Know Your Numbers: What The Numbers Mean and Why They Matter

Transcript generated by AI.

 

Announcer 0:00

Welcome to the MedEvidence Podcast. This episode is a rebroadcast from a live MedEvidence presentation.

Rich Jones 0:06

Welcome to our very latest MedEvidence Live with Dr. Michael Koren. This is all about knowing your numbers and more important, the second part of that, which is what they mean. That's really the most important part. I want to introduce our star of the show, Dr. Michael Koren, Chief Scientific Officer, Flourish Research, practices cardiology, and founded the ENCORE Research Group. You've conducted over 2,500 clinical trials at eight locations in Florida.

Dr. Michael Koren 0:31

Not at the same time, though.

Rich Jones 0:33

That's incredible. So, real quick plug for the clinical trials. Like this is impactful stuff. What are you doing in getting this clinical trial information overall?

Dr. Michael Koren 0:42

We changed the way physicians practice medicine on a daily basis. So our group has been very involved with a number of very high-profile development programs. A few would be Ozempic, if you've heard of that drug. Well, we were involved with that. You've heard the drug called Lipitor, we've been involved with that. And literally, if you name a brand name drug that you all know about, chances are we touched it over the last 30 years. So that's what makes a difference. And it's not just about drugs, by the way. We've helped improve surgical techniques, we've helped improve laboratory data, we've helped people do new things, and we can talk maybe a little bit about that, which is now the exciting world of gene editing and how we can change the way our genes are expressed. We've done work in that and we will be doing more of that.

Rich Jones 1:26

So this is about knowing our numbers. And we do that about every year here at our radio station where we get to have the blood drawn and then we get the report back. And unfortunately, I only get numbers and I don't really know what they mean when they come back for me. So that's why we're here today.

Dr. Michael Koren 1:40

Well, thank you. So, first of all, thank you for having me, and thank you for hosting Med Evidence! And this is actually groundbreaking. We're medical pioneers here because what we're going to do today is we're going to actually have real patients sit with me and go over their numbers together. And I'm finding that it's a great way to educate the masses. And we were just talking about this before. It's just the way the human brain works. Have you ever been in a restaurant where you're having dinner with your family or friends, and there's people next to you maybe talking a little bit too loudly, but you know, they think they're whispering. And then you hear something, well, I think that Uncle Tony is having an affair, and and Aunt Mary is not very happy about this, right? And you can hear that even if it's three tables down, because something about our brain is always thinking about what other people are doing and analyzing it. We can't help it. It's it's how we're wired. And so my thought is that if we can have everybody eavesdrop on a conversation between a doctor and a patient and actually go through the numbers and go through the details, there may be no better way to learn than that. And that learning can then be applied to you. Now, obviously, everybody is different, and in medicine, we have to be very respectful of privacy, and you'll see that I will deal with that before anybody comes up and talks to me. But hopefully, this is an experiment, a media experiment that will be successful and we'll be known for this new way of presenting medical information.

Rich Jones 3:05

And you are a part of that. How about that?

Dr. Michael Koren 3:08

Exactly. So and this is what we do in research is that we look at new ways of doing things, and we always try to get better and better at what providing our patients. So without further ado,

Rich Jones 3:19

I I think you're gonna have a quiz for me, aren't you? You always start with a quiz, and you always call me out because I get it wrong all the time.

Quiz On Cholesterol Signs And Statins

Dr. Michael Koren 3:25

Well, that that's the other concept. You may think that you're getting a free lunch. Sorry, there is no such thing as a free lunch. Don't let anybody tell you it's a free lunch. Even if you're not paying for it, it's not a free lunch. There's always an obligation. And so our obligation is that we need information from you. And part of this is just an assessment of what people know and we don't know. But while we're getting that information, we can have some fun, right? Yeah. So that's what we try to do with these med-evidence questions. These are now world-famous questions. So here we go. Here's the first one. Which of the following should scare you as a high cholesterol warning sign? Is it xanthomas or yellowish fatty deposits on skin or around the eyes? Is it chest pain or discomfort during exertion? Is it erectile dysfunction in men? Is it peripheral ar terial disease or claudication? Is it cognitive difficulties outside of failure to address honeydew lists? Or is it all the above?

Rich Jones 4:27

All of the above is what I'm hearing from everyone.

Dr. Michael Koren 4:28

So I've already assessed that we have a really smart audience. And you got that right too.

Rich Jones 4:33

Oh, thank you.

Dr. Michael Koren 4:35

But it absolutely, all these things could be reflections of vascular disease. And just quickly, xanthomas are these little deposits of cholesterol that typically form underneath your eyes, but they can form on your elbows and other tendon surfaces. Very what very good way for a doctor at a grocery store to diagnose somebody with high cholesterol. And I can't, I have to admit that I've stopped people in line at different places and say, Do you ever get your cholesterol checked? And most of the time they know about it, but I've had at least a dozen people in the last five years who did not know about it. And actually, I think I did something to help their health by just bringing it up to them and people appreciated it. Nobody has hit me with their shopping bag yet, so that's a good sign. Chest pain or discomfort during exertion, of course, can be coronary artery disease, which could be a cholesterol manifestation. Erectile dysfunction in men, that's plumbing. For plumbing, you need blood flow. For blood flow, you need your vessels to be healthy. And cholesterol makes blood vessels less healthy, so that could be a sign of a problem. Peripharterial disease or blockage in the leg arteries, of course. A cognitive thing, obviously, your brain needs this blood supply. So if you're having cognitive difficulties, one of the first things we look at is your vascular disease health and your cholesterol level, since it's so important in vascular disease health. And then, of course, uh, there are a lot of other manifestations, but these are just some of them.

Rich Jones 5:49

Is there any one that's most common that you're seeing or that the trends have been changing at all?

Dr. Michael Koren 5:53

It depends on the patient population. So that's why you get to the individual people and you get an insight into what's most important in that individual. So let's see, I think we have another question. Okay. Why do doctors treat with statin medications? Okay. So I'm gonna for this one, I'm gonna have you raise your hand if you think it's the answer is yes. Okay, if you think it's no, you can keep your hand out. Here we go. Do we do it to treat a family history of heart disease? Raise your hand if you think that's right. Okay. To treat low HDL cholesterol. Does anybody think that's right? Okay. To treat high blood pressure. Does anybody think that's right? Couple there? Okay. To reduce heart disease and stroke. Okay, yeah, all the hands should be up for that. Or E, would you expect otherwise from a doc who grew up on Staten Island? Which which I have to say that semi-proud member of the New Dorp High School class of 1977 from Staten Island. Oh so it I was destined to be a cholesterol expert growing up on Staten Island. Well,

Rich Jones 7:05

let me go back and I'll also raise my hand for D, I guess. Right. I like E, that's good though.

