This Study Shocks Cardiologists: LDL and ApoB May Not Predict Heart Disease Risk in Healthy People with Dr. Nick Norwitz
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What groundbreaking study is discussed in this episode?
Dr. Nick Norwitz, a pleasure to have you on the podcast. I'm a huge fan of your work. I've been trying to get you on for a little while, so I'm grateful that you're here today. And we have some exciting news for our audience. Today, you're here to talk about a first of its kind, groundbreaking study that will give us massive insights into into a few areas that have all come together. The carnivore diet, the low carb diet, high LDL, ApoB, and whether or not certain risk factors lead to poor cardiovascular health and even increase our risk of heart attack. So let's talk about this study, who you did it with and why it matters.
We had a bunch of other things we were going to talk about. We decided we actually found out this morning our paper got accepted. So we're kind of pivoting. You had a lot of enthusiasm in that opening. I hope I can deliver. But this is truly an exciting moment with this paper getting accepted because it is a first of its kind study. It's been one that my colleagues and I, Dave Feldman and Adrian Sotomayor, have been expending blood, sweat and tears on for a few years. And I really have to give most of the credit to Dave Feldman. This started with him. He's, if you don't know him, an outsider, an engineer who had this provocative question. We'll get into it. Delved into lipidology, became obsessed with it, crowdfunded a clinical trial and executed on it. And we've been working on this area of research. We've had like 10 papers on it over the past couple of years.
But this is really the landmark study because what we did, what the team did was take this group of people that turned lean mass hyper responders, these people who go low carb and see their LDL go through the roof, like sky high levels and followed them over the course of one year with high resolution CT angiography to look not just for calcified plaques, but also non calcified plaque to see does plaque progress in this population that conventional wisdom would say is that super, super high risk their LDL levels are 200, 300, 400, 500. Sometimes it's close to 600. We had one person in this trial with an LDL of 591. So do they have plaque progression like conventional wisdom would predict? And if there is plaque progression at a population level, what actually is the major risk factor? What drives the progression? And I'll just give you the headline. There was no or minimal progression in the majority of people.
On a population level, there was a tiny bit of progression, something called percent atheroma volume increased by 0.8%, which is pretty modest at a population scale. And the really critical thing is in addition to most people having no or minimal progression, you had to ask what predicts progression? Is it this LDL cholesterol that we always hear about or the associated marker ApoB? And the answer was no. Actually, there was no predictive value, no association between ApoB and plaque regression or between LDL and plaque progression. LDL and ApoB did not predict plaque progression. What predicted plaque progression was whether or not somebody had plaque at baselines. So you can get functional tests of your heart.
These are becoming more and more mainstream to help people individualize their risk and their treatment decisions. Something called the coronary artery calcium scan is one. And the CAC score, this functional test looking at the heart, did actually predict progression. So basically, if you had plaque to start with, you were more likely to have that plaque progress. If you didn't have plaque to start with, then you were unlikely to have progression. And LDL and Applebee were pretty much irrelevant in determining or predicting whether or not plaque would progress. which is really astonishing given the levels of LDL in this population. Again, 200, 300, 400, 500 LDL. It's quite remarkable. And I just want to emphasize one more thing, and then I'll get off my monologue. The really interesting thing about this population, lean mass hypersponders, is they are the first and only human population we have ever studied that has high LDL as an isolated variable, a
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Chapters
8 chapters
1
What groundbreaking study is discussed in this episode?
0:00–11:32
2
How does LDL cholesterol relate to heart disease risk?
11:32
3
What are the lifestyle factors contributing to plaque progression?
4:33–5:40
4
How can individuals assess their personal heart disease risk?
5:40–10:54
5
What are the worst diet and lifestyle habits for heart health?
10:54–12:57
6
How do different diets affect gut health?
12:57–19:58
7
What insights does the aspartame study provide?
19:58–1:03:50
8
What role do microplastics play in cardiovascular health?
1:03:50–1:37:04
Speakers
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