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Peter Attia MDPeter Attia MD

#52–Ethan Weiss, M.D: Cardiovascular disease and growth hormone—two surprisingly interrelated topics

Original release date: 5/6/19 In this episode, Ethan Weiss, Hopkins trained preventative cardiologist at UCSF, discusses two topics that on the surface may seem unrelated which is cardiovascular disease, and the role of growth hormone and IGF in disease. Ethan provides a masterclass in everything from acute coronary syndrome to all of the complex nuances around stent placement, as well as how calcium scores and results from CT angiograms shape his treatment of patients. He also shares how his idea to study the sex differences in blood clotting as it relates to coronary disease lead him to pursue the field of endocrinology, and specifically what he found with respect to the effect of growth hormone and IGF on the liver, the brain, and overall human longevity. We discuss: -Mutual love for hockey [7:15]; -Ethan’s background and interest in cardiology [13:15]; -Clinical definitions of a heart attack, clotting, and plaque: What causes the acute event? [24:15]; -Defining coronary disease and myocardial infarction: The evolving nomenclature [32:00]; -What happens when someone comes to the ER with a STEMI (ST elevation myocardial infarction)? [47:15]; -Stents [54:45]; -Treatment protocol for both acute and chronic coronary artery disease: History, controversy, and important distinctions [1:06:30]; -Using stents to treat stable angina: What we learned from the COURAGE AND ORBITA trials [1:15:30]; -The “art” of longevity: The challenge of preventative medicine and understanding risk [1:31:45]; -Understanding CAC scores, and CT angiogram results [1:40:15]; -How sex differences in clotting and heart disease got Ethan interested in growth hormone and IGF [2:01:00]; -Impact of growth hormone on the liver [2:07:00]; -Growth hormone and insulin sensitivity [2:18:00]; -The role of GH and IGF on chronic disease and cancer [2:23:30]; -Will taking growth hormone promote longevity? [2:32:30]; -GH and IGF as a treatment for early stage dementia? [2:34:30]; -What happens to IGF while fasting and what about fasting improves longevity? [2:35:15]; -The importance of becoming scientifically literate and making science more exciting for future generations [2:38:30]; -Ethan’s new company: Keyto [2:43:45]; and -More. Show notes page: https://peterattiamd.com/ethanweiss/ About: The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 10 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Peter is the founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City, focusing on the applied science of longevity. The practice applies nutritional biochemistry, exercise physiology, sleep physiology, techniques to increase distress tolerance, lipidology, pharmacology, and four-system endocrinology to increase lifespan (delaying the onset of chronic disease), while simultaneously improving healthspan (quality of life). Learn more: https://peterattiamd.com/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Play: http://bit.ly/TheDriveGooglePlay

Peter AttiahostDr. Ethan Weissguest
Jan 10, 20202h 54mWatch on YouTube ↗

Summaries, chapters, transcripts, and FAQs on this page are made by uListen, not YouTube.

At a glance

WHAT IT’S REALLY ABOUT

Cardiologist Ethan Weiss on Stents, Calcium Scores, and Growth Hormone Biology

  1. Weiss explains that heart attacks mostly result from ruptured plaques that trigger clotting, and that ST-elevation heart attacks call for immediate artery opening while stable angina is largely a symptom-management problem.
  2. Trials such as COURAGE and ORBITA, along with the evolution of drug-eluting stents and antiplatelet therapy, led Weiss to try medical therapy first and keep stenting for patients who still have symptoms or can't tolerate the drugs.
  3. On prevention, both men say calcium scores are most informative in young people with calcium and older people with none, that CTAs add detail but cost and anxiety are drawbacks, and that HeartFlow has not changed their practice.
  4. Weiss describes lab work on growth hormone signaling showing that knocking out Jak2 in liver cells causes massive fatty liver via CD36, and that blocking the pathway in fat cells produces profound apparent insulin sensitivity through shutting off liver glucose production.
  5. The conversation closes with views on growth hormone and longevity, the need for better science education, and Weiss's new breath-acetone ketone sensor company, Keyto.

IDEAS WORTH REMEMBERING

5 ideas

Most heart attacks come from ruptured plaques, not simply total blockage of a narrowed artery.

Weiss says about 99 percent of heart attacks result from a ruptured plaque exposing blood to tissue factor, and that fatal ruptures often occur in arteries narrowed only 30 to 40 percent.

Opening the artery clearly saves lives in STEMI, but benefits in stable angina are mainly about symptoms.

Weiss says there is little debate about mortality benefit in STEMI, while COURAGE and ORBITA suggested stenting stable angina does not reduce heart outcomes and may offer limited symptom benefit beyond optimized medicines.

Patients with stents must take their antiplatelet drug without fail.

Weiss explains that stent thrombosis can be life-threatening, and he tells patients that for the first months, taking Plavix every day is what matters most.

A calcium score of zero is only informative in context of age.

Both men say a zero score tells you little in a young person but is quite informative in someone over 70, while calcium in a young person is a meaningful signal.

Prevention in cardiology rests on judgment rather than trial evidence.

Weiss and Attia argue that clinical trials give averages and prevention trials would take decades, so decisions are evidence-informed art, and success in prevention is only visible as an absence of events.

WORDS WORTH SAVING

5 quotes

I love it when I'm wrong. And there have been a few examples this year where I've been wrong, brutally wrong, and it brings me joy.

— Dr. Ethan Weiss

Being a preventive cardiologist is... no one should feel sorry for me. I have the best job in the world. But it's difficult in that we only know success by the absence of failure.

— Dr. Ethan Weiss

It's the science and art. You're informed by science, but in the end, this still comes down to an art.

— Peter Attia

An inability to understand science makes you a victim for the rest of your life. Whether you want to admit it or not, if you can't at least have some understanding of science and think critically, you are going to be overrun with propaganda and nonsense.

— Peter Attia

If biology teaches us anything, it's to stop acting like we know what we're talking about.

— Peter Attia

Plaque rupture and acute coronary syndromeSTEMI versus stable angina managementStents, drug-eluting stents and PlavixCOURAGE and ORBITA trialsCalcium scores, CTA and HeartFlowGrowth hormone, IGF-1 and fatty liverKeyto ketone breath sensor

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