Beyond Statins: Advanced Cholesterol Management for Optimal Heart Health

Join David Kashmer from the Evergreen Institute as he delves into advanced cholesterol management and its effects on your heart health. Learn about the significance of genetic factors like LPA, the limitations of standard cholesterol tests, and the importance of LDL particle size and number. Discover how diet, exercise, and various natural supplements and medications can play a role in optimizing cholesterol levels. David also highlights the personalized care offered at the Evergreen Institute to help you achieve longevity and the best life in your years. Schedule a complimentary session to explore more personalized approaches to anti-aging and regenerative medicine.

00:00 Introduction to Cholesterol Management

00:36 Understanding Cholesterol and Genetic Risk Factors

01:53 The Firemen Analogy: Rethinking Cholesterol

05:42 Advanced Lipid Testing and Genetic Insights

08:14 Lifestyle and Dietary Approaches

09:18 Natural Supplements and Non-Statin Medications

12:19 Comprehensive Risk Assessment and Personalized Care

14:23 Conclusion and Next Steps

Please note: This entry does NOT constitute medical advice for you or your family. The featured healthcare provider does NOT know you or your medical history. Please consult your phyisician prior to changing, starting, or stopping any healthcare treatments based on the information in this video and transcript.

Dr. Kashmer: [00:00:00] Hello and welcome. Today we're going to talk all about cholesterol management and how it affects your health. My name is David Kashmer. I'm board certified in anti-aging and regenerative medicine, and here at the Evergreen Institute we try to provide this ongoing education all about things like cholesterol.

We do this to focus on your longevity. We do it to focus on things that increase the healthy number of years you have in your life, it's never too early to start to focus on function now, so that by the time we get older, we get the best life in our years. So welcome to this talk on Beyond Statins, advanced Cholesterol management for your heart health We're going to talk about some hidden genetic risk factors as part of the talk today. Risk factors for things like heart disease. It turns out LPA or lipoprotein A represents one of the most significant breakthroughs in cardiovascular risk assessment, [00:01:00] unlike other cholesterol markers, ones that respond to diet and lifestyle changes.

LPA is determined by your genetics. This makes it unique and often overlooked. Now look, before we even get to the specifics of our talk today, let me let you know a little bit about what we're going to talk about, One of the most common thoughts is that the cholesterol panel we get when we go to our doctor correlates incredibly highly with our risk for heart disease, et cetera. It does, it provides useful information. But here's the twist. It turns out that two of the most important or prognostic labs we can get regarding our cholesterol are not even in the typical cholesterol panel that we get when we go to our doctor's office.

Let me explain in order to understand the rest of this talk. Listen to this analogy and the story and tell me what you think. imagine that there is [00:02:00] a home and it is on fire. It is terrible. My gosh. It's so on fire. And you know what? Luckily all the firemen are there. So many hundreds of 'em are there, and the firemen are all around the house.

Working on it, cleaning it, doing all the stuff, spraying it with water, all the things they do to be heroic and try to save the building. And fortunately, they've already gotten everybody out. Does it make any sense to blame the fire on the firemen? Well, of course not. But a lot of what we think about with cholesterol and how it gives plaque in our arteries and blockages is kind of like blaming the firemen for the fire.

Let me explain. The way it works is in our blood vessels. We can collect cholesterol. Cholesterol comes in all different sized particles, and one of the most important ones is your LDL particles, your low density lipoprotein. [00:03:00] Think of these as the firemen. When there's a problem in the blood vessel, like the inner lining gets disrupted or something like that, the firemen kind of get stuck there.

They're almost attracted there. What I'm getting at is you don't blame the firemen for the fire. So why do we blame cholesterol so routinely for all the problems like plaque, et cetera, that cholesterol makes?

Well, it's kind of backward thinking when you think about it. But let me explain a little more. The type of firemen that really cause problems in this are not just the number of firemen who collect in the area. That's important, but also the really small ones. The small LDL particles are problematic because those get into the little cracks in the blood vessels in the injury.

Now look, again, the story with cholesterol is almost like blaming the firemen. It turns out we have ways to work on and heal the [00:04:00] inner lining of the blood vessel, the endothelium, so that the fire doesn't start and the firemen don't get stuck there. It's not the fireman's fault that they just happen to get stuck or are attracted to the area where there's a little break in the blood vessel.

