Latest / Heart Health, Reimagined with Dr. Mona Shah, MD / Cardiologist Reveals the #1 Thing She Recommends Alongside Statins

Transcript

Cardiologist Reveals the #1 Thing She Recommends Alongside Statins · Heart Health, Reimagined with Dr. Mona Shah, MD

• 0:00
  SPEAKER_00: So you did everything right.
• 0:02
  SPEAKER_00: You got the scan, you got the coronary CTA, you got the full lab panel, your APOB, your lipoprotein A, your inflammation markers, your insulin resistant.
• 0:13
  SPEAKER_00: And now it turns out you have some plaque.
• 0:16
  SPEAKER_00: Soft, hard.
• 0:17
  SPEAKER_00: So now what, right?
• 0:19
  SPEAKER_00: This is the moment where most people hit a wall because half the internet says everyone over 50 should be on a statin.
• 0:27
  SPEAKER_00: And the other half says statins are poison.
• 0:30
  SPEAKER_00: But most of those miss the point.
• 0:32
  SPEAKER_00: I'm Dr.
• 0:33
  SPEAKER_00: Mona Shaw, preventative cardiologist.
• 0:35
  SPEAKER_00: I'm passionate about early detection, whole heart care, longevity, and changing outcomes.
• 0:43
  SPEAKER_00: And here's what I want you to know.
• 0:45
  SPEAKER_00: There's so much more than statins now.
• 0:48
  SPEAKER_00: Way more than there was even 10 or 20 years ago.
• 0:52
  SPEAKER_00: And the whole game is precision.
• 0:54
  SPEAKER_00: Not here's your drug, see you in a year.
• 0:57
  SPEAKER_00: The real goal is getting your APOB and your inflammation down and trying to reverse plaque or stabilize plaque with the right combination for you and the fewest side effects.
• 1:11
  SPEAKER_00: The base is always diet, lifestyle, food choices, stress management, exercise, and supplements and vitamins when needed.
• 1:22
  SPEAKER_00: But even then, if you have plaque and can't get your numbers under control, is when the medication talk begins.
• 1:31
  SPEAKER_00: So today I'm going to walk you through the truth about statins, the myths and what's real, the medications most people don't even know exist, and where supplements may fit in.
• 1:42
  SPEAKER_00: This is not medical advice for you specifically, and please do not start or stop anything based on my video.
• 1:50
  SPEAKER_00: This is so you can have a much better conversation with your own doctor.
• 1:55
  SPEAKER_00: Let's get into it.
• 1:57
  SPEAKER_00: Let's start with what are we even trying to do here?
• 2:01
  SPEAKER_00: Once I can see what's actually in your arteries and I have real numbers, I can set a target.
• 2:08
  SPEAKER_00: And for someone with plaque, the target I care about the most is getting your APOB down.
• 2:15
  SPEAKER_00: You've heard me say APOB is a count of every particle that can build plaque.
• 2:21
  SPEAKER_00: For general prevention, I want it under 90.
• 2:24
  SPEAKER_00: However, if you've got significant plaque or you've already had an event, I'm driving that APOB even lower, down into the 50s, possibly 60s, and sometimes even lower than that.
• 2:36
  SPEAKER_00: Here's a difference between me and the old model.
• 2:39
  SPEAKER_00: The old model is your cholesterol's a little high, your LDL is high, here's a statin.
• 2:44
  SPEAKER_00: See you in a year after labs.
• 2:46
  SPEAKER_00: No scan, no APOB, no insulin markers, no inflammation markers, no real plan, just a number and a drug.
• 2:54
  SPEAKER_00: But we don't want to treat numbers on a piece of paper.
• 2:59
  SPEAKER_00: We treat what's actually happening inside your arteries.
• 3:03
  SPEAKER_00: And to get your APOB and your inflammation markers down to a target.
• 3:08
  SPEAKER_00: You have different levers.
• 3:10
  SPEAKER_00: Medication, diet, supplements, and exercise.
• 3:14
  SPEAKER_00: Together, that's the whole conversation.
• 3:17
  SPEAKER_00: And the biggest lever nobody talks about enough is getting your inflammation down.
• 3:22
  SPEAKER_00: So let's talk about the tool everyone argues about first, statins.
• 3:26
  SPEAKER_00: Okay, statins, let me be fair, because this is where people get it wrong on both directions.
• 3:32
  SPEAKER_00: Statins have the strongest and longest track record of any of these medications.
• 3:37
  SPEAKER_00: Decades of evidence that they lower heart attacks and strokes and death.
• 3:43
  SPEAKER_00: And they don't just lower your number, that they can actually help stabilize plaque and sometimes calm the inflammation in the artery wall, which makes the plaque less likely to rupture.
• 3:54
  SPEAKER_00: So, no, statins aren't necessarily a poison.
• 3:57
  SPEAKER_00: For the right person, they save lives.
• 4:00
  SPEAKER_00: But here's the other side.
• 4:02
  SPEAKER_00: They are not one size fits all.