Cholesterol Basics And Lipoproteins

Lipoprotein(a) And What It Means

Dr. Michael Koren 7:09

Well, the answer is, of course, D. And you guys, you did a good job. Thank you. And let's see, we have one last warm-up question here. What is cholesterol? Is it A, an essential molecule for cellular structure and function? Anyone want to say yes to that? Okay. Is it B a waxy, fat-like substance that does not mix with blood outside of a lipoprotein? Okay, we've got a few yeses for that. Is it a modified cardiovascular risk factor for heart disease and stroke? Okay. Is it a pension plan for cardiologists? Or is it all the above? And I would agree with that. All right, so I thank you for participating in those questions. So now we're gonna get into some of the concepts here. Why does cholesterol matter? It's essential for many body functions. What most people don't understand is that cholesterol is so important to cellular function and to animal life, that every cell in our body can make cholesterol from basic ingredients. You don't have to ingest cholesterol, your body makes it. And a misconception, including a lot of doctors don't completely understand this, is that the stuff in our circulation that we measure is the extra stuff that our body has to get rid of, not what we need. So it's a fundamental principle, and understanding that is super important. These are just some of the things that it does. It builds our cell membranes. All of our cells require it. It's the precursor to vital hormones like estrogen and testosterone and cortisol. The body needs it for vitamin D, and it's also necessary for bile acid synthesis for digestion. So again, cholesterol is absolutely essential molecule. And the stuff that we measure is the extra stuff. And if you have too much extra stuff, you get into trouble. So everybody should be thinking in those terms. Next, you talk about the good and the bad, and this is something that most people have a sense for but don't truly understand. So cholesterol is a fat. Does fat and water mix? No. No, right? So how do you get cholesterol from the cells out of the body when it has to go through an aqueous or water environment, the blood? How do you do that? You do that using something called a lipoprotein, which is a combination of a fat, lipo, and protein protein. And the lipoproteins that you've heard of, there's a bunch of them, but the two major ones are LDL, and that's the bad cholesterol, because that does damage when it gets into high concentrations. And there's HDL, which is a good one, and it's good because that recycles cholesterol really, really quickly. So the more HDL you have, the better your body is to get rid of cholesterol. The more LDL you have, the more challenge your body has to get rid of cholesterol. So you can think about it in those terms. Okay, there are other fats. You've probably heard of triglycerides. So that's a fat that your body uses primarily as a store of energy. So any calories that you eat that you can't use right away get turned into triglycerides and then ultimately into fatty acids, and these get placed into your fat cells. They're called adipocytes. And a lot of uh problems with diabetes and other things is related to adipocytes not doing what they should be doing or overwhelming the adipocytes because you're eating too much carbohydrates typically, since that drives triglycerides more than anything else. Lipoprotein(a) is another one. Out of curiosity, who's heard of lipoprotein(a)? Okay, that's pretty good. So we're doing a pretty good job, MedEvidence crew. About half the people have raised their hands. So you might not have heard that much about that because we didn't have any way to treat that until very recently. So as we speak, we have six projects in research on how to treat lipoprotein little a. There's nothing on the market right now that is particularly good at it. And because there's no good treatments, a lot of doctors haven't really focused on it. But in the research world, we focus on it because we have a lot of products in development at different stages. Some are actually in late stage three development, meaning they're within a year or so of being approved. And we have others that are in earlier stages. But this is going to revolutionize treatment. And within two or three years, everybody will know about lipoprotein(a). This is a genetically determined lipoprotein, lipid, fat, and protein, that is a problem in about 15% of the population, and it runs in families. So if you have a family history of somebody who died of a heart attack, a stroke before the age of 65, and you do not know your lipoprotein little a, you should give us a call. Again, that doesn't mean you have to be in a clinical trial. We may have a clinical trial for you, we may not, but you should know that number. And it's a number that your primary physician may not be particularly focused on because, again, in the general physician population, there's no easy way to treat this, but we can treat it in research. And the reason this is a challenge, it's a form of LDL cholesterol that your body can't get rid of. So the receptor on the liver that's responsible for removing LDL does not work for lipoprotein(a). And that's why we need medicines that do something different.

Rich Jones 12:15

So you think maybe two to three years we're close to that kind of medicine coming on the market?

Dr. Michael Koren 12:20

I do, yes. So we're excited about that. And again, this will be another medicine that we had a big part of. In fact, one of my accomplishments was that I was the first author of the first international publication on a drug called. Yeah, I'm trying to remember who has a trade name yet. I don't think it has a trade name yet, but Olpasarin is the generic name. And Olpasarin is a drug developed by Amgen that will probably be on the market within two years. It should have a trade name very shortly. Okay. Uh the best clinicians take an aggressive approach to lipid treatment. So when we talk about lipids, generally we want them low, except for HDL, which we want high. Unfortunately, HDL is one of those lipids that you really can't do a whole lot about. You're kind of genetically determined to have a certain level of HDL. But LDL is something that we can lower quite aggressively and successfully with many, many different drugs, including statins, PCS K9 inhibitors, bempadoic acid. There's a bunch of drugs in the market that are very good at lowering LDL, the bad cholesterol. Not Lp(a), but LDL. And so the key numbers that we look for when we advise patients is getting these to an optimal level. Although that optimal level is different for different patients. So for example, total cholesterol should in general be below 200. But if you have had bypass surgery, you may want that number around 100. The LDL cholesterol should be less than 100, but again, if you've had a stroke, you may want that below 50. If your HDL cholesterol is above 60, then you're genetically blessed. But it's hard to get there. You get a little bit higher with exercise. Drinking red wine brings it up a little bit, but the fact is that it's really hard to move. Triglycerides is less than 150. Again, some people are genetically predisposed to have higher levels than that. But alcohol and carbohydrates raise that number. And that's actually very dependent upon people's diets, and it's actually very responsive to your diet. And then finally, we look at certain things that are ratios. And the concept of ratio is that if the good is higher than the bad, then you're in good shape. So even if your bad is a little bit higher than it should be, it could be compensated by having the higher levels of the good cholesterol.

Rich Jones 14:33

I'm sitting here thinking about how you consume the news that sometimes we'll do, because you mentioned that little bit of glass of wine, red wine. Yeah. How many times do we hear, like, oh, a little bit of uh coffee will extend your life by blah, blah, blah, or a little bit of wine will do this. And as a doctor, you're in your car and you're listening to something like that. Are you just rolling your eyes ready to drive off the road, like, no?