I want you to keep that analogy in mind today as we go through in our webinar, these different risk factors and things that we influence. For cholesterol. It's kind of like blaming the firemen for the fire in a lot of ways when you think about it. for now, let's just remember that lipoprotein A is an A new test, a newer test.

It's a hidden genetic risk factor, unlike other cholesterol markers that can respond to diet and lifestyle changes, like we said, LPA. It's primarily determined by your genetics. If you have an elevated LPA level, you're two to four times risk. Higher of heart disease can be useful to check, so that's a genetic variant of LDL cholesterol that we think can accelerate this fireman.

This fireman type can accelerate plaque [00:05:00] formation and increase risk of clotting or thrombosis, even independent of other risk factors. Okay. Well, we talked about the firemen and how the smaller ones matter. The smaller, low density lipoproteins matter because those can get into the little cracks in the blood vessel.

It's a problem. the number, how many we have and how small they are, are two of the biggest things that are important. But what is so strange is that these of two of the most important factors for whether we get a heart attack eventually from our cholesterol. They're not on the standard panels that we're trained to look for as physicians, I have to order these separate for you when you are a patient at the Evergreen Institute, we have to look deeper to really understand your cardiovascular risk because advanced lipid testing reveals issues that typical lipid testing doesn't. here they are. One is LDL particle number, [00:06:00] how many of the firemen you have here are some optimal numbers and risk factors.

A particle number, how many firemen is a stronger predictor of cardiovascular events than standard LDL, measurements that you get from other lab tests. Also, LDL particle size. Again, smaller particles, denser particles, put you at risk. Those are the ones that can get into those little cracks in the blood vessel, penetrate those arterial walls and promote plaque formation.

So Maura and colleagues demonstrated that LDL particle number is more strongly associated with cardiovascular disease risk than typical LDL cholesterol numbers. It's amazing that these advanced markers, really not even all that advanced, are not in typical lipid panels or typical cholesterol test. Your Dr.

May do. Here's the genetic blueprint of cholesterol management. There are several genes that play a role. The a OE gene, LPA, [00:07:00] PCSK nine, LDLR, and a OB. Each of these, varies with respect to person to person and really impacts cholesterol management.

It's both nature, your genetics and nurture. What we eat and what we do, we'll talk about certain things as we go along that can really help with cholesterol management, but these are the hands we're dealt when we're born. a p Oe influences how your body metabolizes cholesterol and fats can also correlate with Alzheimer's risk.

LPA gene, it can Identification of individuals who need aggressive lowering strategies, can be super useful. This affects LDL receptor function and clearance and variance influence the response to certain medications for cholesterol that we'll talk about later.

The LDLR gene, this impacts LDL receptor function mutations can cause familial hypercholesterolemia. An A POB gene, influences LDL, particle formation and clearance. The bottom line is genetic [00:08:00] insights, which we also utilize at the Evergreen Institute, can go a long way to knowing the cards that we have to play in the hand, for your health.

It's really important and often overlooked as part of cholesterol management. Lifestyle matters. it is both nature and nurture for cholesterol, as we said. dietary approaches can help that Mediterranean diet with extra virgin olive oil and derivatives can be useful. Reducing saturated and trans fat can be helpful.

Increasing soluble fiber intake and Omega-3 rich foods. A regular aerobic exercise improves LDL. Particle size can make 'em bigger. That's really important. So regular exercise can give you bigger particles. Those bigger particle firemen can't get into those little cracks in the endothelium atypical recommendation, it's about 150 minutes of moderate intensity exercise, weekly weight management. even modest weight loss. Five to 10% of body weight can significantly improve lipid [00:09:00] profiles. Different markers of this meta inflammation or metabolic inflammation that improve include, insulin sensitivity.

You get this reduced total body inflammation and better lipid particle profiles. So weight management. Also key evidence-based support. It turns out that red yeast rice works via the same mechanism, for the most part as statin drugs.

Red yeast rice, has statin like effects. Clinical studies show LDL reductions of 15 to 25% in total. Particle number. it really works the same way via HMG co-enzyme, a reductase, an enzyme, related to, cholesterol. it will give you even the same side effects that statins do for the most part.

