with the knowledge you need to protect yourself against the prolific disease that is atherosclerotic CVD, and the sooner you can action this knowledge, the fewer cholesterol years you will bank up. Make sure to tune in to next week’s episode, where we will cover the interventions you can make to optimise your lipids.
To assist with the digestibility of this content, Dr Dayspring, my team, and I have included extensive illustrations and graphs to the video format of these episodes. If you are visually inclined, you can watch these episodes on The Proof YouTube channel. Even if you prefer listening through audio the first time, I highly recommend coming back for a second pass with the video versions. These episodes are investments into a healthier future.
Get your copy of the Lipid Series Cheat Sheet at theproof.com/lipidseries. This comprehensive resource provides valuable insights on assessing your risk, preventing, and treating atherosclerotic cardiovascular disease (ASCVD), the leading cause of death worldwide. The PDF not only highlights key learnings from the 3-Part Lipid Series but also includes a 1-week meal plan designed to promote healthy cholesterol levels.
The best way to support the show is to use the products and services offered by our sponsors. To check them out, and enjoy great savings, visit theproof.com/friends.
Enjoy, friends. Simon
More about Thomas Dayspring, PhD
Thomas Dayspring, who resides in the Richmond, VA area is a Fellow of both the American College of Physicians and the National Lipid Association and is certified in internal medicine, and clinical lipidology. After practicing in New Jersey for 37 years, in 2012 he moved to Virginia and served as an educational director for a nonprofit cardiovascular foundation and later as a Chief Academic Advisor for two major CV laboratories until mid-2019. Currently, he is a virtual cardiovascular educational research assistant & clinical lipidologist at a prestigious national practice. Career-wise he has given over 4000 domestic (all 50 states) and international lectures, including over 600 CME programs on atherothrombosis, lipids/lipoproteins (and their treatment), vascular biology, biomarker testing, and women’s cardiovascular issues. He has authored several manuscripts and lipid textbook chapters and performed several podcasts. Until 2019 he was an Associate Editor of the Journal of Clinical Lipidology. He was the recipient of the 2011 National Lipid Association’s Presidents Award for services to clinical lipidology. He has over 25K followers on his educational Twitter feed (@Drlipid). He is a Social Media Ambassador for the European Atherosclerosis Society.
- 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice • PMID: 34458905, which a helpful table detailing ApoB goals and the equivalent non-HDLC or LDLC
- “Cholesterol-Years” for ASCVD Risk Prediction and Treatment • PMID: 32972527
- 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice • PMID: 34458905
- Acute LDL-C reduction post ACS: strike early and strike strong: from evidence to clinical practice. A clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy • PMID: 36574353
- ApoB versus non-HDL-C: what to do when they disagree • PMID: 19664379
- Apolipoprotein B vs Low-Density Lipoprotein Cholesterol and Non-High-Density Lipoprotein Cholesterol as the Primary Measure of Apolipoprotein B Lipoprotein-Related Risk: The Debate Is Over • PMID: 34773457
- Cholesteryl Ester Transfer Protein Inhibitors and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials • PMID: 32172237
- Discordance between apolipoprotein B and low-density lipoprotein particle number is associated with insulin resistance in clinical practice • PMID: 25911082
- Evaluation of low-density lipoprotein particle number distribution in patients with type 2 diabetes mellitus with low-density lipoprotein cholesterol <50 mg/dl and non-high-density lipoprotein cholesterol <80 mg/dl • PMID: 22621796
- Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association • PMID: 34647487
- Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel • PMID: 28444290
- Natural Dietary Phytosterols • PMID: 26086252
- Natural history and risk factors of atherosclerosis in children and youth: the PDAY study • PMID: 11942537
- Non-HDL cholesterol and apoB in dyslipidaemia • PMID: 17868037
- Quantity versus quality of LDL cholesterol in patients with familial hypercholesterolemia–which is more important? • PMID: 11718692
- The lipid-lowering effect of ezetimibe in pure vegetarians • PMID: 16966491
- There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness • PMID: 36124049