MarcKatzMD
MarcKatzMD
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High Cholesterol: diet, medications, statin risks and benefits, ApoB and Lp(a), supplements more
This video reviews the basics of high cholesterol, what we look at in a lipid panel including: a discussion about ApoB and Lp(a), what LDL levels we target based on cardiac guidelines, how we manage and treat high cholesterol levels including dietary recommendations, secondary causes of high cholesterol, general dietary guidelines including the general recommendation against excessive saturated fat, common myths and half-truths regarding statin therap, alternative medical therapies we use to lower cholesterol and triglyceride levels, and why I don't recommend using over the counter (OTC) supplements like red rice yeast or OTC omega-3-fatty-acids.
*This video is purely for educational purposes and is not meant to replace medical care. If you have general knowledge questions about cholesterol I'm happy to answer them but I cannot answer specific questions about your personal medical care. As always, if you are concerned with your treatment or lab values then talk to your doctor.
Citations:
1. Mach, F. et al. (2019) ‘2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk’, European Heart Journal, 41(1), pp. 111-188. doi:10.1093/eurheartj/ehz455.
2. Kolominsky, J. (2020a) Familial hypercholesterolemia: Cardiovascular risk stratification and clinical management, American College of Cardiology. Available at: www.acc.org/latest-in-cardiology/articles/2020/06/01/13/54/familial-hypercholesterolemia
3. Virani, S, Morris, P, Agarwala, A. et al. 2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia: A Report of the American College of Cardiology Solution Set Oversight Committee. JACC. 2021 Aug, 78 (9) 960-993. doi.org/10.1016/j.jacc.2021.06.011
4. Belardo D, et al. Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease: An American Society For Preventive Cardiology Clinical Practice Statement. Am J Prev Cardiol. 2022 Mar 2;10:100323. doi: 10.1016/j.ajpc.2022.100323. PMID: 35284849; PMCID: PMC8914096.
5. Bellissimo, M, Hundley, W. Low-Carbohydrate High-Fat Diets, Lipid Levels, and Cardiovascular Risk∗ . JACC Adv. 2024 Jun, 3 (6). doi.org/10.1016/j.jacadv.2024.100975
6. Zhong VW, Van Horn L, Greenland P, et al. Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality. JAMA Intern Med. 2020;180(4):503-512. doi:10.1001/jamainternmed.2019.6969
7. Collins R, Reith C, Emberson J, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet 2016;388: 2532-61.
8. Mach F, Ray KK, Wiklund O, et al., for the European Atherosclerosis Society Consensus Panel. Adverse effects of statin therapy: percep- tion vs. the evidence-focus on glucose homeo- stasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract. Eur Heart J 2018;39:2526-39.
9. Newman CB, Preiss D, Tobert JA, et al. Statin safety and associated adverse events: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol 2019;39:e38-81.
10. Berger JS. Aspirin for Primary Prevention-Time to Rethink Our Approach. JAMA Netw Open. 2022;5(4):e2210144. doi:10.1001/jamanetworkopen.2022.10144
11. Zhou, Z, Ryan, J, Ernst, M. et al. Effect of Statin Therapy on Cognitive Decline and Incident Dementia in Older Adults. JACC. 2021 Jun, 77 (25) 3145-3156. doi.org/10.1016/j.jacc.2021.04.075
12. Cannon, C.P. et al. (2015) ‘Ezetimibe added to statin therapy after acute coronary syndromes’, New England Journal of Medicine, 372(25), pp. 2387-2397. doi:10.1056/nejmoa1410489.
13. Sabatine, M.S. et al. (2017) ‘EVOLOCUMAB and clinical outcomes in patients with cardiovascular disease’, New England Journal of Medicine, 376(18), pp. 1713-1722. doi:10.1056/nejmoa1615664.
14. Raal, F.J. et al. (2020) ‘Inclisiran for the treatment of heterozygous familial hypercholesterolemia’, New England Journal of Medicine, 382(16), pp. 1520-1530. doi:10.1056/nejmoa1913805.
15. Cohen, P. A., Avula, B., & Khan, I. A. (2017). Variability in strength of red yeast rice supplements purchased from mainstream retailers. European Journal of Preventive Cardiology, 24(13), 1431-1434. doi.org/10.1177/2047487317715714
16. Hasific, S, Oevrehus, K, Lindholt, J. et al. Effects of Vitamin K2 and D Supplementation on Coronary Artery Disease in Men: A RCT. JACC Adv. 2023 Nov, 2 (9). doi.org/10.1016/j.jacadv.2023.100643
#Cardiology #Cardiologist #LifeOfACardiologist #Residency #InternalMedicine #Fellowship
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ความคิดเห็น

