Understanding Cholesterol for a Healthier Life

TRANSCRIPT:

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Narrator: 0:00

Welcome to the MedEvidence Monday Minute Radio Show hosted by Kevin Geddings of WSOS St Augustine Radio and powered b ENCORE Research Research Group. Each Monday morning, Dr. Michael Koren calls in to bring you the latest medical updates with insightful discussions. Medevidence is where we help you navigate the real truth behind medical research, with both a clinical and research perspective. So sit back, relax and get ready to learn about the truth behind the data in medicine and healthcare. This is MedEvidence.

Kevin Geddings: 0:51

Dr Michael Koren is with us a big part of our family here, of course, at WSOS, and he is indeed a medical doctor, cardiologist, research scientist, and we appreciate him very much and we're going to talk about a couple of things quickly this morning before we get back to the music. Normally, by the way, he joins us on Mondays, but obviously that was the holiday yesterday, so we wanted to see if he could join us on Tuesday, and indeed he is. Let's talk a little bit about cholesterol. I don't think any of us listening, you know, have been to the doctor, where that hasn't been a topic of conversation, but I still think we may leave our primary care physician's office scratching our head, not quite sure you know what's good, what's bad cholesterol and why does it matter.

Dr. Koren: 1:29

Sure Well, cholesterol is near and dear to my heart, evin, as a preventative cardiologist. Hopefully it's not in my heart. So that's you know basically how we think about it. So let me just give people some basics, because there are a lot of things that are misunderstood about cholesterol. So first of all, cholesterol is an essential chemical for all animals. It's part of all of our cells. It's part of all animal cells. So when you eat something, if that something has a mother, then that something has cholesterol in it. So if it's vegetable, it doesn't. If it's something that is in the animal kingdom, it will has cholesterol in it. So if it's vegetable, it doesn't. If it's something that is in the animal kingdom, it will have cholesterol in it, because cholesterol is so important. Every single one of our cells is able to make cholesterol from raw ingredients, except for our eyelashes. It's funny, for the reason those cells evolved in a way that don't allow it to make cholesterol, but every other cell in the body makes cholesterol. So this is important. You can eat no cholesterol. You can have a completely vegetarian diet, but your body still makes cholesterol, and some vegetarians actually have high levels of serum cholesterol. That's an important point.

Dr. Koren: 2:40

The other thing is that when we're talking about cholesterol, we're really talking about something called lipoproteins. So cholesterol is a fat. We know that fat and water don't mix. We know that the blood is mostly water, so your body has to have a way for transporting cholesterol throughout the circulation, throughout the bloodstream. And the way it does it is by forming lipoproteins, which are combinations of fat, cholesterol, triglycerides that are in little packages that circulate through our bodies and go from the cells to the liver and back, and for this reason, we've learned over time that there are certain packages of lipoproteins that are more or less favorable. So when we talk about the bad cholesterol, what we're really talking about is bad lipoproteins. The one that we mostly talk about is called LDL or low-density lipoprotein, but it's not the other one. The evil twin quote-unquote of LDL is what we call lipoprotein little a, which is even worse than LDL, because it's very difficult for our body to remove that particular lipoprotein.

Kevin Geddings: 3:47

So hopefully.

Dr. Koren: 3:47

I haven't lost you yet. Are you still with me?

Kevin Geddings: 3:49

No, I am still with you.

Dr. Koren: 3:51

Okay, all right.

Dr. Koren: 3:52

So what we also know about cholesterol is that lowering it with medication and diet it's hard with diet, quite frankly, but with medication in patients who are at high risk for cardiac disease is incredibly effective medical solution for a lot of people pays dividends for people, and the class of drugs that's out there that's been now out there for oh, quite an extended period of time it really started when I began my training 35 years ago are the statin drugs, and the statin drugs are available, they're generic, they're inexpensive and they save lives, and so that should always be the first-line treatment for people that have high LDL cholesterol.

Dr. Koren: 4:36

But here in the research world we find that some people don't tolerate statins and other people need some additional help on top of statins in order for them to get their LDL or bad cholesterol levels to a proper and healthy level. And finally, statins don't do anything for lipoprotein little a, so you have to have other type of medications that treat that which we have available. So a big point of the research world right now is coming up with products that are additions to statins or are as good or better than statins. That will lower LDL cholesterol up to 90% in some of the studies we're doing right now and lower LPA up to 95%. So it's a really exciting time for us in the preventive cardiology world because we have really a lot to offer people in the research realm.

Kevin Geddings: 5:23

That's Dr. Michael Koren, of course, with us live here on the radio. He's with ENCORE Research Group. They have offices right here in St. John's County near UF Flagler Hospital. Go to ENCOREdocs. com and indeed some of the folks who are listening to us who are struggling with cholesterol levels and the like could participate in a clinical trial with ENCORE Research Group, right?

Dr. Koren: 5:42

They can, they can. We have a number of different projects in our different locations throughout Northeast Florida, so we'd love for people to come in. They can get their LDL cholesterol check, which most primary care doctors will do. But the thing that is a little bit harder to get access to is something called the lipoprotein little a, and not all physicians are fully aware of that yet. They will be in the next few years, but because we don't have anything in the market that specifically treats that, that's usually left to the research realm for a lot of physicians.

Kevin Geddings: 6:14

Okay, and I guess a lot of our listeners too, myself included. I've been on a statin for 22 years now.

Dr. Koren: 6:30

As a matter of fact, statins will get you up to maybe 40 or 50% LDL lowering, but they don't go beyond that. So if you need more than, say, 50% LDL lowering, which some people do need, then you need to use something in addition to statins. Maybe six weeks ago you interviewed me at the American College of Cardiology meeting in Atlanta and I was speaking there about the fact that most doctors do not use any drugs in addition to statins, even when it's indicated for their patients, for a number of reasons. One is the cost. Actually the newer drugs are quite expensive, but of course that's not an issue in the research realm, where we have study grants that cover all the expenses. But getting back to your statins, only get you to a certain point.

Kevin Geddings: 7:45

And speaking of all this medical and good health information we put out there, there's a great website that people should check out too, right, Dr. Koren?

Dr. Koren: 7:51

Yeah, that's our MedEvidence platform, which we're getting just rave reviews about. I'm really excited about it. In MedEvidence you can really get really important insights into a lot of medical issues. We probably have several hundred podcasts on it at this point. A lot of local experts have been participating and what we do on that is have a discussion. So when you look up something on Google, you're typically going to get something back where somebody's trying to sell you something. On MedEvidence, we talk about the issue.

Dr. Koren: 8:28

We talk about what we know, what we don't know and how we're going to find out about the things we don't know, and it's a very sincere conversation, usually between two physicians. I've led a lot of the sessions myself and people are just raving about it, so I'm getting more and more requests to do different podcasts about different areas, and we encourage people to take a look at it and see if they like it.

Kevin Geddings: 8:48

Yeah, it is a great website. Once again, medevidence. com, medevidence. com. I encourage you to help us spread the word if you will take a look at it and then share it with some other folks, and that would be a good thing to do for them as well. So, Dr. Koren, any closing thoughts before we let you go?

Dr. Koren: 9:06

If you don't know your lipoprotein little a level, get it checked out. And if you're interested in research, even if you're healthy, you're a healthy person just on a statin we have a program for you that you might be interested in.

Kevin Geddings: 9:21

Yeah, go to the website ENCOREdocs.com. That's ENCOREdocs.com spelled with an E.

Narrator: 9:39

Okay, sounds great. Kevin, have a great week. Thanks for joining the MedEvidence podcast. To learn more, head over to MedEvidence.com or subscribe to our podcast on your favorite podcast platform.