ApoB Levels and Heart Disease: What You Need to Know | Daniel Soffer | The Proof Podcast EP

[@jayjam9106]

I would like to thank the host and guest for this wonderful informative podcast. It's such a privilege to listen to a real expert who's generous in sharing his knowledge and thinking. Thank you both so much. ,🙏

[@TheProofWithSimonHill]

Our pleasure!

[@mfkleven]

I love the humility of a true expert like Dr. Soffer. Haven't finished yet, but one point: When listing the organs beyond the heart that are affected by hyperlipidemia, I waited with bated breath to hear him mention the brain. The most recent Lancet report makes a convincing case that prevention of dementia might be one more compelling reason to treat apo B elevation, at least in middle age. This recent insight expands the role and importance of his specialty--something to keep in mind when counseling patients on whether or not to treat.

[@TheProofWithSimonHill]

Yep! Did you listen to my eps on dementia recently? We covered this report and also why elevated ApoB is a risk factor for dementia

[@mfkleven]

@@TheProofWithSimonHillNot sure what an eps is, lol, but regardless, I don’t think I heard that. I’m definitely going to search for it, though.

[@pennyt820]

@@mfkleven episode?

[@FrancesFoody]

The Proof always delivers! One of the best podcasts out there

[@TheProofWithSimonHill]

Glad you enjoyed it!

[@iv556]

I like how Simon knows to ask nuanced questions

[@TheProofWithSimonHill]

The next question is often hidden in the guests current response.

[@plants_and_wellness1574]

Pretty much the only podcast I listen to now days 😊 love all the episodes you’ve done, Simon! Keep em coming 🎉

[@TheProofWithSimonHill]

Thank you! Will do!

[@AliceR27]

The little I've seen on PCSK9 inhibitors as far as personal experience with side effects have been horrendously bad side effects, unlike statins, which is why I don't want to consider it. My numbers aren't really high, but are high.

[@markgarcia5845]

Simon, I'm loving this discussion, but however it's been edited is causing youtube to show a commercial every 4 to 5 minutes. At the 14:15 minute point I'd already seen 4 or 5 commercials. I'm now at 18:15 and just got another one. This hasn't happened for me on your other videos. You might want to check to make sure it's not something your editing is triggering them. It only happens on a few channels I watch. This is the first time I've seen it on yours.

[@TheProofWithSimonHill]

Thanks for the heads-up! My team fixed the ad settings-should be smoother now. Enjoy the video!

[@kathryn5742]

Great interview, Simon! Was hoping you would have told us or been asked about your father’s lifestyle before his heart attack and what changes he made after, in addition to drug therapy.

[@sherrygaley4675]

I agreed to go on a low dose statin based on an APOB that was higher than desirable for my age -67. The therapy has lowered my LDL and APOB to much better levels. I’ve noticed a bump up in my A1C though to pre-diabetic levels and I had been working to keep my glucose levels down for the last five years. Can you do a show about this Simon? I’m actually more concerned about being diabetic than having higher lipids as I have pretty low risk of ASCVD to begin with.

[@CaroleMillington]

Diabetes is a leading risk factor for atherosclerosis - much more than lipids

[@mowthpeece1]

Statins cause T2D in many people.

[@heidizee5144]

I’d love to see this issue addressed, too.

[@Cass-gi4kk]

What was your ApoB?

[@sherrygaley4675]

@ 110

[@sladflob]

Just finished listening over the course of a few days. Really interesting. Over the past 18 months or so I've gotten my LDL down to 89 by dietary changes alone, and my ApoB is at 74. I'd love to know whether this constitutes concordance or not, and what can be gleaned from that. I wish we had a Dr Soffer engine that we could plug our numbers into and get a recommendation!

[@TheProofWithSimonHill]

Glad you enjoyed it! Dr Soffer and I will do a round 2 and are working on a few other things

[@Kwirax]

This was incredibly insightful. Thank you. One question though: what about ApoB vs LDL-C discordance where LDL-C is elevated but ApoB is significantly lower, i.e. in normal range? Can anyone point me to literature on this case of discordance please? Thanks!

[@DCGreenZone]

We analyzed the inflammation and changes in the aorta by H&E staining. SOD, MDA, and GPx levels were determined as per the instructions of the kit protocols. ELISA was used to measure the levels of interleukins, whereas immunohistochemistry was carried out for the evaluation of MCP-1 expression. SRP treatment significantly suppressed vascular inflammation in BALB/c mice. Mechanistic studies demonstrated that SRP significantly inhibited the LPS-induced production of proinflammatory cytokines such as IL-2, IL-1, IL-6, and TNF-α in aortic tissue. Furthermore, it also inhibited LPS-induced oxidative stress in the aortas of mice, whereas the expression and activity of monocyte chemoattractant protein-1 (MCP-1) decreased after SRP treatment. In conclusion, SRP has the ability to reduce LPS-induced vascular inflammation and damage by modulating MCP-1.

[@davidbarnes774]

In view of the potential for bleeding issues in Older patients on aspirin. It would seem beneficial to have a test available which would provide the platelet "stickyness" status both for baseline status and after taking aspirin. A "good" baseline result might indicate that aspirin is not needed. Does such a test exist (I can't find one)? Perhaps a good question to put to your relevant guests?