  • @alyshaillies7318
    @alyshaillies7318 วันที่ผ่านมา

    It’s an association, a correlation. There’s no evidence for a causative role. Not to say there isn’t, but it has yet to be proven. The same factors that could result in increased CVD could simultaneously increase cholesterol. And atherosclerosis may be triggered by something other than cholesterol and the resulting atherosclerotic lesions themselves could in turn trigger higher cholesterol. Certainly high cholesterol could be bad in some individuals but high cholesterol alone doesn’t mean someone is unhealthy. There are studies trying to understand a population of lean, healthy adults with high LDL and what makes them different from high cholesterol groups that do have negative health outcomes. We can’t assume to know more than the research provides us.

    • @MarcKatzMD
      @MarcKatzMD 10 ชั่วโมงที่ผ่านมา

      Check out my full 42 minute video where I go into more detail: th-cam.com/video/_LhkAmFUhBI/w-d-xo.html

  • @fredbehnken5493
    @fredbehnken5493 วันที่ผ่านมา

    My wife had type two diabetes and an unknown heart condition at her death. The coroner could see the calcium and micro cellular damage that killed her. The many doctors we interacted with never looked. It is telling that American medicine wont pay for the test in insurance. In other more humane countries it is givne for free. Even in my community there was a group giving free CAC tests at churches. i just did an Ai search and th liars at Google spread goverment genocide propoganda that CAC tests arent worth it an medicare wont pay for it. Just Assholes. If we would have known my wife Vikki would be alive now.

  • @gerardlunow567
    @gerardlunow567 วันที่ผ่านมา

    Great video. At 70 I have a 9. I did a stress test and they stopped it, not me, I was not done yet. The explanations were great. Was happy to pay $100 to have peace of mind. I always think about risk factors. It is being aware of risk, any risk, that allows you to properly manage risk. Now I need to find out how to lower my bp. One day ok, the next 40 points up. Makes no sense to me.

  • @Aaron84danielle
    @Aaron84danielle 2 วันที่ผ่านมา

    This is my results. What does this actually mean? Am I at risk of having a heart attack? My age 60 Total coronary artery calcium score of 56, at the 80th percentile compared to patients

  • @mamajoker24
    @mamajoker24 2 วันที่ผ่านมา

    My 17yr old was just diagnosed with this.. doctors kept saying he was lying about fatigue and dizzy spells even said he was faking his fainting spells.... finally got someone to listen and they pit heart monitor on him and found wpw... makes me want to sue the doctors that kept gaslighting him

    • @marckatz6179
      @marckatz6179 2 วันที่ผ่านมา

      I’m so sorry you had to convince a doctor to listen- patients shouldn’t have to but I’m happy you continued to advocate for your son and found someone to look into it appropriately

  • @enidmrtnz5315
    @enidmrtnz5315 2 วันที่ผ่านมา

    This information is pure gold! Thank you for covering the silent killer, because that’s what High Cholesterol should be called. I also highly suggest any women who’ve had Gestational Diabetes (GD) to get labs done during the 6 week postpartum checkup to check Cholesterol levels and continue to do so with your family doctor every year afterwards because no OBGYN will tell you Cardiovascular Disease is another disease you should worry about after you deliver your baby. All you ever hear is, “maintain a healthy diet and exercise to avoid developing type 2 diabetes.” You will never hear them say that any woman diagnosed with GD is at risk of not only developing Type 2 Diabetes, but also the following: *Cardiovascular Diseases due to high cholesterol. *Malignancies such as breast/ovarian/endometrial/pancreatic cancers. *Ophthalmic Disease. *Renal Disease. Furthermore, I also highly suggest anyone who’ve had GD or was recently diagnosed with GD to stay away from red meats, fried foods, unhealthy oils, excessive carbs, and highly processed foods. If you can’t stay away from eating these types of foods, eat it in moderation and always go on at least a 20min walk after these meals or any meal to be honest.

