Understanding Cardiovascular Wellness

Transcript generated by AI

Announcer: 0:00

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts. Hosted by cardiologist and top medical researcher, Dr. Michael Koren.

Dr. Michael Koren: 0:11

Hello, I'm Dr. Michael Koren, the Executive Editor of MedEvidence, and we have a unique podcast today. I had the great pleasure of getting to know one of our patients who recently screened for a study here at Jacksonville Center for Clinical Research. Obviously a really intelligent guy with a great sense of humor and an interesting history, and we're going to get into all of that, but particularly, we're going to talk about how confusing these lipoprotein profiles can look to the average intelligent person. So go ahead, Danny. Why don't you introduce yourself to our MedEvidence audience? Tell us a little bit about your background, and tell us a little bit about how we ended up getting here at this table based on your interest in a clinical trial.

Danny Chu: 0:58

Thank you, Doc, and my name is Danny Chu. I happened to stumble upon this organization when I was doing some research related to my blood test results, and also, over the past three years or so, I started developing a lot of interest in having a deeper understanding of blood lipids and overall health. And also I'm very much into exercise and then also looking at the nutritional component of this overall, trying to keep myself alive longer and healthier.

Dr. Michael Koren: 1:41

I love that.

Danny Chu: 1:43

So, I kind of stumbled onto this organization. That's why I'm here. So I'm going, stumbled onto this organization, that's why I'm here.

Dr. Michael Koren: 1:46

So, I'm going to interview you a little bit; the way I would interview a patient is so that the viewers and listeners can get a better sense of who you are. So, start by saying you look much younger than your stated age. I don't know if you want to publicly state what that age is.

Danny Chu: 2:01

I am 64.

Dr. Michael Koren: 2:07

I just passed 64 about a week or two ago.

Dr. Michael Koren: 2:08

Wow, Well, I would never have guessed that.

Danny Chu: 2:09

Thank you,

Dr. Michael Koren: 2:09

I would never have guessed that

Danny Chu: 2:10

it's the Asian gene.

Dr. Michael Koren: 2:11

Okay, well, tell us about that Asian gene, tell us where you're from originally and a little bit about how you came to the United States.

Danny Chu: 2:19

I was born in Hong Kong and I came when I was around, you know, a little bit over 14, between 14 and 15.

Dr. Michael Koren: 2:26

So, yeah, I've been to Hong Kong three times and each time I was blown away by how many people move so efficiently in one small place. It's mind-boggling. So you go to the airport. It's incredibly busy, but everybody's moving quickly and everybody seems to be getting to their destination. So we have to learn from that Small place. Yeah, and then so tell me a little bit more about your professional background and the multiple jobs that you've had. You kind of blew me away with all your different careers. So go ahead.

Danny Chu: 3:01

So, just like any other immigrants first came in the country, you do what it takes to make a living, and so I pretty much work in every job, specifically in a Chinese restaurant.

Danny Chu: 3:12

So I start working in a Chinese restaurant washing dishes first or 15 and then start cooking and waiting tables. And I was fortunate enough to get a scholarship went to Virginia Military Institute Beautiful. And then I got my degree in physics and mathematics Fabulous. And then when I graduated, after three years in the country and four years pretty much in prison environment I call.

Dr. Michael Koren: 3:35

VMI, you're calling it prison They may not want to sponsor this podcast.

Danny Chu: 3:43

I think everybody who went to VMI will have that feeling.

Dr. Michael Koren: 3:45

Okay.

Danny Chu: 3:46

I don't think I'm unique.

Dr. Michael Koren: 3:48

Okay,

Danny Chu: 3:49

but when I got, out of VMI

Dr. Michael Koren: 3:51

but it was a high class prison at least.

Danny Chu: 3:54

Well, you got three meals a day, good exercise and good education, so you can't complain, all right. Especially you got it for free.

Dr. Michael Koren: 4:00

I got you.

Danny Chu: 4:02

And then when I got out of college at that time I'm class 83, and I didn't realize that the economy was really, really bad and, being four years in a secluded environment, I didn't know much about what's going on in society and I couldn't really find any jobs. Didn't have a skill and didn't have the understanding how to look for jobs, so I was doing any odd jobs I can find to make a living. Basically I load truck for UPS 3.30 in the morning.