Myths And CAC Scores Explained

Dr. Michael Koren 14:52

Well, yes and no. So usually the advice has some grain of truth, but the advice is not geared toward individual patients. So, for example, if you have AFib and you're sensitive to caffeine, you probably should drink no coffee. On the other hand, a little bit of coffee is probably not bad for most people. Alcohol, we know that alcohol, even at low doses now, raises your risk of breast cancer and colon cancer and other cancers, but it actually lowers your risk of heart disease a little bit. So if you're if you're at more risk for breast cancer, maybe alcohol is not great. But if you're at more risk for heart disease, maybe a little bit of alcohol is good. So you always have to take the general advice and apply it to the individual. Okay, cholesterol confusion, myths versus facts. Only overweight people have high cholesterol. Well, no, anyone can have high cholesterol. In fact, some some really skinny people can have incredibly high cholesterol. Two, I eat healthy, so my cholesterol numbers must be fine. Myth. As I said, your body makes cholesterol. And so the amount that you eat is usually a relatively low contributor to the overall cholesterol levels. You can feel it when your cholesterol is high. But you can feel it when you have a heart attack, which may be due to cholesterol high, but you can't feel the cholesterol. Okay. Eggs in dietary cholesterol cause high cholesterol. Well, that's a little bit of a half-truth. So again, if you ate 100 eggs a day, your cholesterol is going to go up. Yeah. Okay. So at extremes, it will. But at moderate levels, it has less of an impact. Okay. So it's all about the dose, we like to say. So, you know, it's interesting. Uh there was a study that I read years ago about 95-year-old Asian women who are not eating egg yolks at the nursing home because they're worried about their cholesterol level. Well, they probably don't need to be worried. But on the other hand, if you're 16 and you've had a heart attack, well, there's a certain amount of egg yolks for the cholesterol. There's no cholesterol in the white part, that's the albumin, but the egg yolk is where it is, that can contribute. So it's a little bit of a subtlety here that's based on the individual. But the other point here is that you actually generate more cholesterol from saturated fat consumption than cholesterol consumption. So if you have that big juicy steak with a lot of grizzle on it, that grizzle is going to raise your cholesterol a lot more than eating a egg yolk. So saturated fats is actually the worst of the things that you can eat because that will cause your body to make cholesterol. If my HDL is high, I don't need to worry about my LDL. Again, it's it's in proportion. So if you're H if you're blessed to have an HDL of 80 or 90, well, you could probably tolerate higher levels of LDL. But if you have an HDL of 80 and your LDL is 200 and you had a heart attack, well, it doesn't matter. You need to deal with your LDL. And again, LDL alone does not cancel out high HDL, but it is something that is helpful. And again, heretofore, treatment of LDL cholesterol has been our primary therapeutic driver because we know that we can get it down. We have lots of ways of getting it down. And two, getting it down works. So study after study after study after study have shown that getting that LDL cholesterol reduces heart attacks and strokes. Okay. Audience question. I think we originally launched this on Halloween, so we said which of the following might haunt you? Okay. Is it A, HGL level that equals your LDL? Does that haunt anybody? Good, because that's that would be healthy. A low lipoprotein(a) count. Does that haunt anybody? No, that would be good. A high CAC score for your age. Caronary artery calcium. Is anybody haunted by that? Sounds a little scary. Okay, well, I like that. I think your instincts may be correct. A strong family history of art attacks or strokes. Absolutely. Okay. And visiting a cardiologist. That should haunt you.

Shawn Knight 18:55

We like you.

Dr. Michael Koren 18:55

Okay, well, I appreciate that. Okay. So let's see. Let's see what the answer is here. But there's actually two answers. There you go. So you guys were right. So a high CAC score is actually a way of looking at the amount of coronary calcium on the coronary arteries. And your body is constantly trying to heal the damage caused by high cholesterol. And the CAC score, the calcium score, gives you the history of what your body has done. So typically, most people who are 50 years old or less don't have any calcium in the cornear arteries. So if you have calcium on your coronary arteries before 50, you already have a problem. And you should take that seriously. You get to around 70 and yet you have the CAC score in single digits, you're probably okay. But if you're 70 and your CAC score is 100 or more, then you need to take some notice. If your CAC score is over 400, chances are you have a pretty severe problem. So CAC score is actually a very effective way of looking at prognosis.

Rich Jones 19:50

I don't know that I've ever heard CAC score before. Is that common when we're getting our blood drawn? I mean, I know HDL and LDL, but..

How Low Should LDL Go

Dr. Michael Koren 19:55

CAC score is a CAT scan. It only can be determined by CAC scan, CAT scan, but it's a CAT a CT scan or a CAT scan that does not require contrast. Okay. And it's inexpensive. So insurance sometimes pays for it, sometimes not, which is why it's a little bit hit or miss. But you can literally get one at an imaging center for a hundred bucks. Okay. Okay. So ask your doctor about it, but if you're concerned, it's a very powerful way of knowing what your risk is. And then, of course, you have a family history, you should know about that as well. For one reason, to check the lipoprotein(a), but there's other things that you would check. But also just to be smart. So your genes are our destiny. And so be smart. If you have family history of heart disease, make sure that you're doing everything possible to reduce your risk of heart attack and stroke. Okay, so key principles for treating cholesterol. Pretty straightforward. The sooner the better. Don't wait, because the longer you have high cholesterol, the more vascular damage occurs. The lower the better. We all feel that we can get the LDL as low as possible. Used to be, and I still hear this from time to time, this drives me crazy if I'm in my car, that you need a certain amount of LDL. You know, the answer is you can live with zero LDL. In fact, there are people that have certain genetic mutations where their LDL is always less than 15 and they live perfectly normal lives except they don't have heart attacks and strokes. So there's no, you can't go too low on the LDL. A higher LDL offers greater possible treatment benefits. That is really, really important and maybe misunderstood. So if your LDL is 200, that's not good. Your risk is much higher at an LDL 200 than 100, but the benefit of treatment is also much higher.

Rich Jones 21:37

Okay.

