Dr. Boz [Annette Bosworth, MD] - The Biggest Risk For Heart Disease

don't check LDL cholesterol when you eat high fat in the absence of carbs your body circulates fat more this increasing circulation of fat decreases the amount of insulin and that excess inflammatory goo that inflammation that causes heart disease but eating high fat low carb means your cholesterol will be elevated isn't that supposed to increase your risk of heart disease well the answer is complicated and takes this explanation I use the formation of a pimple to explain to patients what happens when a heart attack occurs that pimple that white gooey Center and its explosive moment is the moment that happens for a heart attack so what makes a pimple yeah that recipe does include fat let's look at the other nine ingredients that do predict heart disease that predict the formation of these pimples that take people's lives far too early I created this chart in hopes to simplify something that is complicated we are looking at what is the risk of heart disease when these labs are abnormal to help make this a little simpler we're going to use my numbers for these risk factors at the age of 52 and compare them to a patient of mine who's about a decade older 65 and has had a heart attack my patient and I are also from different age groups which is associated with a different risk of heart disease at Baseline so first let's look at uric acid you may find it strange that I'm looking at that to try and predict heart disease but it does increase the risk Uric Acid found in a blood test so found in circulation is the presence of a waste product that's trying to get out of your body if there's an excessive amount of that waste product you can find it inside your joints or other places in the body you might associate the word uric acid with gout and indeed those higher amounts of uric acid are a direct Association to increase risk of heart disease you may also have heard that uric acid is associated with an increased consumption of meat or purines I would argue that the biggest predictor of uric acid is your consumption of sugar yes as you look at table sugar and you divide the two components of glucose and fructose well glucose is that molecule found in circulation where if I prick your finger and check your blood sugar I'm looking at glucose fructose we used to tell you was healthy because we couldn't see it increasing your blood sugar but indeed it was in increasing your uric acid and that was a dramatic risk in your risk of heart disease as we go through these numbers I think the simplest message shows in this column and this column at my age if my uric acid were abnormal how many people would have heart disease and in my case it was 1 in 23 whereas my patient a decade older it was one in almost six patients both of our Uric acids are normal when we find uric acid elevated we can lower that risk by yeah less sugar less beer and we can also prescribe a medication like alopurinol this next ingredient is something you can't change it's a genetic risk called LP littlea and either it's normal less than 75 or it's elevated you only need this checked once in a lifetime and in both my patient and I we had normal results the next Lab is something I've lectured a lot about hemoglobin A1c and I think you'll find this very interesting on how it relates to the biggest predictor of heart disease hemoglobin A1c measures the average blood sugar over the past 3 months and we're using your red blood cells to look at that as we look at your red blood cells we can see which ones have a sticky or a glycated hemoglobin found inside the red blood cells the higher the number the higher the average blood sugar for as much as I've lectured on this you would expect this to be at the top of the list but it is not you'll see again both my patient and I had normal hemoglobin a1c's this is a great teaching point my patient and I have almost the same hemoglobin A1c that I have an a lower age and I've never had a heart attack and she is about a decade older and has had a heart attack in my age group if the hemoglobin A1c is abnormal it takes my risk of heart disease from 3% to about 38% that's one in 20 when you look at my patient who's a decade older her risk is a 24% increase but because the Baseline for heart disease is already at 14% that's about one in five and a half people hang in there this makes more sense in the next few labs this study points out that LDL is an increased risk factor for heart disease and both my patient and I have an elevated number according to their chart I don't think this is the best way to predict heart disease so let's move to the next number which is body mass index I had a normal bmmi so I didn't increase my risk but the patient had an elevated one my patient had an elevated BMI at 33 this increased her Risk by 33% that's right it's an adjusted Hazard ratio of 1.33 which means she now has a one in five chance of a heart attack I get a lot of you writing in saying BMI has issues yes it's not perfect but it is still a very good predictor of heart disease especially as you age that non-hdl fits in the same category as the last one and we are skipping to one of my favorite Labs highly sensitive C-reactive protein this is a measurement of inflammation and we are measuring it in the right spot we are looking at what is the inflammation of the skin lining on the inside of your blood vessels this is right where those pimples pop and we can see it coming from a mile away when that c reactive protein is normal or less than one it does not