• 4:05
  SPEAKER_00: And this is a myth I want to bust.
• 4:08
  SPEAKER_00: Not all statins are the same.
• 4:10
  SPEAKER_00: There are a lot of them, and they all work a little bit differently.
• 4:13
  SPEAKER_00: And it's also very dose dependent.
• 4:16
  SPEAKER_00: A low dose and a high dose statin are not in the same conversation.
• 4:21
  SPEAKER_00: Most people don't know there are now several other medications beyond statins that we can use.
• 4:26
  SPEAKER_00: Let's talk about them because this is genuinely good news.
• 4:30
  SPEAKER_00: So beyond statins, here are the other evidence-based options.
• 4:34
  SPEAKER_00: And these aren't experimental, they all have proven outcome data, meaning they can lower your numbers, and some of them can actually lower heart attack and stroke risk, not just a number on your lab.
• 4:48
  SPEAKER_00: First, azetamide.
• 4:50
  SPEAKER_00: The brand name azetia, it's a non-statin pill that blocks your body from absorbing cholesterol in your gut.
• 4:57
  SPEAKER_00: It lowers LDL by about 15 to 25%.
• 5:01
  SPEAKER_00: And we often add it when a statin alone isn't enough or when someone can't tolerate a higher dose statin.
• 5:08
  SPEAKER_00: Second, and this is really my go-to non-statin medication, are the PCSK9 inhibitors like Rapatha and Pralulin.
• 5:17
  SPEAKER_00: These are injectable medications that you give yourself every two weeks that block a protein called PCS-K9.
• 5:25
  SPEAKER_00: Normally, that protein causes your liver to get rid of the receptors that remove LDL and APOB particles from your bloodstream.
• 5:36
  SPEAKER_00: By blocking PCS-K9, your liver keeps more of those receptors and clears much more of those markers of cholesterol by about 50 to 60%.
• 5:48
  SPEAKER_00: These medications have also been shown to reduce first heart attack, second heart attack, strokes, and there's also evidence that they can regress and reverse plaque, not just improve the numbers.
• 6:03
  SPEAKER_00: The exciting part is that patients now have more options than ever.
• 6:07
  SPEAKER_00: There's even Enclysuran, brand name LECVIO, which is a long-acting injection given just twice a year after the initial dosing schedule.
• 6:16
  SPEAKER_00: And the first oral PCSK9 inhibitor, Lipfendra, was just FDA approved, giving patients a daily pill option instead of an injection.
• 6:26
  SPEAKER_00: I'll be transparent with you.
• 6:27
  SPEAKER_00: I'm on Repatham myself because of my genetics to lower APOB, to reduce my lipoprotein A, and hopefully regress some of my soft plaque.
• 6:39
  SPEAKER_00: So this isn't theoretical for me.
• 6:41
  SPEAKER_00: It's a decision I've made for my own heart health.
• 6:44
  SPEAKER_00: I am vegetarian, I exercise five to six days a week, I try to manage my stress as best as possible.
• 6:50
  SPEAKER_00: I'm also on supplements, and despite all of that, my APOB was high.
• 6:55
  SPEAKER_00: I had soft plaque that I saw on my own clearly scan.
• 6:58
  SPEAKER_00: And for me, I knew that Rapatha was the best choice.
• 7:01
  SPEAKER_00: But again, for every person and patient, it's a different choice.
• 7:06
  SPEAKER_00: That's why it's nice that we now have a lot of different options that we can discuss.
• 7:12
  SPEAKER_00: So back to the different medications.
• 7:14
  SPEAKER_00: The third one is called bempidoic acid.
• 7:17
  SPEAKER_00: The brand name is Nexlitol.
• 7:19
  SPEAKER_00: It's an oral medication that works earlier in the cholesterol pathway than a statin.
• 7:24
  SPEAKER_00: And it's mostly activated in the liver.
• 7:26
  SPEAKER_00: So muscle side effects are much less common.
• 7:29
  SPEAKER_00: It does lower LDL by about 18 to 25%, and it's a great option for people who genuinely can't take statins or don't want to give themselves injectables.
• 7:39
  SPEAKER_00: So think about what that means.
• 7:40
  SPEAKER_00: If statins alone aren't right for you, or you can't tolerate them anyways, you're not out of options.
• 7:47
  SPEAKER_00: We can mix and match different medications based on your numbers, your side effects, and how you actually feel and what you want to do for your own heart health.
• 7:56
  SPEAKER_00: That's the precision part.
• 7:58
  SPEAKER_00: Let me pause for one second before we talk about supplements.
• 8:01
  SPEAKER_00: If this balanced, no-camp approach to your heart is what you've been looking for, subscribe.
• 8:07
  SPEAKER_00: Every week I put out videos on what the conventional system misses and what you can actually do about it.
• 8:13
  SPEAKER_00: Now, a lot of you don't want to be on any medications at all.
• 8:18
  SPEAKER_00: I hear that every single day as a holistic practitioner.
