#247 ‒ Preventing cardiovascular disease: the latest in diagnostic imaging, blood pressure, metabolic health, and more | Ethan Weiss, M.D. | The Peter Attia Drive

Intro

In this episode of “The Peter Attia Drive” podcast, Dr. Peter Attia invites Dr. Ethan Weiss to discuss the latest advancements in diagnostic imaging, blood pressure management, and metabolic health in preventing cardiovascular disease. Dr. Weiss, a previous guest on the show, shares his expertise in preventative cardiology and cardiometabolic disease, aiming to translate the science of longevity into accessible content for all listeners.

Main Takeaways

Diagnostic Imaging and Risk Assessment

• Diagnostic tools like coronary artery calcium (CAC) and computed tomography angiogram (CTA) provide valuable insight into existing and future risk of atherosclerotic cardiovascular disease (ASCVD).
• Calcium scans are a low radiation and inexpensive tool to assess overall risk of dying from cardiovascular and all-cause problems.
• CT angiograms provide more information than calcium scans and can detect both calcified and soft plaque in the artery walls.
• Plaque characteristics are still not well understood, and more research is needed to predict vulnerability and determine appropriate treatment.

Blood Pressure and Kidney Health

• Blood pressure is a crucial factor in cardiovascular disease, and its impact on kidney health should not be overlooked.
• Even slight elevations in blood pressure can negatively impact long-term kidney health.
• Targeting blood pressure levels closer to 120 over 80, rather than the traditional 140 over 90, has shown significant benefits in reducing cardiovascular risk.
• Optimal medical therapy and lifestyle modifications are effective in controlling blood pressure and improving overall health.

Metabolic Health and Risk Factors

• Metabolic ill health is a factor that drives residual risk in ASCVD.
• Genetic factors and body composition play a role in the risk of developing diseases like coronary heart disease and diabetes.
• Improving gluteo femoral storage capacity may reduce the risk of metabolic diseases and improve overall health.
• Recognizing and diagnosing lipodystrophy, a rare genetic disease impacting fat storage, is crucial for identifying individuals at higher risk.

Pharmaceutical Interventions and Treatment Approaches

• Different pharmaceutical agents are available for managing cardiovascular risk factors, and their effectiveness has been studied in trials.
• Statins, despite some controversy, are considered one of the most important interventions in reducing cardiovascular risk.
• Treatment decisions should focus on causative risks rather than waiting for end-stage problems to occur.
• Personalized medicine and targeted therapies based on genetic insights may offer new options for individuals without specific genetic conditions.

Summary

Understanding ASCVD Risk and Diagnostic Imaging

Diagnostic tools like CAC and CTA provide valuable insights into existing and future risk of ASCVD. Calcium scans offer a low radiation and cost-effective way to assess overall cardiovascular risk, while CT angiograms provide more detailed information about plaque characteristics. However, the interpretation of plaque characteristics and their impact on clinical practice remain areas of ongoing research.

The Role of Blood Pressure in Cardiovascular Health

Blood pressure plays a crucial role in cardiovascular health, and even slight elevations can have long-term negative effects on kidney health. Targeting blood pressure levels closer to 120 over 80, rather than the traditional 140 over 90, has shown significant benefits in reducing cardiovascular risk. Optimal medical therapy and lifestyle modifications are effective in controlling blood pressure and improving overall health.

Metabolic Health and Risk Factors

Metabolic ill health is a significant driver of residual risk in ASCVD. Genetic factors and body composition, particularly gluteo femoral storage capacity, play a role in the risk of developing diseases like coronary heart disease and diabetes. Recognizing and diagnosing lipodystrophy, a rare genetic disease impacting fat storage, is crucial for identifying individuals at higher risk and potentially targeting therapies to improve metabolic health.

Pharmaceutical Interventions and Treatment Approaches

Various pharmaceutical agents, including statins, are available for managing cardiovascular risk factors. Despite some controversy, statins are considered one of the most important interventions in reducing cardiovascular risk. Treatment decisions should focus on causative risks rather than waiting for end-stage problems to occur. Personalized medicine and targeted therapies based on genetic insights may offer new options for individuals without specific genetic conditions.

Conclusion

This episode of “The Peter Attia Drive” podcast provides valuable insights into the latest advancements in diagnostic imaging, blood pressure management, and metabolic health in preventing cardiovascular disease. By understanding ASCVD risk factors and utilizing diagnostic tools, individuals can take proactive steps to reduce their risk and improve their overall health. With ongoing research and personalized approaches, the future of cardiovascular disease prevention holds great promise.