  • @F91RPG
    @F91RPG 3 วันที่ผ่านมา

    9am?9am?999999999???????mine starts at 630 holy shit

  • @josephdirnfeld3593
    @josephdirnfeld3593 4 วันที่ผ่านมา

    I am vegan , no big sacrifice .

  • @HabibCAD_CAE
    @HabibCAD_CAE 4 วันที่ผ่านมา

    Song name?

  • @angelcarreto09
    @angelcarreto09 5 วันที่ผ่านมา

    How much money you make per year

    • @marckatz6179
      @marckatz6179 5 วันที่ผ่านมา

      Buy me a drink first

  • @jeanwilcox3464
    @jeanwilcox3464 6 วันที่ผ่านมา

    Thank you for posting. Next week I will get my first eco

  • @vincentmcgarry3598
    @vincentmcgarry3598 9 วันที่ผ่านมา

    Whats the best heart test to take then?

  • @bobdec6665
    @bobdec6665 9 วันที่ผ่านมา

    Your body makes cholesterol for a reason. You need it. Every cell in your body needs it

    • @MarcKatzMD
      @MarcKatzMD 9 วันที่ผ่านมา

      @@bobdec6665 watch my video on cholesterol for a full perspective

    • @MarcKatzMD
      @MarcKatzMD 8 วันที่ผ่านมา

      @@bobdec6665 th-cam.com/video/_LhkAmFUhBI/w-d-xo.html

  • @bobdec6665
    @bobdec6665 9 วันที่ผ่านมา

    read the cholesterol myth

    • @MarcKatzMD
      @MarcKatzMD 9 วันที่ผ่านมา

      @@bobdec6665 watch my video on cholesterol

  • @joelthorne7434
    @joelthorne7434 10 วันที่ผ่านมา

    Helpful info. Thanks. I had a first-time calcium scan: All 0s except a 58 score for my LAD. I’m 66. I’ll have to re-double my health regime.

  • @vashstampede360
    @vashstampede360 12 วันที่ผ่านมา

    AI does not even understand finance! Let that sink in😂

  • @NRCave1
    @NRCave1 13 วันที่ผ่านมา

    I can tell you ❤️‍🔥 your job but thanks for saving people's lives indeed. Sweet cat 🐈 haha.

  • @annabelmoodie9992
    @annabelmoodie9992 14 วันที่ผ่านมา

    It's the level of TRIGLYCERIDES that are more important

    • @MarcKatzMD
      @MarcKatzMD 13 วันที่ผ่านมา

      @@annabelmoodie9992 did you watch the video?

  • @annabelmoodie9992
    @annabelmoodie9992 14 วันที่ผ่านมา

    There is absolutely NO mention of triglycerides being an important marker Also reducing /eliminating your Carbohydrates ( especially sugar)from your diet. This push for statins is nonsense as the overall risk reduction is 4% verses the side effects of statins. Listen to Dr.Rob Cwyes ( Cardiac Dr. ) he will point you in the right direction without statins. This is paid promotion in my view.

    • @MarcKatzMD
      @MarcKatzMD 13 วันที่ผ่านมา

      Check my video on cholesterol

  • @user-EinsteinSarge
    @user-EinsteinSarge 15 วันที่ผ่านมา

    According to the risk calculator website my risk is 2.3%, however it didn't ask about Lp(a) which mine is elevated at 53 mg/dl. Since I appear to be low risk and my primary care doc just prescribed a low dose statin in response to my Lp(a) score, I can't get my doc to refer me to a cardiologist given my apparent low risk. I will ask for a coronary artery calcium score but doubt they will authorize.

