Can We REALLY Clear Plaque From Our Arteries? — Transcript

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1. 0:00heart disease is still the leading cause
2. 0:02of death worldwide and the tragedy is
3. 0:04that most of those deaths are
4. 0:05preventable in this video I'll show you
5. 0:08three steps to clear plaque from your
6. 0:09arteries and prevent heart attacks
7. 0:11explain the robust scientific evidence
8. 0:13behind each step and then go through
9. 0:15three extra steps to further accelerate
10. 0:17plaque clearance it was once believed
11. 0:20that plaque buildup in your blood
12. 0:21vessels was irreversible however
13. 0:23groundbreaking new evidence shows that
14. 0:25with the right treatment plaque can
15. 0:27actually be reversed and give you a
16. 0:29second chance at a healthier heart we'll
17. 0:31start by having a look at a remarkable
18. 0:33study published last year that changed
19. 0:35our understanding of the effects of
20. 0:37exercise on arterial plaque although
21. 0:39it's been hypothesized that exercise
22. 0:41training may have antiplaque effects
23. 0:44previous research showed that athletes
24. 0:45tend to develop more dense and abundant
25. 0:48artery plaque calcification while other
26. 0:50people who don't exercise tend to have a
27. 0:52more mixed profile and how we interpret
28. 0:55those findings was very uncertain it
29. 0:57doesn't sound great that athletes
30. 0:59develop more abundant calcified plaque
31. 1:01compared to people who don't exercise so
32. 1:04what's going on well it's possible that
33. 1:06exercise helps to stabilize the plaque
34. 1:08making it less likely to rupture and
35. 1:10cause heart attacks and strokes so while
36. 1:12the plaque in athletes appears more
37. 1:14calcified the plaque is stable and the
38. 1:16new study wanted to explore that idea in
39. 1:18Greater detail to not only see if
40. 1:20exercise could help stabilize the plaque
41. 1:22but also to help reduce plaque buildup
42. 1:25so how did the study explore that idea
43. 1:27and what can we learn from the results
44. 1:29well it was a six-month randomized
45. 1:31control trial of people who already had
46. 1:33known plaque buildup in their arteries
47. 1:36one group were given standard lifestyle
48. 1:37advice and the other group was also
49. 1:39given that advice but they were also
50. 1:41instructed to perform a high-intensity
51. 1:43interval workout or a hit workout each
52. 1:46session started with a 10-minute warm-up
53. 1:48at moderate intensity followed by a
54. 1:504-minute interval of high intensity at
55. 1:5285 to 95% of their Peak heart rate and
56. 1:55then they had a 3-minute active recovery
57. 1:58and That Was Then repeated four times
58. 2:00the participants blood vessels were
59. 2:02measured by angiograms and ultrasounds
60. 2:04so a very accurate measurement the
61. 2:06exercise group reduced their pla volume
62. 2:08by just over 1% from 49.5 to 48.3 while
63. 2:13the Standard Group had a small increase
64. 2:15in their plaque volume that's an
65. 2:17incredibly exciting finding as it shows
66. 2:19that exercise can reduce arterial plaque
67. 2:22but does a 1% decrease really matter and
68. 2:24what I mean is that will this 1%
69. 2:26decrease in plaque volume actually
70. 2:28reduce the risk of having a stroke or
71. 2:30heart attack in a perfect world The
72. 2:32study would have gone on for a few more
73. 2:34years to directly answer that question
74. 2:36but to do so is incredibly expensive
75. 2:39instead we can have a look at another
76. 2:40trial of a separate strategy that also
77. 2:42reduced arterial plaque which we'll talk
78. 2:44about later in the video where a 1%
79. 2:46decrease in plaque volume it resulted in
80. 2:48a staggering 25% decrease in the risk of
81. 2:51a heart attack or a stroke so while it's
82. 2:54not 100% proven it's highly likely that
83. 2:56a 1% decrease in plaque volume from high
84. 2:59intensity interval training workouts is
85. 3:01clinically relevant but how do we know
86. 3:03it was the exercise that reduced the
87. 3:05plaque in the study for example a high
88. 3:07blood LDL cholesterol level is a known
89. 3:10risk factor for heart disease so if LDL
90. 3:12cholesterol went down in the
91. 3:14high-intensity interval training group
92. 3:15wouldn't that explain these positive