• 8:22
  SPEAKER_00: And the good news is supplements can be a part of lowering your numbers too for the right person.
• 8:28
  SPEAKER_00: There are some natural options that can help move cholesterol and inflammation.
• 8:33
  SPEAKER_00: Bergamot and red yeast rice are just a few people ask me about a lot.
• 8:38
  SPEAKER_00: Plant sterols can also play a role.
• 8:40
  SPEAKER_00: And remember the five from my supplement video, things like omega-3 and magnesium and CoQ10 that can help on the inflammation side.
• 8:50
  SPEAKER_00: But I want to be really honest with you here because this is where precision really matters.
• 8:55
  SPEAKER_00: For someone with a little bit of plaque and good inflammatory markers, we might work on diet for sure and try to add some supplements first and see how far we can get.
• 9:06
  SPEAKER_00: That's a really good starting place.
• 9:08
  SPEAKER_00: And then recheck and see if we're meeting our targets.
• 9:12
  SPEAKER_00: It's also about having the right targets for what's going on with you.
• 9:16
  SPEAKER_00: However, if you've got a lot of plaque or high lipoprotein A, or your Apo B is nowhere near a target, supplements alone usually are not going to get you where you want.
• 9:29
  SPEAKER_00: And pretending they will when your arteries are telling us otherwise is how people lose years they didn't need to lose.
• 9:36
  SPEAKER_00: So stop framing this as medication versus natural.
• 9:40
  SPEAKER_00: What actually works is the right combination for you, built on what's actually in your arteries, your April B, your lipoprotein A, your metabolic health, your genetics, and what your body tolerates.
• 9:53
  SPEAKER_00: Every person is different.
• 9:55
  SPEAKER_00: That's the whole point.
• 9:57
  SPEAKER_00: So how do you take all of this into your own doctor's office?
• 10:01
  SPEAKER_00: Here's what to do.
• 10:02
  SPEAKER_00: First, the rule I always come back to: do not start, stop, or adjust any medications because of something you watch on the internet, including this.
• 10:11
  SPEAKER_00: This video is here to make your next appointment better, not to replace your doctor.
• 10:17
  SPEAKER_00: So here's how to make that appointment better.
• 10:20
  SPEAKER_00: Know your real picture first, not just your LDL.
• 10:24
  SPEAKER_00: You've heard me harp about this now on several videos.
• 10:27
  SPEAKER_00: Know your APOB, know your lipoprotein A, know your inflammation markers, your insulin resistance, your homocysteine, and ideally what's actually in your arteries from a coronary CTA scan, with or without the AI plaque analysis clearly.
• 10:43
  SPEAKER_00: You've heard me cover all of these in my other videos.
• 10:47
  SPEAKER_00: That's the foundation for any medication decision.
• 10:51
  SPEAKER_00: Then ask your doctor the precision questions.
• 10:54
  SPEAKER_00: What's my APOB target given my plaque?
• 10:58
  SPEAKER_00: If a statin is right for me, what dose and why that dose?
• 11:03
  SPEAKER_00: Are there non-statin options that would fit me better?
• 11:07
  SPEAKER_00: And how are we going to lower my inflammation, not just my cholesterol numbers?
• 11:12
  SPEAKER_00: And then ask for a follow-up plan because see you in a year may not be the right fit for you.
• 11:18
  SPEAKER_00: We recheck the numbers and where it makes sense, we rescan to make sure we're actually stabilizing or regressing that plaque.
• 11:27
  SPEAKER_00: Because remember, we're not doing this to make just numbers look pretty on a piece of paper.
• 11:31
  SPEAKER_00: We really want to affect change inside our arteries.
• 11:35
  SPEAKER_00: That is shared decision making.
• 11:38
  SPEAKER_00: It's your heart, your risk, your choice made with a doctor who's actually looking at the whole picture.
• 11:46
  SPEAKER_00: So you have plaque.
• 11:48
  SPEAKER_00: Now what?
• 11:49
  SPEAKER_00: Now you know the real answer.
• 11:51
  SPEAKER_00: It's not statins are evil, and it's not everyone needs a high dose statin.
• 11:55
  SPEAKER_00: It's precision.
• 11:56
  SPEAKER_00: Statins when they're right at the right dose, the newer medications when they fit you better, supplements where they can genuinely help, diet underneath all of it, all aimed at one thing: getting your APOB and your inflammation down so you can change what happens inside your arteries.
• 12:16
  SPEAKER_00: These tools work because they improve outcomes, not because they make a lab look nice.
• 12:22
  SPEAKER_00: You have more options than you think.
• 12:25
  SPEAKER_00: Go have the real conversation.
• 12:27
  SPEAKER_00: A huge piece of this is something most people never get checked, and it's driving inflammation and plaque in the background.
• 12:35
  SPEAKER_00: If your labs look normal, but you want to know what might still be off, watch my video on good labs but poor metabolic health.
• 12:45
  SPEAKER_00: It's on your screen right now.