    • @MarcKatzMD
      @MarcKatzMD 13 วันที่ผ่านมา

      @@user-EinsteinSarge just FYI, as I review in this video, CACS aren’t typically covered by most insurance but also typically shouldn’t cost >$100

    • @user-EinsteinSarge
      @user-EinsteinSarge 13 วันที่ผ่านมา

      @@MarcKatzMD Thank you, I did see that and I'm happy to pay out of pocket for it but trying to get my PCP to even order it is the issue (I have Kaiser Permanente). I wish I could get referred to a cardiologist to have them oversee my treatment instead of a PCP. Thanks again for responding.

  • @matthewjohnson6360
    @matthewjohnson6360 15 วันที่ผ่านมา

    I've been on it for 19 years 2.5 months a PE I was in the hospital after a surgery. My range is on the lower side. 1.5-1.9.

  • @adrijroy179
    @adrijroy179 15 วันที่ผ่านมา

    Is it possible for an img to match into cardiology, pls give some insight

    • @MarcKatzMD
      @MarcKatzMD 15 วันที่ผ่านมา

      I am an IMG. If you watch my videos about going to Caribbean med school and how to match into internal medicine (and partly in this video) I go over that topic

  • @user-EinsteinSarge
    @user-EinsteinSarge 16 วันที่ผ่านมา

    I'm 60, just got my Lp(a) tested and it was 53 mg/dl and general doc (not a cardiologist) is recommending 5mg Rosuvastatin (even though my LDL is 109, HDL 65, total chol 184, trig 50, A1C 5.1). Are there additional tests I should get before considering statin (CRP, APOB..)?

    • @MarcKatzMD
      @MarcKatzMD 15 วันที่ผ่านมา

      @@user-EinsteinSarge for individuals who are indeterminate risk a coronary calcium score can help guide our management further. Here’s a video I made on that topic: th-cam.com/video/ckvRgUDILPQ/w-d-xo.htmlsi=z-NJZ581V9ZxZojL

  • @bmelvin1234
    @bmelvin1234 17 วันที่ผ่านมา

    Thank you for sharing Dr. This video is very timely! I’ve had high cholesterol for many years, LDL 160, HD 41, triglycerides 230, age 58,. I’ve delayed taking statins for the usual reasons. However, I’m going to revisit my Dr’s recommendation (Rosuvastatin) and try to get it to a manageable level.

  • @DAEDMAN55
    @DAEDMAN55 18 วันที่ผ่านมา

    love your content man, i really like that you give solid advice and try and help people. I hope you keep making content and get more views soon

  • @welovedogs6835
    @welovedogs6835 19 วันที่ผ่านมา

    Hello Dr Katz Do you think this test is of any benefit to someone with multiple sclerosis? thank you so much for your help and this video

  • @arifkhatir07
    @arifkhatir07 19 วันที่ผ่านมา

    I am always get palpitations with escaped beats. after stress.

  • @arifkhatir07
    @arifkhatir07 19 วันที่ผ่านมา

    you bringing high yield facts🎉

  • @arifkhatir07
    @arifkhatir07 19 วันที่ผ่านมา

    I can't remember that we have studied this in medical school😂

  • @rtv7236
    @rtv7236 20 วันที่ผ่านมา

    Good presentation of the main issues around this. There's a lot of conflicting and confusing information out there. I particularly liked the discussion about different doctors giving different recommendations. I've experienced this myself. I tend towards kidney stone development, so lowering oxalates is recommended. "Healthy" diet recommendations include nuts, beans and other foods high in oxalates (quinoa is one of the worst). Finding a path to accommodated both is hard. The Zoe recommendations and intermittent fasting seem right to me and have reduced my A1C and weight. Unfortunately all statins cause big muscle problems for me. If I'm sedentary on statins, no muscle pains. I've I'm physically active I get the pains. Stop the statins and the pain goes away even with physical activity. I've been off of the statins for almost 3 weeks and I feel great. Retest of cholesterol without statins will happen in a couple weeks or so, followed by a meeting with cardiology. Justifying Repatha for insurance will be he next hurdle I'll have to jump over. Thank You. I appreciate your measured presentation and I have subscribed to the channel.

    • @MarcKatzMD
      @MarcKatzMD 19 วันที่ผ่านมา

      @@rtv7236 thank you for the thoughtful feedback!