Danny Chu: 4:33

And I work as a bouncer in the Redneck Biker Bar and I mow grass in the golf course. I work as a cashier in a kind of CVS used to call people's drug store. Right right and years ago.

Dr. Michael Koren: 4:47

So how many careers was it? I think you added them all up at one point.

Danny Chu: 4:50

Up to now, I have about 34 different types of jobs I've done over the years, and then I rewind a little bit, and then eventually, I got a job in the IT field. Rewind a little bit and then eventually I got a job in the IT field and being a degree in physics and math or computer programming luckily came to me a little easier. So I started getting into computer programming, and then I stumbled upon a technology called biometrics, which was years ago.

Danny Chu: 5:22

Nobody even heard of or heard of, but not a lot of people know about it. It is fingerprint matching, facial matching, and I worked with law enforcements over the years and also helped to develop the whole nationwide system under Homeland Security right now to keep track of both legal and illegal apprehension in the United States and also linked to all the state and local law enforcement for criminal activities.

Dr. Michael Koren: 5:48

Super interesting

Danny Chu: 5:48

And then, I ended up starting my own business.

Dr. Michael Koren: 5:52

What was that? That's pretty much it. What was your own business?

Danny Chu: 5:55

My business was. I mainly lived in Northern Virginia over the years until I moved to Florida around 2016. Until I moved to Florida around 2016. It mainly focused on biometric technologies, Nice, and then also healthcare using fingerprints back then. Even now, I have developed. Nowadays, with your credit card, you have a chip on it, but years ago the technology was there, so I incorporated medical information onto that chip. And you can carry your medical information around instead of storing it in a centralized system.

Dr. Michael Koren: 6:35

We should continue to do that. I was actually at a meeting this weekend where I was arguing that's the way it should be done. Unfortunately, we went to these centralized systems where people don't have control of their own data on a day-to-day basis.

Danny Chu: 6:48

And I have developed that 20 years ago. And to make sure it is your data, you can authorize other people gain access to it using your biometric, using your either fingerprint, face whatever, or multiple to have like a second verification. So that was one of my developments through my own company over the years.

Dr. Michael Koren: 7:11

Well, we're actually not here to talk about biometrics, although I'm fascinated by that. So we're here actually to talk about lipoprotein, little a and cholesterol issues. So tell us about your journey in that space and how you ended up here with us.

Danny Chu: 7:24

Well, after I got married, my wife's from a medical family, so she's the one that got me to start doing annual checkups. You know, as most men feel that pretty invincible, we don't need checkup, I don't feel bad, I'm healthy. Over the years Then I developed interest, start tracking my blood work, because when I first had my blood work I have a high cholesterol. I said, well, that's crazy. And then I start digging in more, learning more about cholesterol. Part of it because I have a young child that.

Danny Chu: 7:53

I like to stick around, you know, and I got married late, so there's a. I call self-interest to keep myself healthy to see her grow up.

Danny Chu: 8:00

So for the last eight, nine years I've been tracking this stuff and then, having a scientific background, I'm kind of like interested and start digging in more. You know, go through a lot of YouTube, educational type of materials. It's one of those scenarios the more you dig in, the more questions you have, the more you feel you don't understand. Right, I understand, and so that's really the frustration because there's so much information out there you can't. There's also a lot of contradictory information, sure.

Dr. Michael Koren: 8:34

So Well, yeah, so let's break that down a little bit. So you provided me with your lipid profile. Is it okay if I share this with people who are listening in right now?

Danny Chu: 8:42

Oh yeah, that's fine Okay.

Dr. Michael Koren: 8:54

okay. So there is a lot of confusion, and let's start with cholesterol. So cholesterol is a blood fat, but it's also a structural molecule that every cell needs for essential functions. So, every cell in the body can make cholesterol from basic materials because it's so important to the function of the cell. Except for your eyelashes, by the way, that's the one organ system that doesn't seem to be able to make its own cholesterol, but every other cell in your body can make its own cholesterol.

