本期播客邀请了预防心脏病学和女性心血管健康领域的国际知名专家Erin Michos，探讨了女性心血管疾病的最新趋势。节目深入分析了影响女性心血管健康的多种风险因素，如胆固醇、apoB和Lp(a)等，并强调早期预防措施的重要性。此外，还讨论了降低心血管疾病风险的各种干预措施，包括他汀类药物、GLP-1激动剂、PCSK9抑制剂和降低Lp(a)的药物。节目还特别关注了女性特有的风险因素，如怀孕、多次生育、口服避孕药、更年期和多囊卵巢综合征（PCOS）。最后，Erin分享了她在治疗患者时关于激素替代疗法的实践，以及如何通过生活方式改变和药物来降低风险的建议。

💖 Erin Michos 介绍了女性心血管疾病的最新趋势，并指出女性心血管疾病的死亡率与癌症相当，强调了早期预防措施的重要性。

🩸 节目讨论了多种心血管疾病的风险因素，包括LDL-胆固醇、apoB和Lp(a)。Erin 强调了早期干预的必要性，并介绍了针对这些风险因素的治疗方法。

🤰 节目深入探讨了女性特有的心血管疾病风险因素，如怀孕、多次生育（生育五个或更多孩子）、口服避孕药、更年期和多囊卵巢综合征（PCOS）。

💊 节目讨论了各种降低心血管疾病风险的干预措施，包括他汀类药物、GLP-1激动剂、PCSK9抑制剂和降低Lp(a)的药物，并探讨了Erin在处方他汀类药物方面的实践。

🌱 节目还讨论了营养、压力和生活方式对血脂和心血管疾病风险的影响，并提供了针对低风险和高风险人群的建议。

View the Show Notes Page for This Episode

Become a Member to Receive Exclusive Content

Sign Up to Receive Peter’s Weekly Newsletter

Erin Michos is an internationally-known leader in preventive cardiology and women’s cardiovascular health. In this episode, Erin discusses current trends in cardiovascular disease (CVD) through the lens of female biology and the observation that major adverse cardiac events in both sexes are on the rise. She walks through risk factors including LDL-cholesterol, apoB, and Lp(a) and makes the case for the importance of early preventative measures. She explains various interventions for reducing risk including a discussion of statins, GLP-1 agonists, PCSK9-inhibitors, and drugs that lower Lp(a). She goes in-depth on female-specific factors that contribute to CVD risk such as pregnancy, grand multiparity (having five or more children), oral contraceptives, menopause, and polycystic ovary syndrome (PCOS). Additionally, she explains her approach with patients as it relates to the use of hormone replacement therapy and provides advice for people wanting to lower risk both through lifestyle changes and medications.

We discuss:

Erin’s background in preventive cardiology and women’s health [2:30]; Recent trends in cardiovascular disease in women, mortality data, and how it compares to cancer [5:15]; Why early preventative measures are critical for cardiovascular disease risk [13:15]; ApoB as a causal agent of CVD, and why high apoB levels are not being aggressively treated in most cases [19:45]; The rising trend of metabolic syndrome and other factors contributing to the regression in progress of reducing cardiac events [27:00]; GLP-1 agonists—Promising drugs for treating diabetes and obesity [33:30]; Female-specific risk factors for ASCVD (pre- and post-menopause) [37:15]; Polycystic ovary syndrome (PCOS): prevalence, etiology, and impact on metabolic health, lipids and fertility [47:00]; The effect of grand multiparity (having 5+ children) on cardiovascular disease risk for women [52:30]; The impact of oral contraceptives on cardiovascular disease risk [55:00]; The effect of pregnancy on lipids and other metabolic parameters [58:45]; The undertreatment of women with familial hypercholesterolemia (FH) and how it increases lifetime risk of ASCVD [1:02:00]; How concerns around statins have contributed to undertreatment, and whether women should stop statins during pregnancy [1:09:45]; How Erin approaches the prescription of statins to patients [1:16:00]; PCSK9 inhibitors and other non-statin drugs [1:21:15]; Advice for the low- and high-risk individual [1:28:30]; The impact of nutrition, stress, and lifestyle on lipids and CVD risk [1:31:00]; Lp(a) as a risk enhancer for cardiovascular disease [1:41:15]; The effect of menopause on cardiovascular disease risk [1:50:30]; How Erin approaches decisions regarding hormone replacement therapy (HRT) for her patients [1:55:30]; The urgent need for more data on women’s health [2:03:30]; Erin’s goal of running a marathon in every state [2:09:45]; and More.

Connect With Peter on Twitter, Instagram, Facebook and YouTube