  • @misterbaleize
    @misterbaleize 21 วันที่ผ่านมา

    Anyone who refers to LDL Cholesterol as being "bad" is still living in the dark-ages. LDL-C only become "bad" when it is damaged by sugar. When one keeps one's Triglycerides under 0.8mmol/L it is proven that LDL-C is undamaged and, as such, is just going about its excellent work as evolution intended it to do.

    • @MarcKatzMD
      @MarcKatzMD 17 วันที่ผ่านมา

      Did you watch the video?

  • @kevinmarshall184
    @kevinmarshall184 21 วันที่ผ่านมา

    I was swayed towards a low carb diet due to A1c being high , it helped me improve all of my health marker. I dont think a Keto diet is a carnivore diet as you infer , but rather a low carb diet which cuts out much of the processed and refined foods that flood the market. Time has proven you cant live on a vegan or vegetarian diet alone it just isnt healthy long run. Another point to be had cooking with olive oil is only safe if you dont cross the smoke point as it becomes just another bad cooking oil, that is if you really believe you have olive oil. Everything in moderation, no artificial ingredients, and take to walking as much as you can.

  • @sleepmoreworryless4547
    @sleepmoreworryless4547 21 วันที่ผ่านมา

    What about people who have high LDL and High HDL?

    • @MarcKatzMD
      @MarcKatzMD 21 วันที่ผ่านมา

      @@sleepmoreworryless4547 did you watch the video?

    • @sleepmoreworryless4547
      @sleepmoreworryless4547 20 วันที่ผ่านมา

      😂 yes, I paused it, asked my question. Then you covered it.

  • @edgarreyes6587
    @edgarreyes6587 21 วันที่ผ่านมา

    Electric blue pants model plis? Pisco, axim, cairo? Medium rigth??

  • @humbleguy9908
    @humbleguy9908 22 วันที่ผ่านมา

    The ESC/EAS guidelines also mention, that coronary arterial calcification can be used to diagnose your risk (p 126-7). Having LDL of more than 200 mg/dl (5mM) since at least 20 years, my general practitioner suggested the initiation of a statin therapy. We agreed to make the decision dependent on the outcome of a heart CT. It turned out, that at the age of 67, my CAC score was well below the 50% percentile of my age group.I kind of expected this result, having a BMI of 27, daily exercise and no cardiovascular risk in the family. Ironically, my attempts to avoid any regular medication was flouted, when I had my first attack of gout 3 years later, despite (high-) normal uric acid levels.

    • @MarcKatzMD
      @MarcKatzMD 22 วันที่ผ่านมา

      Based on guidelines, an LDL >190 should be on cholesterol lowering therapy. Generally we don’t use CACS to risk stratify these individuals because they should be on lipid lowering therapy regardless of calcium score. As I said in this video, meds aren’t a cure but those with LDL that high are at a much higher long-term risk. Ultimately decision is between you and your doctor and being a low risk individual is certainly better than having multiple cardiac risk factors. But based on guidelines, LDL >190 in most patients should be treated

  • @lucidmynd5957
    @lucidmynd5957 22 วันที่ผ่านมา

    Thank you. Super helpful info. Oddly, my symptoms began with my COVID 60 days ago... and my Doc prescribed a low dose of prednisone. Oops. Which kept me up all night with heart palpitations. I think that's where it began. Doctors still really suck at diagnosing this condition. Been i7-8 level npain for months and all I needed was two Advil? You gotta be kidding me?

  • @ynasra1065
    @ynasra1065 22 วันที่ผ่านมา

    I think diet is indivisual specific ,effect of diet depends of how your body is constructed to react and consume and burn that food that you consume....

  • @brianf761
    @brianf761 23 วันที่ผ่านมา

    At 50, and refusing a statin prescription for ldl at 120,with 59 Hdl and 70 triglycerides had a CAC of 0, pcp finally relented and said just keep doing what you're doing.