GLP-1 Drugs And Research Frontiers

Dr. Michael Koren 21:38

So don't freak out, but make sure you get treatment. The greater the risk for atheroscratic cardiovascular disease or ASCVD, the greater the treatment benefits. And that's absolutely true. So if you are a 95 year old Asian woman in a nursing home that's never had a heart attack or stroke, well, I can give you stents, but then I can do anything. If you're a 50-year-old man with diabetes, high cholesterol, and a family history and smoke half a pack a day, we can do a lot for you. We can reduce your risk in a major, major way. Okay, cardiovascular disease is statistics. So it's actually a lot of good news. This is actually one of the incredible success stories. You and I actually had a conversation about this a couple of years ago. And believe it or not, the rate of cardiovascular disease in the United States, particularly in our area, we're like sort of part of the stroke belt. Northern Florida is part of this whole kind of southern stroke belt, they call it, where you have higher risk for heart attacks and strokes. The risk of heart attacks and strokes has gone down by 60% over the last 30 to 40 years. But here's the you know, other incredible statistic. Even though it's gone down by 60%, it's still the number one killer of Americans. And women, Americans, uh both men and women, yes, absolutely. So for that reason, we have more work to do. But it's it's amazing that we've done a lot, and that should give you confidence that what we're talking about should have continued benefits over time. The bad news 92 million Americans still affected, a death every 40 seconds, one-third of all U.S. deaths, 60,000 US deaths per month. And if we don't get better at controlling the obesity epidemic, that's going to keep on going up. Okay. So again, when we talk about when we talk about treating heart, preventing heart disease, I should say, there's certain things that are in your genes that you just have to live with and try to overcome those issues versus things that are in your environment. And we'll help you with both. So we consider these the modifiable risk factors. Again, cholesterol is called lipids, and we can definitely do things that will change that. Diabetes we can treat. Being overweight, of course, is this revolution of GLP1 drugs. Our research center has been very, very involved in this. And interestingly, they started out as diabetes drugs. And I first learned about Ozempic, for example, about 15 years ago at an investigator meeting in Orlando. And I was looking at the data for the drug which is called semaglutide, and I was blown away by it. I couldn't believe how good it was. But the company that developed it called Novo Nordisk was under pressure from the FDA to show that it didn't hurt people with cardiovascular disease. Because other diabetes medications that have been developed, something like pyoglytozone, for example, or Avandia, was actually shown to keep diabetes under control, but not help heart disease. In fact, it made heart disease worse. So the original studies with the GLP-1s were about making sure the drugs were safe. But lo and behold, we did these safety studies and we're seeing fewer heart attacks, fewer strokes, of course, people losing weight, their diabetes was better. But also compulsive behavior started going away. A bunch of other things happened. So it's really a wonder class of drugs that is still being developed as we speak. And we have studies as we speak trying to help uh patients with heart disease overcome their risk through these GLP-1 mechanisms. So, for example, we have a study as we speak for people that may have been diagnosed with congestive heart failure that get a shot, it's once a month instead of once a week for the GLPs. So there's all kinds of neat things, and again, all these things are free of charge and super interesting. So we encourage people to look at that. Lack of physical activity is a huge issue that we try to help people with, unhealthy diet, of course, smoking, high blood pressure, and stress. Stress is sometimes hard to mitigate, but we'll we'll try to help you with that. But these are all considered modifiable risk factors. We can change them. And then, of course, there's some things that we can change. Your family history, you can't change. I always like to tell people one of the most important things in life is to pick good parents. And fortunately, we have a limited ability to do that, but we'll try to help you overcome that. Uh, your age is uh something that a lot of people have tried to reverse. I've gone down to St. Augustine to the Fountain of Youth. It has not worked yet. I still get older, but I'll keep on trying. Uh there was a comment about you know sex and gender. Women definitely are at risk for heart disease, but they lag men by about a decade. And there's probably some protective effects of female hormones. Interestingly, there was a big clinical trial done about 40, 50 years ago where they gave men estrogen to see if you can turn men into women. Does that sound familiar? And whether or not that would help their heart disease. Okay. And you know what happened? The men died. I kid you not. The study was stopped because there was an excess of men who died from estrogen. Okay, so there's a lot of complexity to that to medicine, it's not what you think, but literally, that was a that was an NIH, a US government study to give men estrogen to prevent heart disease, and it felt miserably. And the other thing we like to talk about is weather. Believe it or not, weather has a big impact on health. So you like after hurricanes, after earthquakes, or after all these natural disasters, there's always an uptick in cardiovascular disease complications. You can't change that. Although Rich, I know you're working on that.

Rich Jones 27:03

Trying. One question that I'm wondering, going back to like the Ozepic and all the GLP-1 drugs that have come up, do you think that long-term, like over the next decade, we're likely to see the number of heart attacks dramatically decrease as a result of not just the weight loss, but to your point, the behavior changes and all the other modifying factors that are there?

Dr. Michael Koren 27:22

Well, they are they are going down. So if you actually look at the statistics, there was a huge drop in cardiovascular death between 1980 and about 2010. Yeah. And that was pretty steep. But then between 2010 and 2023, 24, it was really flat. We weren't making a dent. And there's a number of reasons for that, which will be another lecture.

Rich Jones 27:42

Yeah.

HS-CRP Inflammation And Better Targets

Dr. Michael Koren 27:42

But now we're starting to see maybe another uptick, and one of the theories is that the GLP-1s are starting to kick in and having public health benefits. That's a great question. And so this is uh really about I'm not gonna go through all this, but to point out that if all these drugs on this map, we've touched and researched pretty much, with maybe a few exceptions. So there's a it's been a remarkable road. And right now we're dealing with these really cool concepts, or which are a new class of drugs, one is called obacetrapib, which is a whole new class of drugs that we're working on now. Uh, we're working on what's called small interfering RNA molecules, we're looking at drugs that reproduce the things that injections do now. So if you've heard of Repatha, for example, we have studies that are trying to find an old an oral form of that. And as I mentioned, we're about to start the first gene editing studies for cholesterol problems in the United States, our center here in Jacksonville. So we're the the contract is actually on my desk to sign today. So we're excited about that. So you'll probably be hearing a lot. Maybe we'll do a show, but just about that because it's such an exciting area. And if you've heard of CRISPR, but there has been a product of gene editing that's been approved by the FDA. CRISPR has a product for treating for treating sickle cell anemia that's on the market. And we'll be working potentially with CRISPR in the near future to bring these type of studies for cholesterol issues to Jacksonville. So we're excited about that. All right. And the other thing I'm gonna mention before we bring our patients up is this concept of hsCRP. Who's heard of that, out of curiosity? Just one. And our recruiters in the back, uh, if you hadn't heard about it, I'd be really, really disappointed. Anyway, so we need we need to do some work to get you to know about this a little bit more. But this is actually a marker of inflammation. And I did a recent podcast with Paul Ritker, who's actually one of my medical school classmates, and is the world expert on CRP. So check out MedEvidence Podcast, you can learn more about it. But basically, the hsRP is more predictive than your LDL level for determining if you're likely to have a heart attack or stroke. And Paul published data recently that looked at young nurses, you know, nurses in their 20s, 30s, and 40s, and their CRP level at 20s, 30s, and 40s predicted who was gonna get a heart attack at age 60.

Rich Jones 29:58

Wow.

Real Patient Numbers With Sean

Dr. Michael Koren 29:59

So super interesting research, and we have some studies that are looking to mitigate that. And statins, for example, lower CRP. And that's believed to be one of the mechanisms by which they benefit people. So and that's a quote from Paul. CRP was a stronger predictor for risk of future cardiovascular events and death and cholesterol assessed I LDL. So check this out and you'll hear more about this story. All right, back to the audience questions. We we gave you that little tidbit because it'll help you with the answer to this question. Okay, what treatment goal best reduces heart disease or stroke? So, what should you be looking to be at in terms of knowing your numbers which have the lowest risk of heart disease and stroke? Is it one and HDL less than 40 and a CRP greater than two? Is it two, LDL less than 70, and HhsRP less than one? Is it LDL less than 120 and triglycerides less than 150? Is it LPA less than 100 and LDL less than 100? Oh, give the answer. Okay, show of the hands. Okay, yeah, the answer is two. Yes. Yeah. So the concept here is that the LDL and the hsCRP together are the ones that are most predictive of prevention and the success of treatment. Okay. So now we're gonna get into our new concept. real people, real results, real-time physician insight.