Dr. Michael Koren: 9:17

So the stuff in your circulation is the extra cholesterol that your body is trying to get rid of, and then it goes from your bloodstream to your liver, to outside of your body through your stool.

Dr. Michael Koren: 9:28

So when people talk about cholesterol, they sometimes have the misinformation that we need dietary sources of cholesterol in order for us to live healthy lives, but that's not true.

Dr. Michael Koren: 9:39

Your body makes cholesterol from basic ingredients.

Dr. Michael Koren: 9:43

Triglycerides are another type of blood fat, and that's a blood fat that's primarily focused on your energy needs for your body.

Dr. Michael Koren: 9:51

So triglycerides are an energy store that eventually can be made into starches in your liver but ultimately are used for energy reasons, but we know that fats are not soluble in water or in fluids in most fluids, so therefore, your body has to come up with a way to allow these fat particles to circulate, and they do that by forming what's called lipoproteins, which are these complex molecules that combine a lipid or a fat component and a protein component that is allowed to move throughout your circulation and ultimately find targets in your body to be removed, mostly in the liver.

Dr. Michael Koren: 10:33

So your liver is responsible, for example, for helping your body get rid of extra cholesterol through something called the LDL receptor, and the drugs that we use to help people with lipid problems often work by making the LDL receptor work better, and two major classes of drugs that do that are statin drugs, what's called PCSK9 inhibitors. So take a deep breath. I threw out a lot of stuff there in a short period of time, but the key thing is that when we're looking at these analyses like advanced lipid profiles, we're looking at lipoprotein concentrations in your body.

Danny Chu: 11:07

Okay, Now I did enough research to understand the basics of this thing. Is it okay if I ask a deeper, lower level question? Yeah, go ahead. Like, for example right, the normal primary physician and insurance will pay for is standard blood work, which doesn't give you what I call next level of blood work like your particle numbers, your large LDL, your medium LDL, your small LDL, right.

Danny Chu: 11:35

So let's assume the individual has a high number, small LDL, number, small LDL, which is my understanding, is probably the most important type of LDL for the negative effects on your body, right Okay? I also hear that you have a good ratio of triglyceride to HDL.

Danny Chu: 11:58

Okay, that also an indicator

Dr. Michael Koren: 12:01

that you know your prognosis is better or worse. Yeah, Correct.

Dr. Michael Koren: 12:08

Let me?

Dr. Michael Koren: 12:08

break that down for the audience a little bit, okay? So, first of all, we typically have different ways of measuring particles, and with your physics background, this will make sense, and I'll try to make it as easy to understand for the average person. So you can measure something based on its weight. The weight would be a milligram or a gram or a kilogram or a pound, right? It would be its concentration, meaning the number of particles per volume. That's pretty easy to understand, right. So a lot of these things get confusing for people because you'll see one or the other, and when you start getting into particle number, that's a fundamentally different thing than something that says milligrams because milligrams is a weight, whereas a particle number is a concentration. So what these advanced lipid profiles help you understand is do you have a lot of smaller particles that weigh less but ultimately measure up to something significant, or do you have, at the extreme, some really big particles that are very few in number? They can both add up to basically the same thing in terms of the weight, but they're fundamentally different in terms of the number of particles. So we learned over time that having a low-density lipoprotein, having lots of smaller particles, is worse than having fewer big particles. So that's pretty simple, right, and that's what we learn from these lipid profiles.

Dr. Michael Koren: 13:33

But even more fundamental than that is this whole concept of HDL versus LDL. So LDL is called low-density lipoprotein. We call that bad cholesterol and the reason for that is if you store your cholesterol primarily in that lipoprotein, you're going to have more complications on average than if you store it in the HDL, which is called the good cholesterol. So you're very fortunate, you have a very high level of HDL. I'll mention to the audience your HDL is 76.

Dr. Michael Koren: 14:05

It's probably a reflection of exercising, staying thin, eating well and picking good parents, because it's also genetic, so that's terrific. Your LDL, though, is a little bit high, so your LDL is 159. But, fortunately, the high level of HDL is offsetting some of the bad elements of having a higher level of LDL. And then we get into something called the different patterns of LDL, a versus B, which has to do with the amount of triglycerides that are part of those lipoprotein packages, and your triglyceride level is actually very low, 51. So I'm not surprised that you have a pattern A LDL, which is more favorable.