    • @MarcKatzMD
      @MarcKatzMD 22 วันที่ผ่านมา

      @@brianf761 That’s great! CACS of zero is one of the every few times we can confidently say “you don’t need meds!” (Assuming LDL not >190 mg/dL)

    • @brianlane9534
      @brianlane9534 14 วันที่ผ่านมา

      ​@@MarcKatzMDI went to a cardiologist to follow up on test from 2 years ago because of very high pvcs. Low regurgitation rate etc. In the mean time I had a cac score 18 months prior. It was zero. I'm 65 years old. My latest lipid panel LDL 137 I think, tri in 80s, HDL 63. Total cholesterol 210. He didn't want to discuss anything but putting me on statins if I don't lower my cholesterol in 90 days. I'm gonna find a new doctor.

    • @brianlane9534
      @brianlane9534 14 วันที่ผ่านมา

      Plus my heart perfomance was greatly improved, pvcs went from 15000 in one day to almost gone after 2 years of lifestyle change. Stress was off the charts.

  • @cmlopez1982
    @cmlopez1982 23 วันที่ผ่านมา

    Best video explanation. I just had one done and Im at 97 percentile. Doctor prescribed cholesterol meds

  • @mikeandcarterwebb5177
    @mikeandcarterwebb5177 24 วันที่ผ่านมา

    I’m 53 and got my results today. My score was 55.

  • @turkishempire-wl3bh
    @turkishempire-wl3bh 25 วันที่ผ่านมา

    actually i am student of pre medical and starting medicine next year so interested in doctor'life so therefore watch your video Sir and want to become cardiologist

  • @official.rajarshidutta
    @official.rajarshidutta 26 วันที่ผ่านมา

    God, I love cardiology. this video pumped me up.

  • @Hikkarii_x
    @Hikkarii_x 29 วันที่ผ่านมา

    I am in highschool and want to become a cardiologist so please wish me luck

  • @areguapiri
    @areguapiri หลายเดือนก่อน

    The virus lunacy again.

  • @shibdassarkar9357
    @shibdassarkar9357 หลายเดือนก่อน

    Sir do you earn 600k dollars a year as a cardiologist? Plz reply in yes or no. Thanks a lot.

  • @LawB-gv2ww
    @LawB-gv2ww หลายเดือนก่อน

    @marcKatzmd Great Video. I have been hearing how current thinking indicates that Triglycerides are more important than LDL because Triglycerides become the much more dangerous VLDL. Would love to hear your thoughts on this.

    • @MarcKatzMD
      @MarcKatzMD หลายเดือนก่อน

      I have a new video coming out soon on cholesterol and will answer this question in greater detail but generally LDL, ApoB, and LpA are more important than TG. Persostently elevated TG are not to be ignored so I certainly care about TG but LDL is still largely a greater focus

    • @LawB-gv2ww
      @LawB-gv2ww หลายเดือนก่อน

      @@MarcKatzMD I am looking forward to your new video. I hope you address these two issues (1) The Framingham heart study showed a 30% increase in CVD associated with high LDL but an 80% increase in CVD due to TG 2) LDL (as you stated) is correlated with increased CVD but there is no causation rationale. The folks who believe TG is the issue believe that inflammation caused by sugar, smoking, and alcohol attracts the LDL as the LDL is trying to heal the artery. Blaming the LDL for CVD is like blaming the scar for the knife wound.

  • @beckyboop2867
    @beckyboop2867 หลายเดือนก่อน

    I’ve just had this I can’t take ibuprofen because I am asthmatic so had to use Codeine

  • @DrCardio
    @DrCardio หลายเดือนก่อน

    Lol. I thought it was an issue only here in Pakistan. I guess cardiology and pre-op risk assessment is the same all over the world. 😅

  • @Dawn_dusk12
    @Dawn_dusk12 หลายเดือนก่อน

    Very confident doctor. I have a few questions: What if Crp reduces but Esr remain in 40s? Is a thin film of about 3mm of PE of any significance? Does the patient keep on repeating 2-D echo to see that quantity of fluid is not increasing? If so how often? Any other diagnostic tests? Lastly can the fluid go away in its own ?

  • @pushpa19-c3m
    @pushpa19-c3m หลายเดือนก่อน

    While AI can help physicians with a variety of activities, it cannot take the place of the human touch and knowledge that are necessary to deliver high-quality medical care.