Rich Jones 31:33

So you can hear him on our partner station, Hot 106.5 every afternoon. He is all over social media as well. You can see him here in the Farah and Farah Performance Studio as well, as we do quarterly events with the Hot 106.5 team. Ladies and gentlemen, Sean Knight.

Shawn Knight 31:50

Thank you, fine people. Yeah, let me just tell you, I am not a fan of needles, even though it was a little small one, but yeah. I was very intrigued by knowing my numbers. I just turned 50 in January. I know I don't look my age, that's a superpower, but I was more intrigued with knowing my numbers as now I'm I'm getting older. That's that's a harsh reality, and I wanted to dispel the myth that African American men they are concerned about their health. So, and and I've had some close friends and colleagues, just a colleague yesterday said that he had a stroke. And so that was more of an alarm to go off. It's like, I'm getting older. I want to make sure that I know my numbers so I can make sure that I can prolong health and life as much as I can. So here we are.

Dr. Michael Koren 32:43

Well, Shawn, thank you for being a volunteer here. And you know, in medicine, as you well know, we're very concerned about privacy, and this is not a private setting. This is a very atypical setting for a doctor and a patient to have a discussion. So before we move forward, I want to make sure I have your permission to discuss things openly.

Shawn Knight 32:59

Yeah, we're fine.

Dr. Michael Koren 33:00

Okay. And if there's anything, any questions I ask that make you uncomfortable, you want to take it offline, you you can do that.

Shawn Knight 33:07

Okay.

Dr. Michael Koren 33:07

You can stop at any time. It's you know, you you you're in control here.

Shawn Knight 33:11

Okay.

Dr. Michael Koren 33:11

Okay. But our goal is also to educate. So again, we're gonna use your numbers as a way of educating the entire room, as long as you're comfortable with that.

Shawn Knight 33:20

Let's do it.

Dr. Michael Koren 33:20

All right, here we go.

Shawn Knight 33:21

The point of no return.

Dr. Michael Koren 33:25

Okay. So we're gonna review these results. So, first of all, a remarkably handsome, 50-year-old gentleman with a-

Shawn Knight 33:33

-whoever said that lunch is on me.

Dr. Michael Koren 33:35

Currently, this gentleman is on Lisinopril 20 and Amlodipine 5. Those are two blood pressure medications. Is that accurate? Uh, speaking about you personally, but just from the standpoint of of handsome, wonderful people.

Shawn Knight 33:49

Yes, yes. Um, that that is accurate.

Dr. Michael Koren 33:51

Okay. And there was uh you know other medications, and the most recent blood pressure assessment was 146 over 90. We'll get to that in a second. And these are the numbers. So do these numbers look familiar?

Shawn Knight 34:03

Yes, these numbers look familiar.

Dr. Michael Koren 34:05

Okay. So let's let's dig into this a little bit. So the first number is total cholesterol. And as I mentioned, this is the amount of cholesterol in the blood, not in the whole body, because you're cholesterol is everywhere in your body. Right. And this is the stuff that your body's putting into the blood and measuring it, and the units always better very much, and I always like to point this out. This is milligrams per deciliter. Basically a tenth of a quart. Okay, so there's a number of milligrams, which is a weight, of cholesterol in a tenth of a quart of blood. And yours is 238. The lab sheet says the gold is 200. That may be it, or maybe even lower than that. We'll get to that in a second. Okay, LDL, as I mentioned, is a lipoprotein. We talked about that before, a combination of cholesterol and other lipids, and a protein. And that allows cholesterol to circulate and go from the tissues to the liver, where it's removed by the liver through something called the LDL receptor. So your number is 145, and an ideal number according to lab is 100. Again, that could be even more less. HDL is the good cholesterol. That's another lipoprotein, and that's really efficient at delivering cholesterol to the liver through a receptor called the SRB1 receptor. And through that receptor, there's a very rapid transport of cholesterol. We call that reverse cholesterol transport. And having a high number is good, and you have a high number, so you pick good parents. Congratulations.

Shawn Knight 35:33

Thank you, God. Thank you.

Dr. Michael Koren 35:35

And so you can see that the goal there is to be over 60 and you're at 84. So 84 is a really, really good number. And actually, maybe at best, 10% of the population is going to be over 80. So you're in a relatively good group from that standpoint. Then we have triglycerides, and as I mentioned, it's another form of blood fat, which is an a quick energy type of blood fat that your body uses for a quick energy. And again, there's an interesting relationship. People that have low HDL tend to have high triglycerides, and people with high trig with high HDL tend to have low triglycerides. So you're blessed again that you have this combination of high HDL and low triglycerides. So that's that's a good thing. And you can see you're definitely below the goal there. And then the non-HDL is related to the fact that total cholesterol, that top number, is related to the other numbers by a formula. It's a formula we call the Friedewald formula. And what basically the non-HDL is, is you take that total cholesterol and you subtract HDL. So 238 minus 84 should be approximately 155. So this is our way of checking on the lab. And if you do the math, you can see it's actually 154 based on these numbers, but rounding errors. So the lab actually did it right. By the way, really good lipid people know to look for that to see if the lab is on track. And also to see what formula, if they're using a formula, is the right formula. So again, this formula is called free-level. In your case, it was done correctly. And the non-HDL is simply, they didn't even need to list it. It's a very simple math equation of the total cholesterol minus the HDL. And then you have the triglyceride to HDL ratio, and that you know ideally that would be less than three, and you're again in a good ballpark because your HDL is so high. So again, because of your good parents, your HDL is high and that ratio is low, which reduces your cardiovascular risk. And then A1C is a measurement of the amount of glucose in your circulation, and yours is 5.6, and that's you know upper limit of normal. So you're not on the verge of diabetes. So that's good. And it's a number of number of things that we look at. So those are those are the numbers, and I know we have okay, so that's the next case. So let me let me ask a few questions. And again, if you're uncomfortable with any of these things, you just tell me. But I'm curious, have you had any inkling about a cardiovascular event, any symptoms of heart disease or anything that concern you?

Shawn Knight 38:04

No. If anything, there was um in January I I had like a series of of headaches, and that pretty much it was a lingering headache, and that's kind of what alarmed me to go and get checked out because it usually a headache would would not last that long. So once I started to get the once I realized that my blood pressure was high, that was something that caught me off guard because it's never been that high before. So that's where we are today.

Dr. Michael Koren 38:32

Okay. But never had a chest pain, never passed out, never had a heart attack, nothing like that.