93. 3:17results well in this study the LDL
94. 3:20cholesterol and the fob levels were
95. 3:22unchanged so it's highly likely that it
96. 3:24was the exercise that was responsible
97. 3:26for the reduced plaque rather than any
98. 3:28other Factor overall the study provides
99. 3:31strong evidence that if we get exercise
100. 3:33right we can reduce arterial plaque
101. 3:35buildup but the key is getting exercise
102. 3:38correct for example a separate study
103. 3:40found that vigorous exercise can help
104. 3:42reduce plaque buildup very vigorous
105. 3:45activity can actually worsen plaque
106. 3:46buildup so for most people doing a light
107. 3:49to moderate exercise protocol is a
108. 3:51reasonable option and after discussing
109. 3:53with your doctor no more than twice
110. 3:55weekly high-intensity interval training
111. 3:57workouts are likely to provide
112. 3:58additional benefits but in the
113. 4:00high-intensity interval training trial
114. 4:02there was something else that the
115. 4:03participants were doing in addition to
116. 4:05exercise they were all on cholesterol
117. 4:07lowering medications and that brings us
118. 4:09onto the second of three steps which is
119. 4:12that we must get our blood cholesterol
120. 4:13levels right and on social media this
121. 4:16topic is ripe with controversy and
122. 4:18whenever there's controversy we need to
123. 4:20focus on the evidence so from a 2023
124. 4:23metaanalysis that included 23 separate
125. 4:26studies cholesterol lowering therapies
126. 4:28they did reduce arterial pla and it was
127. 4:30that same study that showed that a 1%
128. 4:32decrease in plaque volume resulted in a
129. 4:3525% decreased risk of heart attacks and
130. 4:37strokes so to understand how to lower
131. 4:39our blood cholesterol correctly we need
132. 4:41to First wade into the social media
133. 4:43controversy so you'll hear people say
134. 4:45that LDL cholesterol isn't a risk factor
135. 4:48for heart disease that it's actually
136. 4:49insulin resistance which is the true
137. 4:51culprit but while other risk factors
138. 4:54like insulin resistance are critical to
139. 4:56manage and I'll go through those other
140. 4:57risk factors later in the video there an
141. 4:59avalanche of evidence showing that lzl
142. 5:02cholesterol is a causal risk factor for
143. 5:04heart disease and it's why every Medical
144. 5:06School hospital and Cardiology guideline
145. 5:09Advocates to lower LDL cholesterol the
146. 5:12evidence comes from metaanalyses such as
147. 5:14this one in 2017 that looked at a
148. 5:16mixture of data including randomized
149. 5:18controlled trials involving over 2
150. 5:20million participants with over 20
151. 5:22million person years of followup that
152. 5:24unequivocally establishes that LDL
153. 5:27cholesterol causes heart disease and
154. 5:29this graph perfectly illustrates the LDL
155. 5:31cholesterol to heart disease
156. 5:33relationship if you just wanted to look
157. 5:35at the randomized control trials for
158. 5:37example you can see the relationship
159. 5:38clearly in terms of LDL cholesterol
160. 5:41targets from the pie study we can see
161. 5:43that plaque begins to develop if the LDL
162. 5:46cholesterol is above 50 to 60 milligram
163. 5:49per deciliter even if all of the other
164. 5:51risk factors such as insulin resistance
165. 5:53are optimal there's even a suggestion in
166. 5:56the literature that the optimal LDL
167. 5:58cholesterol level appears to be the
168. 6:00level present at birth so between 20 to
169. 6:0240 mg per decil so in addition to
170. 6:05getting my exercise right I aim to have
171. 6:07my LDL cholesterol below 60 now LDL
172. 6:11particles are only one type of particle
173. 6:13that contributes to blockages in our
174. 6:14blood vessels so if you want to catch
175. 6:16all of the particles that contribute to
176. 6:18these blockages measure your Appo b and
177. 6:21a reasonable Target is below 50 to 60
178. 6:24and to reach that Target I take a lowd
179. 6:26do Statin specifically 5 mg of re Statin
180. 6:30and I've got a detailed video about
181. 6:32cholesterol lowering medications here
182. 6:34but lowering cholesterol levels isn't
183. 6:36just about taking pills and that leads
184. 6:38us onto the third step diet a landmark
