Biomarkers associated with the risk of the leading diseases | Peter Attia

Biomarkers associated with the risk of the leading diseases | Peter Attia


But, yes, Alzheimer’s disease is one of the
neurodegenerative diseases that are up in the top four or five, like you mentioned,
cause… [Peter]: Well, it’s the top. It’s the only neurodegenerative disease that’s
on the top 10 list of death. [Rhonda]: Top 10, yeah. So cardiovascular disease… [Peter]: So cardiovascular is far and away
number one. It’s not even…I mean, cancer in an aggregate
is number two, but as an oncologist I, sort of, take an issue with that because cancer’s
a completely heterogeneic form of diseases. So to put this in perspective, right…so
breast cancer, who’s not afraid of breast cancer if you’re a woman? Breast cancer accounts for 3% of deaths in
women. I was shocked to learn that, very low. I would have thought much, much higher. Now, cancer in women, all cancers, 20%, 21%. Cardiac disease, 22% 23%. So if you’re woman, if you ask any woman in
the street, “Are you more afraid of heart disease or breast cancer?” I think most women would understandably say
breast cancer. And yet, it’s dwarfed by cardiac disease by
a factor of seven and a half to one. [Rhonda]: And we definitely know that diet
and lifestyle play a major role in your risk for cardiovascular disease. [Peter]: Yeah. I mean, I think there’s no place where that’s
more obvious than actually in Alzheimer’s disease for other reasons, which is… [Rhonda]: Really? Alzheimer’s? [Peter]: Yeah. I think so. [Rhonda]: More than cardiovascular? [Peter]: Well, I mean I say that just based
on what I called the existence principle, right? So cardiac disease, I mean I think that’s
entirely true. I think cardiac disease is inevitable. Right? And, while we’ve had a deterioration in our
lifestyle over the past 40 years, a pretty precipitated and accelerated, sort of, move
in the wrong direction on that, it’s been largely offset by pretty amazing medical advances. So the three things that have, I think, allowed
cardiac disease to remain…in fact, it’s actually come down. If you look at the death rate from cardiac
disease, it’s come down. So it’s still the number one killer but it’s
actually on a downward slope, I mean it’s sort of plateauing. But when you look at what, sort of, the three
biggest drivers are of cardiac disease, the first one is not disputed. It’s smoking. So the data are really clear that if you could
only make one behavioral change to reduce your risk of heart disease, it’s don’t smoke. The next two are actually, because they are
so cross-correlated you can’t actually distinguish which one is more important, are hypertension
and elevated ApoB or LDL particle number. And, again, ApoB is the single best biomarker
or LDL-P to distinguish your risk of cardiac disease. It trumps LDL cholesterol, it trumps non-HDL
cholesterol, it trumps triglycerides, HDL cholesterol. Those things don’t hold a candle to LDL particle
number ApoB. Well, think about it. Think about the advances we’ve made in the
last 40 years on all of those, right? So smoking has gone from 45% of the population
to 18% of the population. So we reduced smoking. [Rhonda]: In the U.S.?
[Peter]: In the U.S. that’s right. Obviously, we haven’t done the same in the
developing world. Think of the litany of drugs we have for controlling
hypertension and think about the litany of drugs we have to bring down ApoB. So despite enormous improvements in the three
big picture drivers, it’s still the number one killer. So it’s got to be lifestyle-driven but we’re
blunting the effect of that. Whereas in Alzheimer’s disease, we don’t really
have any pharmacotherapy plays. Like, we’re still arguing about what the environmental
trigger is. Is it all diet-driven, is it sleep-driven,
is it stress-driven, what’s the combination of factors? Is it is a virus? Is it prions? I mean I’ve heard every argument under the
sun, right? But here’s what we do know. We know that in the last 50 years, the prevalence
of Alzheimer’s disease has gone up about 2.5%…per year, by the way. I’m sorry. That’s per year. Whereas we know that our longevity has increased
at about 0.6% per year over that same period of time. Now, over a 50-year period, a 2% spread per
year of prevalence. Actually, I think that might be incidence,
now when I think about it. I think it’s incidence. And longevity suggests that Alzheimer’s disease
isn’t just the natural response of getting old. There’s something driving it. And even if you accept that part of that increase
in incidence is a greater appreciation for the diagnosis, it’s hard to argue that makes
up the full 2% spread. And to me, that’s the most convincing case
for why there is something in our environment that’s triggering Alzheimer’s disease and
it is not just the natural consequence of aging.