Shawn Knight 38:36

No.

Dr. Michael Koren 38:37

Okay. Have you had had a stress test?

Shawn Knight 38:40

It's been a while. It's been a while since I've done that.

Dr. Michael Koren 38:42

Okay. How long ago would you say?

Shawn Knight 38:44

Maybe five, ten years ago.

Dr. Michael Koren 38:46

Okay. So again, without getting into a lot of details, I have a couple of observations. I assume you never had a CAC score?

Shawn Knight 38:52

No.

Dr. Michael Koren 38:53

Okay. So you have LDL level that's above where it should be, but you have a good HDL. So the question is, would we put somebody like you on a statin or would we recommend an aspirin? So a couple other questions to make that decision. Tell me about your family history. Anybody die of a heart attack or stroke before the age of 65?

Shawn Knight 39:12

No.

Dr. Michael Koren 39:12

No brothers or sisters who've been diagnosed with heart disease or stroke?

Shawn Knight 39:16

No.

Dr. Michael Koren 39:16

Okay. So that's another positive thing that leads us to be maybe a little bit less aggressive. So one of the things that you might consider on specifically the issue of whether or not you need a statin for that LDL, which is clearly higher than it should be, is what your CAC score is. So at age 50, if your CAC score is zero, I would tell you as a patient, okay, diet and exercise are a perfectly reasonable way to approach your problems. Obviously, get your weight down a little bit, keep the exercise program going, and things should take care of themselves. But if you have evidence of atherosclerosis based on the CAC score, I would use a Statin as an insurance policy. Okay? Even though you have a high level of the HDL.

Shawn Knight 39:57

Okay.

Dr. Michael Koren 39:58

The other thing I would tell you is that I'm probably a little bit more concerned about your blood pressure than your cholesterol. So one of the things good clinicians do is you pivot. So you came to me to know the numbers, but you happen to show the your blood pressure number. And for somebody like you that has a high HDL, African-American, your risk for having a complication of hypertension is actually greater than your risk of having complications of a high LDL. So I would also recommend that you have an echocardiogram so that I would know your heart size. If your heart size is enlarged, that means you need to take a very aggressive approach at reducing your blood pressure, which will in turn reduce your heart size and reduce your stroke risk, which is probably a bit higher than your heart attack risk, based on what we know now.

Shawn Knight 40:48

Wow.

Dr. Michael Koren 40:49

Okay.

Shawn Knight 40:49

Okay.

Dr. Michael Koren 40:50

So that is a quick exercise in knowing your numbers. And of course, there's some homework there, which uh you can call me offline or you can work in the primary physician, but there's some testing details that I'd love to know to give you the best advice.

Shawn Knight 41:04

I appreciate it. All right.

Rich Jones 41:05

What do you think, Shawn?

Shawn Knight 41:07

Um, it's uh now that I'm in the process of trying to be more conscious about my health, and I know there are some things that I need to work on, but now that there is a clear detail on here's what the where the problems are, I know exactly what needs to be done or how to attack it in order to reverse some of the things that's going on.

Dr. Michael Koren 41:27

Right. And I would not be afraid of a GLP-1 in you because that'll help you lose weight and it will help lower your cholesterol and your blood pressure.

Shawn Knight 41:36

Yeah, the summertime is coming, so that's laugh. It's funny. It was funny.

Dr. Michael Koren 41:46

Any other questions for me?

Shawn Knight 41:47

No, no, not at all. Oh, thank you.

Rich Jones 41:49

Let's hear it for Sean Knight. Thank you for putting yourself out there, so I'm appreciated.

Shawn Knight 41:53

You owe me lunch, Rich.

Rich Jones 41:55

Bring uh Miss Alyssa up here.

Alyssa 41:58

Thank you.

Rich Jones 41:58

Our next test case. Oh boy. Hi, Alyssa. I saw something about a lovely and that was all I saw.

Dr. Michael Koren 42:07

So Alyssa, full disclosure, is our head of recruiting at MedEvidence and ENCORE.

Alyssa 42:12

Yep. And having a hard time getting up.

Dr. Michael Koren 42:15

You good?

Alyssa 42:16

Yep.

Speaker 42:16

Okay.

Alyssa 42:17

Got it.

Speaker 42:18

Okay.

Alyssa 42:18

Yep.

Speaker 42:19

Excellent.

Alyssa 42:21

Yep. Hello?

Dr. Michael Koren 42:22

So thank you for being part of this.

Alyssa 42:24

Absolutely.

Speaker 42:25

So first things first, of course, do I have your permission to discuss things?

Alyssa 42:29

Absolutely. All in the name of science.

Dr. Michael Koren 42:31

Okay, well, at any point, if I say anything uncomfortable, you can just stop and we can always take this offline. But you're comfortable discussing your numbers and your health history with this group.

Alyssa 42:41

Absolutely.

Dr. Michael Koren 42:41

Okay. All right. So let's see what your history looks like here. A genuinely lovely.

Rich Jones 42:49

Genuinely lovely, yes.

Dr. Michael Koren 42:50

Yes. 54-year-old woman.

Rich Jones 42:52

I I thought you were 34.

Alyssa 42:54

That's right.

Dr. Michael Koren 42:58

I learned a lot about this just being here. I can't.

Rich Jones 43:01

Medical research.

Dr. Michael Koren 43:01

Yeah, there we go. With a history of a quote, fluffy heart attack. So you'll have to explain what your perception of that is. Currently on atorvostin, 20 milligrams, that's a statin drug, three times a week, hydrochlorothiazide, that's HCTZ, which is a diuretic for blood pressure, 25 milligrams, and compounded retitrutide, which I'm sure is a GLP-1.

Alyssa 43:22

Yeah.

Dr. Michael Koren 43:22

Right?

Alyssa 43:23

Triagonist.

Dr. Michael Koren 43:24

Uh 2.5 milligrams daily, and titrating that up. So that's the history, and these are the numbers. Okay. So the total cholesterol is 266, as mentioned. That's the weight of cholesterol per tenth of a quart in your blood, and that's certainly higher than we would consider ideal. Less than 200 is the general recommendation, but again, more a lower number and more aggressive targets for certain people. LDL 194. That's a little concerning. That's a pretty high LDL and something that should be a target. Now, was that drawn on the Lipitor? Before you start a lipitor.

Alyssa 44:01

Before

Dr. Michael Koren 44:01

Okay. So that's an important point. So Lipitor at the maximum dose of 80 milligrams should be able to lower LDL by about 50%.

Alyssa 44:09

Okay.

