The BIGGEST Risk Factor For Heart Attack

what I'm about to tell you might be so shocking so unbelievable that I almost don't want to tell you at the start of this video but I will is that LDL cholesterol the bad cholesterol is not the most important biomarker when assessing metabolic health and in particular assessing the risk of having a heart attack by the end of this video you'll understand exactly why this is the case and also what is the biggest risk factor for heart attacks and the biggest risk factor of dying from a heart attack so let's get to it we all need cholesterol to survive because for one it's an important component of cell membranes but also because it's a precursor to steroid hormones if you don't eat cholesterol your body has to make it now you've probably heard of hdls being the good cholesterol that's high density lipoprotein and LDL as being the bad cholesterol doctors pay attention to both of these but when the LDL is too high they're going to tell you to eat less fat in your diet and also to take a Statin medication let me know in the comments below if this is what your doctor tells you and for many years has been thought of as being the most important biomarker to assessing the risk of having a future heart attack statin's lower LDL levels but do they decrease the risk of heart attack and do they decrease the risk of dying from a heart attack to answer that question we have to look at how this all started in the first place cholesterol and ldlc in particular emerged as a risk factor based on the Framingham heart study a huge observational study in Massachusetts that started decades ago and continues to this day the big takeaway was that if you had a very high ldlc you are more likely to suffer a heart attack but when the data was more carefully analyzed what was realized was that ldlc was only a risk factor if it was very high like over 190. now most people never have an LDL this high and if you do you probably have a genetic condition that's causing that now people with ldlc levels less than 70 on the other hand rarely have heart disease what about the majority of the population who fall between 70 and 90. in this context here ldlc is not a great predictor of having a heart attack while it's true that the hazard ratio of ldlc is 1.3 meaning if you have an elevated ldlc there's an Associated or correlated 30 increased risk of a heart attack correlation does not equal causation when you remove younger people from the analysis and just look at people 60 and older and also remove the people that have genetic reasons for super high LDL levels the LDL levels don't predict heart attacks let's say you get blood work done and your LDL level is 100. okay so you're right here on the scale you're all but guaranteed to get a script for a Statin medication which inhibits cholesterol synthesis the current mindset in the medical establishment is to get the LDL down as low as possible by means of Statin medications and sometimes other drugs and also eating a low-fat diet well despite governmental recommendations to eat low-fat diets and despite statins being the most prescribed medications for the population as a whole ldlc levels overall remain high now some researchers and doctors will argue that fewer people are actually dying of heart attacks in high income countries like the United States and this is true but even though there's less people dying of heart attacks more people are suffering them why because we're better at treating heart attacks because we become faster at recognizing them with faster ambulance response times and we're faster at getting patients that clot Buster medication or getting that patient to the cath lab to get a stent put in we also provide better care after someone has a heart attack so even though the number of deaths from heart attack have gone down the total number number of heart attacks have gone up and as the accelerate trial showed us lowering ldlc does not improve the risk of having a heart attack and here's something that 99 of people don't know including most doctors the standard fasting lipid profile the blood test that looks at your cholesterol numbers assumes that all LDL particles are identical there's actually two types of LDL but that lipid profile test measures them together as one number eighty percent of the LDL cholesterol that circulates in your bloodstream comes in the form of large buoyant LDL also known as type A LDL and this is the one that increases when eating more fat it's also the LDL that decreases when taking a Statin medication the large buoyant LDL is cardiovascularly neutral meaning it's not the LDL particle that causes plaque to accumulate in the arteries which is what leads to a heart attack so I think of this LDL as being nothing more than a big cuddly teddy bear now let's meet the true bad cholesterol and his name is small dense LDL also known as type B LDL this bad boy cholesterol only makes up 20 percent of LDL particles this is the LDL that goes up when people have metabolic syndrome from eating processed food especially refined carbohydrates and sugar this is the LDL that's causing that plaque to build up in the artery leading to a heart attack but if you really want to predict your risk of a heart attack you need to look at this type of LDL now this study in this analysis was particularly striking which can be visualized with these graphs this study showed that the risk of coronary heart disease depends on the small density LDL not the large buoyant LDL levels and the problem with statins is that they're going to lower your total LDL levels because they're mainly reducing the large buoyant ldls and not so much to small dents in fact the Jupiter trial confirmed the heart disease risk associated with small LDL even in patients treated with a Statin and who an average ldlc of 54 which is very low they still had a significant increase in risk for coronary heart disease and death now over time medical guidelines have continuously expanded the recommendation for the number of people that should get a Statin medication the argument goes like this statins are Lifesavers and that people will die if they stop taking them you even have big time researchers from prestigious academic institutions declaring that everyone over 50 should be on a Statin in order to reduce their risk of cardiovascular disease and there's no question they do lower ldlc and if you have a genetic disorder that's causing your LDL to be through the roof they're necessary but outside of that group are they reducing heart attacks no and I'm not even going to get into the potential side effects of these drugs so why are the medical guidelines so adamant about pushing these statins onto the population well for one there's a lot of financial incentive with big Pharma two it wasn't until recently that we now know that it's the small LDL not the total LDL that predicts heart disease risk and three the data from these studies on statins initially looked way more promising than they really they are kind of makes you go hmm for example do you want to guess the increase of median life expectancy in those with heart disease thought to be the best candidates for