It'll give you myalgias, pain in the muscles, et cetera. So red yeast rice, a quote, natural supplement, but it works the same mechanism as statins do. in part to help with the [00:10:00] downside of either statins or red yeast rice, coenzyme Q 10 relieves those painful muscles that you get from either a statin or red yeast rice.

Omega-3 fatty acids. Lower triglycerides can improve LDL particle size. Plant sterols and stanols reduce cholesterol absorption in the intestine. And berberine can also lower LDL cholesterol and triglycerides. It can go on to improve insulin sensitivity. So lots of natural supplements, many of which work on par with statins, and even via the same mechanisms.

Non-statin medications? Well, we have some now. We have, for example, ezetimibe and that blocks cholesterol absorption in the intestines. By inhibiting a certain protein, it can reduce LDL by a lot and has proven cardiovascular benefits when added to a statin. again, the bottom line here is that there are many medications that are not just statins.

Some [00:11:00] patients come to us and don't want to be on statins for some of the different downside risks they've learned about. So these are just some other things that can be used. PCSK nine we talked about earlier. Here's an inhibitor for that. This is an injectable monoclonal antibody that dramatically lowers LDL cholesterol.

Really valuable. If you have a patient who has familial hypercholesterolemia or ones who can't tolerate a statin, there are a couple of these that are available. It reduces cholesterol synthesis upstream of the level where statins work.

It avoids muscle related side effects. And it will also lower LDL on par with how Statin works. So this can also be used in combination, but the bottom line is here we need to work on some markers that often aren't even tracked by regular cholesterol tests. We need to work on your LDL particle size and number, and these are just some of the ways besides a statin that we can get that done.

We talked about LPA and we can [00:12:00] target that also. It turns out that niacin can do that. It can lower LPA by 20 to 30%. there can be some side effects here with flushing and other side effects. We talked about the PCSK nine inhibitors and lipoprotein apheresis, which can lower directly LPA numbers

The Evergreen Institute and I focus on advanced testing and here's some of that comprehensive risk assessment. First is LPA measurement that can be important, but LDL particle size and number super important and we can get that from an advanced cholesterol panel. APO lipoprotein B, it re reflects total atherogenic particle burden.

Which can be important. Inflammatory markers for markers of having an inflamed arterial and vascular system. there are some that are available, although they're nonspecific, that can include C-reactive protein Genetic testing panels we talked about. These can show us some. Interesting [00:13:00] novel targets that we can use to help lower your cholesterol.

And then comprehensive metabolic assessment. This is really key for factors that show us insulin resistance and other cardiovascular risk factors. Here's what the Evergreen Institute does for personalized cardiovascular care. It's actually a lot more than just the cholesterol portion that we've talked about.

Evergreen is focused on helping you embrace timeless wellness, and I'm really privileged to be part of the team that focuses on each patient and what we can do to achieve the best life in their years. One of those things is to optimize cardiac function,

For Atherogenesis and for the plaque formation in the coronary arteries in particular. although this is just the cardiovascular portion of things, there are many other elements to optimized cardiac function that evergreen addresses.

And again, I feel fortunate to be a part of. Those include things like heart rate variability optimization. [00:14:00] Pulse ox wave optimization for pulse wave variability. Lots of different things that show how old our, cardiovascular system is and how at risk it is. And what we try to do at the Evergreen Institute is take those interventions on a personalized way and do things that improve function and time, that we can have for our lives.

So I'm just so happy to be able to do it. I invite you to take the next step, which is to visit the evergreen institute.org.

You may be on there now, which is how you're watching this. There's a purple button if you go ahead and click that you can, schedule your complimentary. Explore the institute session. You'll discover how our innovative, personalized approach to anti-aging and regenerative medicine can help you transform your cardiovascular health and overall wellness.

So find out more, schedule your free, session via the purple button at the top of the website, not this one. That's blue. And we'll go from there and see how we can help you achieve the best [00:15:00] life in your years to embrace timeless wellness. Have a great day. Thanks for listening, and please any questions, just get in touch with us, either via the website or go ahead and call the institute.

We're happy to answer. Thanks.