Dr. Michael Koren 44:10

So that's something to keep in mind. And you're starting it at a low dose and not every day. And we'll and we'll definitely get to that. But that that LDL of 194, you know, is a concern. HDL of 50, so not as good as Sean's HDL. Not horrible, but again, not what it should be. And uh women tend to have higher HDLs than men. And the 50 is definitely not at the level that we'd like to see, which is 60 or above, but that's hard to move. Triglycerides 123, not horrible, but again, there's usually this correlation between HDL and triglycerides. The non-HDL was not listed here, but again, it's very easy to calculate, which is 266 minus 50, 216. So we actually know what that is, so we're smarter than the lab because we know the formula. And then the trig the total cholesterol to HGL ratio is also pretty easy to figure out, which is greater than five and should be less than three. Again, that's 266 divided by 50, which is certainly greater than five, it should be less than three. And the hemoglobin A1C is right at that borderline of prediabetes. Okay. So looking at those numbers, well, before I get to that, so tell me about the fluffy heart attack.

Alyssa 45:21

It was an incidental finding. I went to see myu doctor, well, she's nurse practitioner and she's very thorough. And she just did an EKG because I was complaining of like shortness of breath a few weeks ago and a little bit of a pressure on my chest. I I said just felt like a monkey on my chest or something. She took she took the EKG and she saw Q wave inversions. Which is and she said, Alyssa. I hate to tell you this. And she told me.

Dr. Michael Koren 45:54

So let me let me break that down for everybody. So Alyssa had some symptoms that were concerning. She went to her physician and her ECG was abnormal.

Alyssa 46:03

Yes.

Dr. Michael Koren 46:03

Now, that doesn't mean for sure you had a heart attack, but there's a concern for a heart attack.

Alyssa 46:08

She actually said.

Dr. Michael Koren 46:09

she doesn't know. In fairness. So again, I I'm not looking at the EKG, but a Q wave is a possible indicator of a heart attack, but it's not definitive. And some Q waves are worse than other Q waves. So you don't know for sure. I assume, well, I should ask you the question, not assume. Did you have any other imaging tests yet?

Alyssa 46:31

No.

Dr. Michael Koren 46:32

So now if you have a Q wave on your ECG and then you do an echo and part of your heart is not moving, then I would say you had probably had a heart attack. Or if you had a nuclear stress test and there's an area that is not perfusing, I would say you probably had a heart attack. But a Q wave alone on ECG is not diagnostic criteria for heart attack.

Alyssa 46:52

Thank you.

Dr. Michael Koren 46:52

Okay. So again, that's why fluffy means we don't know for sure, but it's concerned that doesn't take away our concern. So you've had symptoms, you have a completely unacceptable LDL that needs to be treated much, much more aggressively. So you mentioned you being on Lipitor 20 milligrams three days a week.

Alyssa 47:10

Yes.

Dr. Michael Koren 47:10

Okay. Did you try a higher dose more days a week, or is there any problem with that?

Alyssa 47:15

I have a follow-up on the 20th, and on that actually wanted to ask you what do you think about addition?

Dr. Michael Koren 47:22

Yeah, I it I would say that I have enough information right now to recommend that you take 80 milligrams every day.

Alyssa 47:27

80? Okay.

Dr. Michael Koren 47:28

Right off the bat, because you have a very high LDL, you have a concerning history, you have an EKG finding that may or may not be a heart attack, but your risk is super high. Plus, you have a hemoglobin A1C that's borderline for diabetes. So there's really no reason at all for you not to be on a torvastatin 80 milligrams.

Alyssa 47:48

And can they take the CoQ10 with that?

Dr. Michael Koren 47:50

Certainly. CoQ10 is a supplement that helps some people avoid the muscle aches that's going to cause. So no objection to that. Typically, people take between 100 and 300 milligrams of CoQ10 or UBI, or otherwise known as ubiquinol.

Alyssa 48:03

Yes.

Dr. Michael Koren 48:04

Okay. And there's no problem with that. Not everybody needs it, but if you're worried about possible muscle aches related to statins, that's a reasonably good thing to do. But that that should be a definite right-of-way. Then, of course, there's a lot of other things. So what's your exercise pattern now?

Alyssa 48:17

I'm starting. I've started aggressively the last few weeks on my Peloton.

Dr. Michael Koren 48:22

Okay. Yeah. As they say, uh the old Chinese saying, a journey of a thousand miles takes the first step, right? So you've got to start with the first step. But there's also some important tests that you need.

Alyssa 48:33

I'm going for the Lp(a) this week. I spoke to nurses.

Dr. Michael Koren 48:37

Okay. So again, that's the type of cholesterol that runs in families. Do you have a family history of heart disease?

Alyssa 48:42

I do not.

Dr. Michael Koren 48:43

Okay, well, that's good. You have brothers and sisters diagnosed with heart disease. Then we died of a heart attack or stroke before 65?

Alyssa 48:48

No, actually, longevity runs in my family.

Dr. Michael Koren 48:50

That's a good thing, thank your parents again.

Alyssa 48:53

Thank you. I did incorporate a lot of sardines in my diet, I will tell you.

Dr. Michael Koren 48:57

I'm all for that. Mediterranean style diet. It's the best. But this is really important. You need to get some cardiac tests to determine if, in fact, you had a heart attack.

Alyssa 49:06

I will get that CAC score.

Dr. Michael Koren 49:07

And you should get, well, not a CAC score is okay for you, but you need an echo to see if there's been any damage to your heart and to make sure that there's no other findings that are responsible for that Q wave on the ECG. And you probably need some sort of stress test. Probably going to need a nuclear stress test because when your EKG is abnormal, a standard stress test when you're just walking the treadmill is going to be less accurate. So a nuclear stress test, it could be a PET scan, it could be a thium test, it could be a system maybe test. All these are ways of determining the blood flow characteristics for your heart. Now, if the blood flow characteristics are abnormal with that Q wave and your risk factors, then I would say you probably got a heart attack. But until you get that testing done, you just don't know.

Alyssa 49:50

Okay.

Dr. Michael Koren 49:50

If you are proven to have a heart attack, I would get super aggressive in you. So let's say, let's let's think positively, let's say that the Q wave can be explained by other things and your stress test is fine, and you're you're you're on track now. Okay. You would get on your Lipitor 80 and then hopefully have an LDL below 100 and then turn your lifestyle around and you should be aptly treated. But if you had a heart attack, then I would say that I want your LDL down below 70 and probably around 50.

Alyssa 50:19

That's right.

Dr. Michael Koren 50:20

And you're not going to get there with just atorvistatin 80.

Alyssa 50:23

That was my question.

Dr. Michael Koren 50:24

Right, you're going to need something in addition to that. So you can either use one of the drugs in the market like Repatha to help you. If it's just a little bit more, there's a drug called Lazetamide, a drug called Bempadoic Acid, or do one of the studies where we have these products that will bring your LDL down. So as we speak, for example, we have a study that's using an oral PCSK9 inhibitor . And this is a molecule that we've been very, very involved with. In fact, I I was the first author on the first paper published on this particular molecule. And we have access to that problem as we speak, which is looking at people like you that are already on the maximum dose of stats that need this extra lowering. So again, your target's gonna either be below 100 or perhaps even 50. And quite frankly, the lower the better for you.

