#185 - Allan Sniderman, M.D.: Cardiovascular disease and why we should change the way we assess risk
Nov 29, 2021
Allan Sniderman is a highly
acclaimed Professor of Cardiology and Medicine at McGill University
and a foremost expert in cardiovascular disease (CVD). In this
episode, Allan explains the many risk factors used to predict
atherosclerosis, including triglycerides, cholesterol, and
lipoproteins, and he makes the case for apoB as a superior metric
that is currently being underutilized. Allan expresses his
frustration with the current scientific climate and its emphasis on
consensus and unanimity over encouraging multiple viewpoints, thus
holding back the advancement of metrics like apoB for assessing CVD
risk, treatment, and prevention strategies. Finally, Allan
illuminates his research that led to his 30-year causal model of
risk and explains the potentially life-saving advantages of early
intervention for the prevention of future
disease.
We
discuss:
- Problems with the current 10-year
risk assessment of cardiovascular disease (CVD) and the
implications for prevention [4:30];
- A primer on cholesterol, apoB,
and plasma lipoproteins [16:30];
- Pathophysiology of CVD and the
impact of particle cholesterol concentration vs. number
of particles [23:45];
- Limitations of standard blood
panels [29:00];
- Remnant type III
hyperlipoproteinemia—high cholesterol, low Apo B, high triglyceride
[32:15];
- Using apoB to estimate risk of
CVD [37:30];
- How Mendelian randomization is
bolstering the case for ApoB as the superior metric for risk
prediction [40:45];
- Hypertension and CVD risk
[49:15];
- Factors influencing the decision
to begin preventative intervention for CVD
[58:30];
- Using the coronary artery calcium
(CAC) score as a predictive tool [1:03:15];
- The challenge of motivating
individuals to take early interventions
[1:12:30];
- How medical advancement is
hindered by the lack of critical thinking once a “consensus”
is reached [1:15:15];
- PSK9 inhibitors and familial
hypercholesterolemia: two examples of complex topics with differing
interpretations of the science [1:20:45];
- Defining risk and uncertainty in
the guidelines [1:26:00];
- Making clinical decisions in the
face of uncertainty [1:31:00];
- How the emphasis on consensus and
unanimity has become a crucial weakness for science and medicine
[1:35:45];
- Factors holding back the
advancement of apoB for assessing CVD risk, treatment, and
prevention strategies [1:41:45];
- Advantages of a 30-year risk
assessment and early intervention [1:50:30];
- More.
Show notes page for this episode: https://peterattiamd.com/AllanSniderman
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