Dr. Boz [Annette Bosworth, MD] - How to predict a heart attack with 94% accuracy

This might be the most important case I've ever shared. It's a story of a 68-year-old man named Doug. And for 14 years, Doug was the perfect patient. He saw the best cardiologist. He was on the best medications, including the best statins. His LDL cholesterol, or as his doctors called it, the bad cholesterol, was as low as seven. Yes, seven. For reference, Doug's crack team of medical experts were happy as long as that number was under 100.

But while his cholesterol numbers looked perfect, a different, more dangerous process was happening inside his arteries. Doug was on the path to a major cardiac event. Despite having the best, lowest cholesterol numbers I've ever seen, his coronary artery calcium score, a direct measurement of the plaque buildup in his heart, grew from 603 to over 2,000 during the same period of time, putting him at severe risk for a heart attack. How is that possible? How can you have a perfect cholesterol but still be actively calcifying your arteries? His doctors were focused on the wrong metric.

There was another number, one that wasn't being tracked as closely, that was driving his heart disease along, his morning blood sugar. Instead of a perfect blood sugar in the morning, which would be around 70 or 80, Doug had triple-digit fasting blood sugars, which is a screaming red flag for high insulin. That high morning blood sugar told me his insulin had been high for a while. So high blood sugars with high insulin means his liver was packed full of fat. This high insulin state was preventing his body from properly recycling those little balls of fat called lipoprotein particles and letting them hang out in his circulation for way too long. Instead of shuffling those through the liver and recycling them, those lipoproteins set up their home in his blood. His long residency time for these particles allowed the damage to really hurt him. Said another way, he had very low particles of cholesterol. Remember, his LDL cholesterol was seven. But these particles circulated in his blood for days. That week-long residency time allowed them to become damaged, oxidized, and stick to his artery wall. All while his labs looked perfect. The fix wasn't about lowering his cholesterol even further. How could you? It was about lowering his insulin.

Doug's case is the perfect example of a new and critical understanding in heart disease. Insulin resistance is a much stronger risk factor for cardiovascular disease than LDL cholesterol. Your doctor can't see this by just looking at your hemoglobin A1C. Your hemoglobin A1C is a measure of the long-term blood sugars, but you can have a normal blood sugar and still have a dangerously high insulin. This is the stage where the damage starts.

So, how do we measure insulin resistance? We use a test called the LPIR score, lipoprotein insulin resistance score, which you can get from an advanced blood test called an NMR. This score directly measures the lipoprotein abnormalities caused by insulin resistance. It gives you a score from zero, which is most insulin sensitive, that's good, to 100, which is the most insulin resistant. That's not good.

This isn't just a theory. A major 2021 study by the Mayo Clinic and Harvard looked at over 28,000 women over 21 years, and they compared dozens of risk factors. Here's what they found. For premature cardiovascular disease, which means before the age of 55, the hazard ratio for an LDL cholesterol was 1.38. That means you're 38% more likely to get heart disease for every bump up on your LDL cholesterol. But the hazard ratio for an LPIR score was 6.4. This means you are 540% more likely to get heart disease for every bump up on your LPIR score. This is massive. They're not even in the same ballpark. Your LPIR score is a vastly more powerful predictor of your future heart disease than an LDL cholesterol number. This is the number I look at when I'm trying to predict who's going to die of a heart attack. But most doctors will rarely order the lab.

Let's look at Doug's actual lab reports. His advanced NMR tests showed many small, dense particles of fat hanging out in his blood for far too long. This is a bright red flag of terrible insulin resistance. His perfect LDL number was a complete illusion. His metabolism had been broken for years.

So, what happened when we finally started focusing on the right metric? Doug's wife dragged him kicking and screaming into my class. We didn't focus on his cholesterol. We focused on one thing, getting his morning blood sugars out of the triple digits and closer to that 80 first thing in the morning. He learned to measure his glucose and his ketones. He learned how to fast for long enough time to start to lower the blood sugar and his insulin. Within just a few days of the class, he had a morning glucose of 96. Not perfect, but much better. And his ketones were 1.2. He had proof he was finally lowering his insulin.

The best part, he repeated his advanced labs a few months later and showed a profound change. He had shifted from those dangerous, small, dense particles of fat to ones that were much healthier. They were larger and fluffier. For the first time in decades, he was actually reversing the root cause of his disease and emptying the fat from his liver and his bloodstream, recycling it and using it properly.

If you're just chasing a lower LDL number, you could be missing the fire that's burning right behind it. Your fasting glucose and, more importantly, your LPIR score are the numbers that will actually tell you if you're at risk. So, what can you do instead of a statin? Click here to find out. I'll see you there.