What Causes Heart Disease? | The Peter Attia Drive Podcast (Ep 203, AMA 34)

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In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of atherosclerotic cardiovascular disease (ASCVD)—the number one killer in the developed world. Peter argues for the importance of paying attention to and understanding ASCVD given its ubiquity and inevitability. He goes into great detail about the development of atherosclerosis and how it can take hold at a very early age, the role of cholesterol, and the causal factors of ASCVD that determine prevention strategies. Additionally, he discusses the important metrics and biomarkers found in blood work, as well as diagnostic tests such as coronary artery calcium scores (CAC) and CT angiograms which help to determine the level of arterial damage present. Finally, Peter lays out the keys to understanding and interpreting calcium scores before wrapping up the conversation with his key takeaways regarding prevention.

In this sneak peek, we discuss:
00:00 - Intro
00:10 - The importance of understanding atherosclerosis early in life
07:52 - Defining atherosclerotic cardiovascular disease (ASCVD), its causes, and the role of cholesterol

In the full episode, we also discuss:
-The process of developing ASCVD, part 1
-The process of developing ASCVD, part 2
-The process of developing ASCVD, part 3
-How early in life ASCVD can start to develop
-Case studies of atherosclerosis and figures showing real pathology
-Coronary artery lesions present in autopsies of different age groups
-The causal factors of ASCVD that determine prevention strategies
-Labs to identify biomarkers of ASCVD
-Diagnostic tests to determine the level of arterial damage present—CAC, CTA, CIMT, and more
-Calcium scores: keys to understanding and interpreting a CAC score and/or CTA results
-Is there a risk from cholesterol levels being too low?
-Key takeaways regarding prevention
-More.

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About:

The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 40 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more.

Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life).

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[JDsMotivationHealthChannel]

“Health is a state of complete mental, social and physical well-being, not merely the absence of disease or infirmity.”

[Ace_Hunter_lives]

Of all the AMA's Peter has done this one REALLY should be made public. I have heart disease and this AMA explained it better to me than ANYTHING else I have ever seen. I am a paid subscriber and have watched it at least a dozen times and more-or-less used it to explain heart disease to people who do not really understand what ASCVD actually is. I've even given out my login info to family in order for them to understand exactly what it is I have. I'm sure Peter is doing quite well financially. It wouldn't hurt to release this AMA as a public service and make it free for everyone. I honesty think it could save lives.

[sharon]

I am 55 now. 14 years ago I went to see an interventional women's cardiologist due to family history of heart disease on my father's side. Lipid panel always good - 174 total cholesterol. Risk ratio low. Don't drink, smoke, and exercised since teens. 3 months ago I insisted on a calcium score. These tests have been around since the 90's. I scored 706. 99th percentile - only one percent of the population had a worse score thsn mine for my age and sex. I wish, and I hope doctors and professionals reading this include calcium scoring as part of the total heart health picture. In my case I clearly lost 14 years of intervention because my bloodwork was excellent and I was female and told i had nothing to worry about. Genetics can not be underestimated in heart disease folks.

[TheJwebb]

I was hoping to hear some further insight relating to metabolic syndrome, insulin resistance, and a carbohydrate excess diet. How are these things related to ASCVD?

[vrb]

I wanted to ask. I recently had stomach inflammation and it went on for like a month and half, I got a blood test and it showed I have high Lp(a) around 55 mg/dL, but I had it tested when I was on meds and I was feeling very sick. Could that possibly have an effect on Lp(a) reading?

[Marta_is_here]

I am 59 now, at 50 I was diagnosed with FH. I had a CAC test and my score was almost 800.
I had never been overweight, always into health and fitness, so needless to say I was shocked and deeply saddened. I had always lived my life to live to be 104!! I’m hoping I still make it.
I had a baby at 40, my son is 18 now and was diagnosed with FH 2 years ago. He also has high triglycerides that I never had.
We are both on statins, and I feel horrible about him being on them.
He also takes health and fitness seriously, is an accomplished athlete and enjoys real food.
I’m praying that there will be more understanding and treatments for our issues very soon.
I always pay attention to Dr. Attia since he is one of the only public persona doctors that speaks to cholesterol, FH and heart disease.
Thank you

[arnoldfrackenmeyer]

What causes heart disease is a subject that has fascinated me for the last 24 years. The heart disease maps and 100 year timeline were valuable study tools. I have lived in the two States with the lowest death rates, and now living in a State with high death rates. What a contrast in lifestyle and environment.

