Sign up to receive Peter's email newsletter: https://bit.ly/4c602k2 World-renowned lipidologist Tom Dayspring returns to give an update on the current thinking in lipidology as a follow-up to his 2018 five-part podcast series. In this episode, Tom discusses the growing consensus that atherogenic lipoproteins are essential drivers of atherosclerotic vascular disease. Tom further emphasizes apolipoprotein B (apoB) and lipoprotein(a) (Lp(a)). He provides insights into risk assessment, including which lab metrics to use, how to interpret them, and the appropriate therapeutic targets. Additionally, Tom discusses the most recent developments in lipid-lowering drug therapies—from the continued evolution of PCSK9 inhibitors, to the latest understanding of EPA and DHA, and the most recent addition of bempedoic acid to the list of therapeutic agents. We discuss: 00:00:00 - Intro 00:03:45 - The latest in the field of lipidology and cardiovascular disease 00:09:30 - Apolipoproteins—the key to understanding lipid biology 00:16:30 - ApoB as a preferred metric over LDL-P 00:21:45 - Therapeutic goals for apoB concentration 00:34:15 - Drivers of atherosclerosis 00:37:00 - Overview and current thinking on high density lipoproteins (HDLs)—Is it a useful metric? 00:55:00 - Lipoprotein(a)—the most dangerous particle you’ve never heard of 01:13:15 - Are low density lipoprotein triglycerides (LDL-TGs) a useful metric? 01:17:45 - Tom’s preferred lab measurements 01:21:30 - The latest in lipid-lowering therapies 01:30:45 - The different pathways among various lipid-lowering drugs 01:38:15 - The latest on EPA and DHA 01:49:45 - Fibrates—an underappreciated treatment for hypercholesterolemia Show notes page: https://peterattiamd.com/tomdayspring6/ About: The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 30 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life). Learn more: https://peterattiamd.com/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Play: http://bit.ly/TheDriveGooglePlay