Danny Chu: 14:46

So,

Dr. Michael Koren: 14:49

does that make it easier or more confusing?

Danny Chu: 14:52

I think the confusing part is says if you look at, let's say I can phrase this question clearly Due to the fact I have a high LDL, let's say you have two column plus and minus. That's clearly a minus. So in the meantime, I have a high HDL. Now, if you can address the ratio between triglyceride and HDL, in my understanding, I could be wrong again due to the fact

Dr. Michael Koren: 15:21

the more commonly used ratio is your total cholesterol to HDL, which yours is favorable.

Dr. Michael Koren: 15:26

I'm looking at it right here it's 3.3. And the other ratio that we look at is HDL to LDL. So we have people in studies that get treated and then their LDL is lower than their HDL and we think that's really terrific. So those are the ratios that are more commonly looked at, rather than the triglyceride to something ratio.

Danny Chu: 15:47

Okay, let's focus on HDL. Then I got a question on that. Yes, you look at the history of my HDL. I actually have a spreadsheet to show you. My HDL has continued to improve. When I first started tracking about eight, nine years ago, it wasn't really bad, but it's not like what it is today. But I did that in my opinion, I did that through, probably.

Danny Chu: 16:12

I started intermittent fasting about two, three years ago and I noticed that when I started doing intermittent fasting, somehow my triglyceride and HDL improved drastically in my opinion,

Dr. Michael Koren: 16:26

what was your HDL before you did intermittent? Fasting.

Dr. Michael Koren: 16:31

Was it over 60 previously?

Danny Chu: 16:36

It's over the so-called the worst. Whatever it's 50, isn't it?

Danny Chu: 16:40

I think it's over 50

Dr. Michael Koren: 16:42

Well, different labs report different things, but if your HDL is 60 or more for a man, that's really terrific.

Danny Chu: 16:49

I see, so I think it's right around there. I guess it wasn't as bad as I thought it was, you know, but it did show improvement.

Dr. Michael Koren: 16:59

and exercise is a big part of that.

Danny Chu: 17:03

Yeah, I do a lot of exercise

Dr. Michael Koren: 17:04

and a little bit of alcohol raises your HDL. Do you use any alcohol? I drink maybe a glass of wine, a beer, every two weeks nowadays, maybe at best, so probably not much of a movement I wouldn't consider myself a big drinker nowadays.

Danny Chu: 17:20

Those days are over, okay.

Dr. Michael Koren: 17:23

That's when you were in prison.

Danny Chu: 17:25

No, even not those days. You can't have it

Dr. Michael Koren: 17:29

All right, well, anyhow. So your HDL-LDL ratio, or your total cholesterol to HDL ratio, are the two most commonly looked at ratios, and in your case, they're both extremely favorable.

Danny Chu: 17:41

But what's the worst ratio? Can you give that number a little bit, since I don't know much about these ratio numbers?

Dr. Michael Koren: 17:47

Well, those are the two that are most highly established as having a prognostic impact on people, ie the ability to predict whether or not you're going to have a heart attack or a stroke.

Dr. Michael Koren: 17:59

Okay, and yours is very favorable

Danny Chu: 18:01

, so let me add another dimension to it. Sure, okay, as you know, there's like a multiple points related to it, so I did also. I also did a calcium score Right About two, three weeks, probably about a month ago.

Danny Chu: 18:13

Just out of curiosity. Sure, I said, hey, you know.

Dr. Michael Koren: 18:16

What'd you get?

Danny Chu: 18:17

So I have a total of close to about 600, some the total number Interesting, but the highest one is 400-something, if I recall I have it on my iPad

Dr. Michael Koren: 18:29

In one blood vessel

Danny Chu: 18:29

In LAD.

