本期AMA节目深入探讨了动脉粥样硬化性心血管疾病（ASCVD），它是发达国家头号杀手。Peter强调了关注和了解ASCVD的重要性，因为它普遍存在并且不可避免。他详细介绍了动脉粥样硬化的发展过程，包括它如何在很小的年龄就开始形成，胆固醇的作用以及决定预防策略的ASCVD的病因。此外，他还讨论了血液检查中重要的指标和生物标志物，以及冠状动脉钙化评分（CAC）和CT血管造影等诊断测试，这些测试有助于确定动脉损伤的程度。最后，Peter概述了理解和解读钙化评分的关键，并以预防方面的关键要点总结了本次对话。

🤔 **动脉粥样硬化的发展过程：** 动脉粥样硬化是一个慢性疾病，它从早期就开始发展，甚至从儿童时期就开始。它是一个渐进的过程，随着时间的推移，在动脉壁上积累斑块，最终导致血管狭窄。这个过程始于动脉内膜的炎症，然后是脂质（包括胆固醇）的积累，最终形成斑块。这些斑块可以破裂，导致血栓形成，从而阻塞血管并导致心脏病或中风。

🧬 **胆固醇在动脉粥样硬化中的作用：** 胆固醇是人体必需的物质，但过高的胆固醇水平会增加动脉粥样硬化的风险。胆固醇分为两种类型：低密度脂蛋白胆固醇（LDL）和高密度脂蛋白胆固醇（HDL）。LDL被称为“坏胆固醇”，因为它会沉积在动脉壁上，形成斑块。HDL被称为“好胆固醇”，因为它可以将胆固醇从动脉壁中清除。

🧪 **诊断和预防：** 可以通过血液检查和影像学检查来诊断动脉粥样硬化。血液检查可以检测胆固醇水平和其他生物标志物，而影像学检查，如冠状动脉钙化评分（CAC）和CT血管造影，可以评估动脉损伤的程度。预防动脉粥样硬化包括健康的生活方式，例如健康饮食、定期锻炼、控制体重和戒烟。

🔍 **早期干预的重要性：** 由于动脉粥样硬化是一个缓慢发展的过程，因此早期干预至关重要。通过早期诊断和预防措施，可以延缓或阻止动脉粥样硬化的进展，降低心脏病和中风的风险。

🩺 **关键要点：** 了解动脉粥样硬化及其发展过程至关重要，因为它是导致心脏病和中风的主要原因。通过定期体检、监测胆固醇水平和采用健康的生活方式，可以降低患上动脉粥样硬化的风险。

View the Show Notes Page for This Episode

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In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of atherosclerotic cardiovascular disease (ASCVD)—the number one killer in the developed world. Peter argues for the importance of paying attention to and understanding ASCVD given its ubiquity and inevitability. He goes into great detail about the development of atherosclerosis and how it can take hold at a very early age, the role of cholesterol, and the causal factors of ASCVD that determine prevention strategies. Additionally, he discusses the important metrics and biomarkers found in blood work, as well as diagnostic tests such as coronary artery calcium scores (CAC) and CT angiograms which help to determine the level of arterial damage present. Finally, Peter lays out the keys to understanding and interpreting calcium scores before wrapping up the conversation with his key takeaways regarding prevention.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #34 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

• The importance of understanding atherosclerosis early in life [2:15];
• Defining atherosclerotic cardiovascular disease (ASCVD), its causes, and the role of cholesterol [9:00];
• The process of developing ASCVD, part 1 [15:00]; 
• The process of developing ASCVD, part 2 [24:00];
• The process of developing ASCVD, part 3 [32:45];
• How early in life ASCVD can start to develop [40:30];
• Case studies of atherosclerosis and figures showing real pathology [43:00];
• Coronary artery lesions present in autopsies of different age groups [49:15];
• The causal factors of ASCVD that determine prevention strategies [52:15];
• Labs to identify biomarkers of ASCVD ]59:00];
• Diagnostic tests to determine the level of arterial damage present—CAC, CTA, CIMT, and more [1:00:30]
• Keys to understanding and interpreting a CAC score and/or CTA results [1:05:15];
• Is there a risk from cholesterol levels being too low? [1:13:00];
• Key takeaways regarding prevention [1:15:45];
• More.

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