[MissaLifeStyle]

My cousin had an aorta dissection at 37 with no previous heart issues and was a swimmer as a teenager. He found out after genetic testing that he had Loeys-Dietz syndrome (LDS).

[treysullivan]

What is your take on Dr Nathan Bryan's work in regards to nitric oxide, keeping cholesterol above 200 and no use of statins?

[Youtubedisco]

My cousin was 57 y/o when he had a fatal heart attack. Looked like the picture of health; had just played tennis with his daughter.

[Rickdiculousme]

I wish I could pay a lower subscription fee ($50-$60 Canadian per year) and just choose X amount of podcast episodes each month I could listen to. I want to support, but don't need the high detail on all the topics

[oikwongfong]

What I don’t understand is what is the evidence that high blood pressure has directly lead to Death ? Also why are the Blood pressure numbers the same for everyone irrespective of age, sex, body type, health etc.

[DMS]

At 47 yo I was 100, 99, 98 and 95% blocked in my coronary arteries with NO symptoms until “one day.” I felt absolutely fine, watched my diet and could exercise normally. Less than a year before, I beat my wife and young daughter out of Carlsbad caverns, a very strenuous hike that lasted a couple of hours.

I had a quad bypass.

Four different doctors told me the first thing that should have brought me to the hospital was an ambulance carrying my dead body.

NO symptoms until the day I had them. None.

Chest pressure that felt like anxiety. A deep, sternum stretching inhale would relieve it. That was my only symptom until my left ankle swelled up. Ischemic cardiomyopathy. It Fooked my heart. My EF is 20%. I feel great but I’m skating near the edge.

[cypriano]

have Alan Flanagan one to discuss the diet/heart hypothesis and the role of LDL in the developement of heart disease.

[jetjaguar]

So if a person doesnt live in ur area, do u an “angies list” for us to find a dr like the two of u based on where we live?

[alidaggar]

Is air conditiond (cooled) room is good for heart attack patient? Just curious

[donaldberry]

Give a heads up if you’re just gonna tell us what we already know and then cut it off before we get to the good stuff.

[btudrus]

The same bullshit again and again.

Atherosclerosis is IN FACT caused by 2 things: 1) endothelian injury (e.g. through sugar intake or smoking), 2) which prevents the healing processes from being sucessfull and actually leading to more damage and at the end causing either a MI or a stroke...

Lipids and hypertension are actually a minor issue, and BOTH are actually a downstream effect of intake.

And yes, atherosclerosis PER SE is not inevitably progressive, there have been some very good mouse-model studies which show that after transplanting an aorta from an "atherogenic" mouse into a healthy one will REVERSE the atherosclerosis in about a week...

The best way to protect itself from atherosclerosis is to stop eating sugar completely and be sure that you are insulin-sensitive and your insulin is low most of the time...

[douglasbooth]

Not always able to understand it. My father, a soldier from the age of 15, never smoked or drank. Triple heart bypass at 44. Myself quadruple heart bypass at 48. Never smoked or drank. Have excercised all my life. Physical job also. My 2 other brothers have had stents. They are older and smoked. My father is now 80’anx still alive. I’m only 53 and cycle 10 hours a week. My resting heart rate is 47 and my max which I hit weekly is 182. We are now in a genetic test to see why we got hit with hit. It’s not diet or excercised or weight caused with us anyway.

[kurrjur]

I really wish I had found Dr. Attia years ago. I may have avoided a coronary event. I thought that since I wasn't overweight, ate healthy, and had healthy blood pressure that I was fine.