Dr. Michael Koren: 18:30

Right. So you have three major coronary blood vessels. The LAD is typically the largest. One runs down the front of the heart and you had a 400 score in the LAD, so that's a high number. So it's really, really interesting. So your overall lipid profile is pretty good, but the one thing that's not the greatest is you have a high level of lipoprotein little a, and your lipoprotein little a here was 142 nanomoles per liter, which is definitely above normal. And lipoprotein little a is another type of lipoprotein that contains cholesterol that runs high in certain families. That's associated with coronary events, particularly coronary calcification and aortic valve calcification, and so I'm going to guess that you've done a tremendous job with a lot of these elements of your lipid profile. But all your exercise and intermittent fasting is not going to really change that Lp(a) level. Now, it's not the worst I've ever seen. 142 is above normal, but we have people that are way above that. But that's one of the reasons you came to the center to learn more about that and maybe get involved in a clinical trial.

Danny Chu: 19:35

That is correct.

Dr. Michael Koren: 19:36

And I understand you screened out of that clinical trial because you haven't had a cardiac event or a stroke, which is a good thing. Yeah, knock on wood a bunch of times. But that's what we do in our research here is we don't necessarily put everybody in. We evaluate you and then we get to know you a little bit and if there's a program that's enrolling at the time that you come in, we're happy to get you involved. But we now know you. So the next program comes around that you fit into, we'll let you know about that. So that's the beauty of working with a clinical research center is that you will not be forgotten. So even though you didn't get into this particular program, there's probably something for you down the road.

Dr. Michael Koren: 20:16

But I'm also gonna make a hypothesis, and I don't know this for sure. What we like to say in MedEvidence is the things we know for sure. . There's things that we don't know and there's things we want to learn. So we know for sure is that lipoprotein little a is definitely associated with cardiovascular events, heart attacks and strokes and calcification, particularly of the aortic valve and the coronary arteries. We know that it runs in families, but we don't know is that if we lower it, does that make people better off? And that's what we're doing the research on right now.

Danny Chu: 20:50

So in this particular real-life scenario, looking at HDL, LDL, you average out based on my understanding, what you said is I am okay in that area, but then you add the LP, little a, which I have zero control over because of genetic, and then, on top of the calcium test score that I happen to get, how would you look at individual like me? I exercise regularly.

Dr. Michael Koren: 21:28

I'll tell you exactly what I would do my recommendation from our conversation, from these numbers. Do you want me to say that on video, or do you want me to say this privately?

Danny Chu: 21:34

It doesn't matter Okay.

Dr. Michael Koren: 21:36

So I would recommend strongly that you get on a statin drug. Okay, and the reason for that is that we cannot do a whole lot about your Lp(a) with the current medicines on the market. Our research medicines may lower that by 90 or 95%, but those are not on the market. But of the things on the market we have statins which lower your LDL, which bring down your risk tremendously and offset some of the impact of having a higher LP, little a Okay. So I would make a strong recommendation. Your LDL on this analysis was 159. I want to see that around 80. And you can do that with a statin.

Danny Chu: 22:15

So just for your information, I was taking some Crestor.

Dr. Michael Koren: 22:20

Okay.

Danny Chu: 22:21

Until about-.

Dr. Michael Koren: 22:21

Excellent drug that we helped develop.

Danny Chu: 22:23

Three years ago. Okay, until about Excellent drug that we helped develop Three years ago.

Dr. Michael Koren: 22:25

Okay, why'd you stop?

Danny Chu: 22:27

I personally would prefer not to take any medicines, so I start using different methodology to see there any changes. So I'm more like using my own body as research. Sure, okay, all right, Instead of other people's bodies. So that's why I started tracking this. That's why I started looking into more and more of these informations. So I purposely stopped it just to see the changes in my cholesterol. It did increase slowly, increase back up before I was compared when I was taking Crestor.

Danny Chu: 23:00

I only take 5 milligrams which is not a lot

Dr. Michael Koren: 23:02

which is a very low dose. You can take up to 40 milligrams of Crestor.

Danny Chu: 23:04

Yeah, I try not to take more than I need, Right?