[@KiwiBee21]

Corneal arcus can indicate a variety of different health concerns, including high blood pressure, high cholesterol, and atherosclerosis. If eyes are external protrusions of the brain & cholesterol can’t cross the BBB is the arcus lipid derived from brain cells that synthesise their own cholesterol? Not a scientist but very curious now.

[@xenotbbbeats7209]

LDL is something our body needs. Its the bandaid that patches up damage to the inside walls of vessels. Without it, your cells could not maintain its membranes. Your brain is made up of it. Stop eating sugar and carbs which cause inflamation and weakens the walls of your vessels and keeps you from developing HBP which furtger does damage. Then you won't fill the vessrls with "bandaids" and clog them. People with high LDL live the longest. Super athletes tend to have high LDL. If you don’t eat processed garbage, you don't need to know any of this.

[@DrTomMD]

This was an excellent guest and a great interview. Kudos! I’m still not sure that apoB shouldn’t be included in metabolic heath. Metabolic syndrome’s definition doesn’t include apoB or non-HDL or LDL. But metabolic syndrome is a concept directed to insulin resistance. It doesn’t mean that metabolic as a term has necessarily been hijacked from including apoB containing particles. It’s a problematic and potentially dangerous public health message trend to normalize LMHR as metabolically healthy without yet the definitive proof that their markedly elevated apoB is truly muted as a risk. Just my opinion FWIW.

[@KelVarnsen-j9k]

Thanks for posting, I look forward to watching this later. I'm particularly wondering what ideal levels of Apo B are as I recently got mine tested

[@TheProofWithSimonHill]

Hope you enjoy it!

[@amueller585]

42:10 I love your guest went directly into FH instead of taking your bait to discredit the LMHR.

[@TheProofWithSimonHill]

Where you see it as bait to discredit something I see it as challenging a hypothesis. If you want to present a new model you have to be open to having it challenged. That’s science. Simply accepting new models isn’t science … frankly, it’s foolish.

[@amueller585]

@ agreed! But com’on it was bait. You wanted to lead him towards an LMHR dogpile but he refused to rise.

[@georgecav]

Actually, I haven’t yet seen that segment but it sounds like avoiding an inconvenient challenging hypothesis and avoiding it is unimpressive when there is a chance and need to offer an alternative view to the lmhr proponents

[@BillyBoy66]

Simon, I am typically very critical of your stance on diet (I'm keto) and your views on cholesterol in general but I will say this is a very good interview. IMO, Dr. Soffer is more palatable then Dr. Dayspring in his presentation of this material. And the part he mentions about "pleotropic" effects of statins is a good point. For example, I think many lipidologists/cardiologists are finding out that the benefits of statin therapy also include reduction of inflammation, which IMO is more important than the reduction of LDL-C. But perhaps both are equally important. Who really knows for sure???

[@woofinu]

Great and helpful discussion. I have re-listened to it several times but could not decide on one point: Is LDL a "superset" of ApoB, or is ApoB a superset of LDL? In discordant cases, does LDL catch more or does ApoB catch more?

[@TheProofWithSimonHill]

@@woofinu ApoB is superior when there’s discordance. It totals all atherogenic particles - LDL + IDL + VLDL’s.

[@woofinu]

@@TheProofWithSimonHill Thank you for the quick response. I understand now.

[@KiwiBee21]

In the context of poly autoimmunity disorders, are there studies investigating if LDL-C is affected by chronic systemic inflammatory responses that provide an environment for the oxidation of ldl that may be synthesised in the cells to address the need for increased quantities of cholesterol to make steroids to cope with the chronic inflammation?

[@pennyt820]

thank YOU Simon from one who inherited this gene. trying to keep it as a "match stick" and not throw gasoline on the logs!

[@TheProofWithSimonHill]

Glad to help

[@gregmeissner9960]

I love this kind of detailed consideration of a topic. By the way Simon, you look better without the baseball cap (personal opinion).

[@TheProofWithSimonHill]

Thanks

[@davidbarnes774]

Advanced Imaging Techniques for Risk Assessment (01:25:50)??? . there is no mention of imaging here only talks about blood tests?

[@MarkusSchulz-b2g]

Simon Hill PLEASE DEBATE Dr. Eric Westman!!! You will get a million views!

[@TheProofWithSimonHill]

Honestly have never heard of him! Will look him up

[@ad3781]

thoughts on a polyunsaturated fat keto diet?

[@TheProofWithSimonHill]

Better than high sat fat! Look up the eco atkins diet

[@triluve]

Summary, anyone?

[@Seanonyoutube]

@@triluve be healthy, good luck

[@TheProofWithSimonHill]

My team is pulling out the key clips, so keep an eye out for those, or follow us to catch them as soon as they’re up!

[@Aaron-kw7mh]

I was surprised to see Mark Bell (who's channel you've been on) have a different position in this video. As the episodes you featured in, it seemed he agreed with the ApoB position. kzbin.info/www/bejne/bWarhJppjZqfm6s Thanks as always for the content, always A+ quality.

[@TheProofWithSimonHill]

He’s entitled to His own view but I’m going to go with clinical consensus and advice from career lipid specialists like Dr Soffer and Dr Dayspring.

[@jddj9269]

I do apologise but 3 hours is a bit too much for me personally so I didn’t listen at all. Any chance for short version with important information?

[@TheProofWithSimonHill]

My team is working on pulling out some shorter clips with the key highlights, so keep an eye out for those! But if you get a chance, the full episode has some real gems in it.

[@ad3781]

simon puts in time stamps. very helpful. utilize those.