Lecture Notes on Cardiovascular Health and APOB Levels

Introduction

• Discussion on managing APOB levels through nutrition and medication.
• Importance of understanding personal risk profile.

Personal Experience and Risk Assessment

• Speaker's Background:
  • Not a physician, but has experience in nutrition science.
  • Personal anecdote of father’s heart attack at 41.
  • Emphasizes that cardiovascular disease can be present even if one feels healthy.

Target APOB Levels

• Risk Profile:
  • Low-risk individuals should aim for 80 mg/dL or lower.
• Feeling Good vs. Reality:
  • Feeling healthy doesn’t guarantee absence of cardiovascular disease.

Combination of Nutrition and Pharmacology

• Dietary Impact: Dr. David Jenkins' Portfolio Diet
  • Rigorous changes can reduce LDL cholesterol by 30%.
  • Diet includes low/no animal protein, high plant protein, phytosterol supplements, nuts, seeds, soy.
  • Comparable to effects of low-dose statin.
• Consideration for Medication:
  • Necessary if dietary changes aren’t enough to reach target levels.
  • Options: PCSK9 inhibitors, Statins, Bempedoic acid.

Case Study: Hyper Responders

• Example of High Cholesterol:
  • Individual eating 10 eggs daily, LDL cholesterol around 200 mg/dL.
• Cholesterol Absorption:
  • Hyper responders absorb more cholesterol due to genetics (e.g., NPC1L1 gene).
  • Options include dietary restrictions or medications like Ezetimibe.

Mechanism of Cholesterol Absorption

• Cholesterol Sources:
  • Dietary cholesterol and reabsorption of liver-produced cholesterol.
• Liver Response:
  • Liver produces less cholesterol when absorption is high, upregulates LDL receptors.
• Impact on APOB Levels:
  • Excessive cholesterol absorption leads to downregulation of LDL receptors, increasing APOB levels.

Conclusion

• Combination of diet and medication is often necessary for managing APOB levels.
• Regular testing and working with healthcare providers is crucial for maintaining cardiovascular health.