Dr. Michael Koren: 23:08

Well again, Crestor is a very well-established medication. We know that it improves prognosis in people just like you With the coronary calcium count that you mentioned, particularly in the LAD. I would actually strongly recommend that you're on a statin and I would give you a target of somewhere between 70 and 80 milligrams per deciliter. Now, when you measure LDL and you don't measure it directly, it also measures lipoprotein, little a. So this gets a little bit more complicated and sophisticated and I'm happy to guide you in the future about that. But it's pretty clear to me that you should be on Crestor. Quite frankly, I would put you on at least 20 milligrams a day.

Danny Chu: 23:46

What's the question on the number of milligram? How do you decide 20, 70? Yeah.

Dr. Michael Koren: 23:55

So good question. So we know from a lot of research that's been done over the years the approximate amount of LDL lowering you're going to get based on any particular dose. So with 20 milligrams I'm going to guess that your LDL is going to go down somewhere between 40% and 50%. If you get up to the maximum dose of 40 milligrams per day, you'll find that that goes up another 6% or 7% lowering.

Danny Chu: 24:27

Now I don't know this is correct or not. I also again, there's a lot of contradictory information out there. I also learned that these statin drug research, the improvement of so-called improving people going to have a cardio event or not, doesn't really make a difference. You take statin or you don't take statin the number comes out.

Dr. Michael Koren: 25:00

No, that's not true. I don't know we read that, but I would cross that off your list of sites to go to. Statins have consistently shown reduction in morbidity and mortality over the course of now 30 years. So the first major study that showed that statins actually saved lives and reduced heart attacks was called the 4S study, which was published back in 1994 in 4,444, mostly Europeans, I think virtually all Europeans comparing Simvistatin 40 milligrams versus placebo. And that was in 94. So fast forward 30 years. Every time we've looked at a statin drug we find that people do better. So if anybody tells you anything about the side effects of statins, what I tell them is the number one side effect of statins is you live longer.

Danny Chu: 25:47

Well, there is a side effect.

Danny Chu: 25:48

based on my personal experience

Dr. Michael Koren: 25:50

and I'm being facetious, of course, but the point being is that statins are something that you can take to the bank in quotes, and that is a very, very reliable way of improving your prognosis.

Danny Chu: 26:02

Okay, so let me ask you this then let's assume that we take the statin, and how? Obviously nobody can quantify risks, because there are different levers that you can pull right. There's food, there's exercise, there's sleep there's mental health.

Danny Chu: 26:22

You name them all and Based on so-called standard risk factor, the only risk factor I have, using myself as an example, and hopefully my example can help other people. That's one of the reasons I'm doing this Sure, because there's so much information out there that sometimes it just gets really confusing. So the Lp(a) is not much can be done until some interesting stuff come out. Correct, some interesting stuff come out.

Dr. Michael Koren: 26:47

Correct.

Danny Chu: 26:49

And so my only risk factor really, besides the Lp(a) and high LDL by taking a statin drug you lower the LPL.

Dr. Michael Koren: 26:59

The LDL. Yes, the LDL.

Danny Chu: 27:02

So what is the risk factor for the Lp(a) alone then?

Dr. Michael Koren: 27:13

Well again, there's nothing we can do to lower Lp(a) significantly. We have some stuff that lowers it, maybe 20, 25%, but there's nothing that brings it way down, except the stuff in research. The stuff in research is bringing it down 90, 95%. So we can't address that. But we can address the LDL, and the lower the LDL, especially when you use statins to lower it, the better off. You are Very simple

Danny Chu: 27:34

by better off, based on

Dr. Michael Koren: 27:36

Fewer heart attacks, fewer strokes.

Danny Chu: 27:41

I guess I'm trying to find some research paper.

Danny Chu: 27:44

They do clinical, whatever research

Dr. Michael Koren: 27:48

they do there are thousands of research papers on what I just said, including a number that I wrote.

Danny Chu: 27:54

Okay.

Dr. Michael Koren: 27:54

So I'll be happy to give you an autographed copy of one of my research papers.

Danny Chu: 27:59

Yeah, I'd love to see it because there's so much data. It's not that I won't believe you. Okay, you know, just like any other good scientist, you want to look at concrete data points.