Alyssa 51:11

Okay.

Dr. Michael Koren 51:12

And then you mentioned you're on a compound. Is it a compound GLP-1?

Alyssa 51:16

Yep, it's a tripeptide.

Dr. Michael Koren 51:17

Okay. So that's one of the newer ones. There's a bunch of them out there. And there's a lot of controversy about the compounding, which I'm not gonna get into right now.

Alyssa 51:24

Absolutely.

Dr. Michael Koren 51:25

But but you're on a low dose of that.

Alyssa 51:27

Yes.

Dr. Michael Koren 51:27

And I would certainly encourage you to get to higher dose, help you lose weight, but more importantly, have all your cardiovascular risk factors move in the right direction.

Alyssa 51:36

I will. Thank you.

Rich Jones 51:36

Question question. When did you start the GLP-1?

Alyssa 51:41

Actually, I was I started it back in November, but I had to stop for a little bit. My insurance wouldn't cover it. So I am I am compounding it.

Rich Jones 51:52

Okay.

Alyssa 51:52

So um I stopped for a little bit, so this is my second, I'll be doing my second dose consistently right now, and then I titrate up.

Dr. Michael Koren 51:59

Okay, and we would strongly support that. Any questions from any?

Alyssa 52:04

Can I also add a Ezetimibe to my regimen right now?

Dr. Michael Koren 52:08

Again, I'd first get on atorvastatin 80 and see where you stand. Okay. And I'd find out about the heart attack. I will. Obviously, the whole trajectory of our treatment depends on whether or not you had a heart attack. And we'll get a reasonably good determination based on those test results.

Alyssa 52:22

Okay. Thank you so much to feel. I feel great. Thank you. Thank you for this. I appreciate it. Thank you.

Justin’s Numbers And Trial Invitation

Dr. Michael Koren 52:33

Do we have one more or something?

Rich Jones 52:35

Yeah, we have Justin. Okay. But he's not here? Okay. Okay, you're welcome.

Dr. Michael Koren 52:40

Well, again, given that he's not here and I don't have his permission. I'm just gonna be very brief.

Rich Jones 52:43

Yeah, Justin is a member of our team here at Cox Media Group.

Dr. Michael Koren 52:47

Yeah. So 34-year-old gentleman, history of exercise-induced asthma, GERD, low back pain, history of smoking. He reports taking no medicines. These are his numbers. And again, without his permission, I'll just make the point that he he did not pick good parents. Only joking, Justin, but his HDL is only 29, which means that he's very highly genetically predisposed to metabolic syndrome and cardiovascular disease. And so we have to get aggressive. And as I mentioned, there is this relationship between low HDL and high triglycerides, which you see here. And fortunately, hemoglobin is still low and he's still young. But this is a person that needs to do a lot of exercise to get that HDL up and reduce the cardiovascular risk. Obviously, there's a history of smoking. Hopefully, that's not happening now, but there's no room at all for smoking in this person. And the LDL is not horrible, but that low HDL is the key thing. And unfortunately, we don't have any easy ways to treat low HDL. We did a lot of research over the last 20 years to see if raising HDL would make a difference. And there's actually drugs that can raise HDL by 100%. But unfortunately, they don't reduce heart attacks or strokes. And there's a complicated mechanism behind that, but which I won't go into today. But that low HDL is a very potent risk factor of heart disease. So that would be my focal point for him is to really work on lifestyle. So this is a person that's not going to necessarily need any drugs, but needs a real good lecture about lifestyle. And then moving to participating in clinical trials, who in the room has done a clinical trial with us? Okay. Okay, if you look at that. Yeah, so they maybe speak we'll have a little question and answer time, but um then they may speak to what it was like. But my favorite statistic to report for people who have not done a clinical trial before is that when you ask general populations in the US or in Europe who have not been in a clinical trial whether or not they're interested, just interested, 40% said yeah, they would do it if their doctor approved. But if you ask somebody that's done a clinical trial, that's had the experience, would they do a second one? 97 to 99% of people say yes. So what product or service can you think of where before you're exposed to it, you're very skeptical, but once you had your first experience, you're a big fan. There are not too many products out there like that. Maybe heroin, I don't know. Joking, I'm joking. It was not a slide against that was not a slight against RFK Jr., sorry. Anyhow. Excuse me. Nonetheless, there's very few products like that. And so we're proud of that. We're proud of that notion. And the reason is several fold. One is that these trials are all covered by outside grants, so it doesn't cost you anything. Two is that the care you get is unbelievable. You know, we have this great team that just looks out for our people. And three, it's an incredible learning process. People learn so much during their participation. So if you if you like this kind of information, you get this on a regular basis when you're part of a clinical trial. And in some cases, we actually pay people, so that's not a bad little perk as well. So for all these.

Rich Jones 56:00

We are paying people by the way, here, so if you do want to, we will draw one winner before the end of it. So we'll pay a little bit.

Dr. Michael Koren 56:04

So again, look at it. And again, we're doing studies in hypertension and heart failure and diabetes and orthopedic problems, thyroid disease, you know, you name it, fatty liver disease, you name it, we're probably touching it in one way, shape, or form. So, you know, just if you allow us to just get a little bit of information about you, we'll keep you informed. And if you want to come in and learn more and see if you're a good candidate, I think you'll enjoy the experience.

Rich Jones 56:26

Are we seeing an increase in you mentioned the health director? Are we seeing an increase in the number of opportunities for more clinical trials under this administration?

Closing And Where To Subscribe

Dr. Michael Koren 56:37

Yeah, it's interesting. Yeah, Rich and I were just talking about that. Um, Marty Makari, who's the current FDA commissioner newly appointed, has made it a priority to do more early phase research in the U.S., in part because of a perceived threat from China. So you know China about 10, 15 years ago, made a government decision to get more involved in early phase research and be more involved in biomedical research overall. And now about probably at least 50% of the new products being developed in medicine are coming from China. And the current administration is seeing that as a threat. So they're they're they're trying to encourage more of the research being done in the US. As I mentioned, uh, we're going to be doing these studies for gene editing for uh for cholesterol problems. So if you think you may be a candidate or you know somebody, let me know. I want to be very clear though that most people will not be good candidates, but we will give you some benefit from that interaction. I'm estimating that maybe one in 200 people that are interested in these gene editing trials are the right candidate. Because again, this is early research. It's been used so far in about 140 patients around the world. So it's not zero, but it's not a huge number. And we'll be the we should be the first to do it in the US here in Jacksonville. So we're excited about that.

Shawn Knight 57:52

Thanks for joining the MedEvidence Podcast. To learn more, head over to MedEvidence.com or subscribe to our podcast on your favorite podcast platform.