increase your risk of heart disease but as as that C-reactive protein Rises and stays there for a long period of time the risk of heart disease grows over time now you'll notice if my lab was abnormal it would increase my risk of heart disease to one in almost 16 people but because my patient has aged her risk shoots up very quickly and to one in four the next ingredient is as close as we're going to get to checking your cholesterol this is a lipo protein called apob apob is the measurement of lipoproteins in circulation at the time of your fasted cholesterol test so think of this as the goblets of fat or oil that are in circulation at this time and it's as close as I'm going to get to checking cholesterol it's the next test that I put a lot of weight on and this is your fasting triglycerides you might think that these strings of fat would measure your fat intake but triglycerides are strictly linked to your consumption of carbohydrates early in the pimple making process if the insulin is low those triglycerides come into the circulation and they are gone long before your fasting cholesterol is checked but when triglycerides are elevated 12 hours after the last time you've eaten it shows me that your liver first filled with glucose then filled with glycogen and over time has started to fill with fat and triglycerides so if your insulin is high and your liver is already filled with the stored triglycerides you keep them in circulation which is how I can measure them in this lab so check this out at 52 my triglycerides were 88 so I did not have an increased risk of heart disease but our patient had triglycerides that were elevated not once not twice but for the past decade and that has increased her risk to 1 in 43 now the point is kind of mute with this patient because she's already had the heart attack but it was the years of triglycerides that increased that risk along with several others on this list but the last two ingredients are even juicier for making heart attack pimples yeah number two on the list is easy to measure it is your blood pressure you can measure this at home and the numbers should be in the one teens over the 70s and I had normal blood pressure but this patient has had elevated blood pressure for over a decade and was on several medications in hopes to pull it down the best we were able to do is to keep her blood pressure in the 130 range and the bottom number in the 80s so let's do the numbers one more time if I develop high blood pressure at the age of 52 it has an adjusted Hazard ratio of 2.2 which is 124% increase in my risk for heart disease so because the Baseline risk for heart disease in my age group is about 3.6% that will change the risk to one in 12 people my age when their blood pressure is high but check out how this impact acts my patient when her age is in this age group The Baseline heart disease at 14.3% has an increased risk of heart disease by 48% that takes it to about one in five people will have heart disease at her age when their blood pressure is elevated but wait for it that's not the best predictor looking back at all these risk factors what do they all have in common what happens when you can't get rid of waste or if you have a genetic component but what happens when the average blood sugars are elevated or that body mass has grown or that the inflammatory markers on the inside of that blood vessel can't seem to just return to normal that you have a high number of triglycerides in circulation and that the top number of your blood pressure just will not get under 120 what we're looking at is this impact on insulin resistance there is a blood test that measures that it's called lpir it's found as part of a nuclear magnetic resonance process looking at the lipoproteins in Circ culation in other words it's the best way to look at what's happening with the delivery of those fats in circulation yes on a ketogenic diet you will increase the amount of fats in circulation that's not the question the question is how long does it take you to get from the moment you make those fats to their delivery and then recycle The Little Ships that they're being transported in this process is measured by something called lpir and look at what it predicts at my age I had an lpir that was less than 25 this did not put me at increased risk but had it done that it was a 540 per increase yeah a hazard ratio of 6.4 which would have taken my risk to one in four said another way if insulin resistance is pathologic throughout these other markers you will have a predictor of heart disease the part that shocks me is to look at the difference of risk in hemoglobin A1c yeah your average blood sugar and compare that to this lpir lpir is as insulin is rising what is it doing to these particles in your circulation and that happens early in the process unlike what happens with hemoglobin A1c the average blood sugars stay controlled for years for decades but the amount of insulin it takes to control that is often a mystery to me and to you lpir exposes is that and again look at our patient as her lpir hung out in the 50 range above the abnormal range it was a huge predictor of her heart disease one in three patients like her will have heart disease and this is fixable this patient's heart attack is in the past and we are trying to prevent the next one by lowering these numbers and as we do that we'll use the tool of omad one meal a day and that has rules as well you need to watch this video before before trying that so you don't make the mistakes that patient made I'll see you then