Dr. Michael Koren: 28:09

Right, but here there's a lot of data and then there's a limited amount of really good data. So the key thing is that you want to look at data from randomized clinical trials, and most of the stuff that's thrown out there is not from randomized clinical trials. So we talk about the quality of the evidence, and for statins, we have incredible quality evidence, and we have what's called meta-analyses, where lots of studies have been put together, and the conclusion is beyond any shadow of a doubt that statins reduce heart attacks, reduce strokes, save lives.

Danny Chu: 28:41

So are these trials done by drug company or just by independent?

Dr. Michael Koren: 28:46

Combination. Some are government-sponsored, some are drug company and a mix. A good number of them are done by drug companies, but very, very high quality and, by the way, a lot of these studies have been monitored by major academic institutions like Oxford University and Harvard and Cleveland Clinic, and typically a pharmaceutical company hires one of these academic centers to make sure the integrity of the trial is as good as possible.

Danny Chu: 29:10

But you understand why I had this question right. Most people don't know a lot of this research is done by the drug company.

Dr. Michael Koren: 29:17

Well, the drug company is required to do it.

Dr. Michael Koren: 29:19

Frankly, that's one of the reasons we're in business. They have to get an independent party to do the research. I don't own stock in drug companies, but I have to make sure that we do the research right and provide the accurate answers. So that's the beauty of what we do. So it's a great question, an important one, but when it comes to statins, it's unequivocal that statins have positive effects.

Dr. Michael Koren: 29:43

The only thing I will say about that and this is the tricky part is that if you use a statin in a 20-year-old pregnant woman who's worried about their LDL, that would be a misuse of the drug. So we know drugs have effects, but the effects will be proportionate to the risk of the patient. So if you're dealing with a 20-year-old pregnant woman, there's very little you're going to do for many, many years to reduce that person's risk of a heart attack or stroke. But you could put them at risk if they get pregnant and have a birth defect related to the drug that they're on. So again, it's a very important part of medicine is that the effect of the drugs is one thing and the patient population you apply it to is another thing, and I'll leave you with a very interesting study that was done in Hong Kong.

Dr. Michael Koren: 30:28

Actually, to go back to that, so there was an observational study that showed that there were 90-year-old women in nursing homes in Hong Kong that were avoiding eating the yolk of eggs because they were worried that they were going to get too much cholesterol. Okay, and that's not a bad thing, but the truth is that if they were 90 years old, they probably didn't have any heart issues. Chances are that the yolk wasn't going to hurt them because of how they established themselves as people that were probably not going to have that complication. So I always remind people, it's one the intervention, but also the patient population in which you're intervening. They're both critically important. Danny, thank you so much.

Danny Chu: 31:15

Oh, you're welcome

Dr. Michael Koren: 31:16

, this has been a great learning experience for me and I think we articulated some very common questions that people have and hopefully it's a little bit more understandable and what maybe seems like a paradox or disagreement maybe is not quite a disagreement when you break it down a little bit more. And I'm going to ask you one final question, based on what you told me in terms of your background Do you have a favorite physicist?

Danny Chu: 31:41

Einstein, of course,

Dr. Michael Koren: 31:43

okay, okay. Well, that's a good choice, that was a good choice.

Danny Chu: 31:46

But then Einstein will tell you without the previous giant there won't be an Einstein.

Dr. Michael Koren: 31:53

Yeah, and that was Sir Isaac Newton. If I've seen further than most, it's only because I stood on the shoulder of giants. That was Newton, who was certainly a giant, and Einstein said that imagination was more important than information. And my favorite is probably Richard Feynman, familiar with him. Oh yeah, yeah. So he won a Nobel Prize and was at Caltech for a while and he said that there is a joy of figuring things out that you can't reproduce any other way, and I think we both share that.

Danny Chu: 32:28

Yeah, I mean, like I said, this area really piqued my interest. Number one it's related to myself and I find it's kind of fascinating and you know, human body is a very complex organism that is hard to figure it out.

Dr. Michael Koren: 32:45

No doubt. Well, I appreciate you joining me.

Danny Chu: 32:47

Oh, thank you.

Announcer: 32:49

Thanks for listen to MedEvidence.