statins over a five-year period yes you heard that right people who qualified for statins in these trials they took statins and they postponed their deaths a whopping four days now what about other drugs that lower LDL numbers zedia reduces intestinal cholesterol absorption then you have drugs like evolakumab better known as repatha which is a pcsk-9 in a body it works by blocking an enzyme and ends up allowing the liver to clear more LDL from the bloodstream it was found that it reduces the number of heart attacks reduces strokes but so far no mortality benefit so we have medications that reduce LDL but if it's not going to significantly reduce this LDL you can't expect it to have significant health benefits especially when it comes to reducing heart attacks and deaths from heart and this isn't surprising because the root cause of the problem is metabolic illness that stems from insulin resistance which is caused by eating processed food so this can only be fixed or improved by eating unprocessed food and to a certain extent exercise it's these small dense LDL that rises in response to eating refined carbohydrates especially added sugar and when most people cut out the fat they usually are going to replace it with refined carbohydrates and or simple sugars and if you want more evidence that total LDL levels aren't the best biomarker for cardiovascular disease prevention or treatment take a look at the Leon heart study where they looked at people eating a Mediterranean diet for secondary prevention of a heart attack secondary means after you've already had the first heart attack the Mediterranean diet is mostly unprocessed food and it's not considered a low-fat diet the results of this study were much more impressive compared to that of statins and guess what when you get that fasting lipid panel this small dense LDL isn't the only dangerous particle that you have to look at the other one is this guy the triglyceride the more of these guys you have the higher likelihood of metabolic syndrome fatty liver disease and heart attack the largest study of heart attacks in the United States revealed that two-thirds of them had metabolic syndrome in fact when it comes to the risk of heart disease having elevated total LDL levels isn't as bad as having elevated triglyceride levels the hazard ratio for high LDL levels is 1.3 compared to the hazard ratio of high triglyceride levels of 1.8 meaning your risk is 80 percent higher with higher triglycerides compared to LDL when you get blood work done and you have that fasting lipid panel done pay special attention to the triglyceride level to understand why serum triglyceride levels are so important we have to first understand its physiology or its biochemistry once that serum triglyceride unloads its fat at the adipocyte the fat cell it then turns into a small dense LDL therefore that triglyceride to HDL ratio is the real ratio of bad to good cholesterol it's the best biomarker of small dense LDL which is the best biomarker of cardiovascular disease in the best indirect way of determining your degree of insulin resistance and metabolic syndrome if that triglyceride level is higher than 150 it's all but guaranteed that you're dealing with metabolic syndrome so triglycerides the most important thing to look at in the lipid panel but then the second most important biomarker to look at in that lipid panel is the HDL the high density lipoprotein if it's higher than 60 that's great cardiovascular health but if it's less than 40 in men or less than 50 in women that's going to increase the risk of heart disease and one more thing on this triglyceride to HDL ratio for unknown reasons Race Matters with this if the ratio is over two and a half in Caucasians or over one and a half in African Americans that is a correlate of metabolic syndrome and what about that total LDL cholesterol well if it's less than 70 the fraction of small dense LDL ends up being so low that it's highly unlikely to cause harm now if it's over 300 which is super high there's a high probability ability that you have a rare genetic disease like familial hypercholesterolemia in which you can't clear your LDL now in this genetic condition because you can't clear your LDL you need a low-fat diet and likely require a Statin medication and in some instances even this medication here repatha AKA evolocumab so if you're in this range like most people let's say less than 190 but more than 70 well you already know what to do take a look at those triglyceride levels those HDL levels and that triglyceride to HDL ratio and just remember that high triglyceride levels in metabolic syndrome are a direct result of insulin resistance which comes from eating too many refined carbohydrates and simple sugars this is why adults shouldn't consume more than 25 grams of added sugar per day and it's no wonder that treatments that reduce triglyceride levels also reduce the amount of small dense LDL research shows that exercise running in particular at least with this study did exactly that now other researchers showed that diets loaded with simple carbohydrates have a direct correlation with levels of small LDL particles fish oil supplementation which contains omega-3 fatty acids have been shown to reduce triglyceride levels and small LDL as well why while omega-3 fatty acids help to reduce inflammation and inflammation contributes towards plaque formation so small LDL particles inflammation and trans fats all three of these cause that plaque to form and when that plaque ruptures that's what causes the heart attack so if you really want to minimize your risk of having a heart attack it really comes down to what you eat exercise and of course not smoking so besides cutting out or reducing refined carbs and simple sugars you also need to make sure you avoid eating those trans fats which mostly come from fried foods but can also come inadvertently when you overheat meaning you go past the smoking point of certain unsaturated fats when you're cooking them so for example olive oil has a smoking point of about 350 to 375 degrees and if you're cooking at temperatures above that then that monounsaturated fat which has a CIS bond in it that heat will turn that into a trans Bond and that is now a trans fat when people eat too much highly processed food their ratio of omega-6 fatty acid to omega-3 fatty acid is around 20 to 1 and ideally it'd be around one to one which is what happens when you eat mostly unprocessed food now why is that important if you're at 20 to 1 as opposed to one to one well that's going to generate more inflammation in the body and that's going to contribute towards that plaque formation now what about saturated fat is it good is it bad well spoiler alert it depends and if you want to know exactly the detailed answer on that check out this video right here

Channel: Doctor Mike Hansen

Views: 1,123,205

Keywords: prevent heart attack, how to be healty, heart attack, causes of hearth attack, saturated fat and heart attack, ask your doctor, doctor mike, problem wih heart, heart attack older men, heart attack symptoms, heart attack treatment

Id: G7FvPhaz0As

Length: 13min 4sec (784 seconds)

Published: Sun Oct 30 2022