185. 6:41study in 2022 changed our understanding
186. 6:44about what the best diet is for blood
187. 6:46vessel Health it was a randomized
188. 6:48control trial that ran for 7even years
189. 6:50and it enrolled 1,02 patients who
190. 6:53already had had a heart attack half of
191. 6:55them were assigned to a lowfat diet and
192. 6:57the other group were given a medit Anan
193. 7:00diet after 7 years there was a roughly
194. 7:0225% risk reduction in the Mediterranean
195. 7:05group compared to the lowfat diet group
196. 7:08now of course no diet is going to be
197. 7:10perfect for everyone but there are some
198. 7:12critical diet fundamentals we want a
199. 7:14diet rich in lean protein we want to
200. 7:16have fruits and non-starchy vegetables
201. 7:19unsaturated fats such as extra virgin
202. 7:21olive oil nuts and seeds we want to have
203. 7:23a diet that's low in sugar salt and
204. 7:26saturated fats and all of that has got
205. 7:28great evidence for reduced heart disease
206. 7:30and I go through the diet fundamentals
207. 7:32for reducing heart disease in another
208. 7:34video here so if we get out exercise
209. 7:37blood cholesterol and diet right we are
210. 7:39well on our way to reducing arterial
211. 7:41plaque and preventing heart attacks but
212. 7:43there are an additional three steps to
213. 7:45really accelerate the plaque clearance
214. 7:48the first is Stress Management stress
215. 7:50raises our inflammation and for some it
216. 7:53causes them to turn to unhealthy Comfort
217. 7:55foods and often results in poor sleep so
218. 7:57if you are stressed please don't sweep
219. 7:59your mental health under the rug seek
220. 8:01help from your doctor counselor friends
221. 8:03and family guided meditation from apps
222. 8:06such as headspace can also be a
223. 8:07GameChanger for some people the next
224. 8:10step is Weight Management now hopefully
225. 8:12by following the previous sections and
226. 8:14addressing your diet exercise sleep and
227. 8:16stress your weight will be controlled
228. 8:18but if you're struggling with weight
229. 8:19loss and insulin resistance that's okay
230. 8:22there is help in addition to all of the
231. 8:24lifestyle factors that we've gone
232. 8:25through we've got fantastic medication
233. 8:27options to help patients such as the
234. 8:30glp1 class of medications and one
235. 8:32example of that is AIC now I'm not
236. 8:35affiliated with AIC at all I just wanted
237. 8:37to mention that as an example of a
238. 8:39medication that can really help patients
239. 8:41in addition to the lifestyle factors
240. 8:43it's certainly not a replacement for any
241. 8:45lifestyle change and they are currently
242. 8:47expensive and they're not a short-term
243. 8:49fix so much like other medications if
244. 8:51you stop using them then the same issues
245. 8:53come back so most people if they stop
246. 8:55the glp1 medication they will regain
247. 8:58most of the weight that they've lost
248. 9:00this is a long-term medication and I get
249. 9:02such a thrill at the clinic when I see
250. 9:04my type 2 diabetic patients we work hard
251. 9:06on their lifestyle factors and we
252. 9:07prescribe a gp1 then after a few months
253. 9:10we can usually stop the insulin the next
254. 9:13step is blood pressure blood pressure
255. 9:15puts a needless strain on our blood
256. 9:17vessels and it's known as the silent
257. 9:18killer because often it doesn't cause
258. 9:20any symptoms until something goes pop
259. 9:23and ideally we want to check your blood
260. 9:24pressure at home so from the
261. 9:26groundbreaking Sprint study we can see
262. 9:28that a Sy IC blood pressure of 120
263. 9:31offers significant risk reductions in
264. 9:32heart disease compared to higher blood
265. 9:34pressures of around 136 now again
266. 9:37ideally we want to be measuring blood
267. 9:39pressure at home and it should be below
268. 9:41120 we may accept slightly higher
269. 9:43readings for older adults around 130
270. 9:45because we don't want to drop their
271. 9:46blood pressure too low and cause them to
272. 9:48feel dizzy and fall over but for blood
273. 9:50pressure with the lifestyle changes and
274. 9:52weight management hopefully it will be
275. 9:54absolutely fine but if not there are
276. 9:57fantastic medication options available
277. 9:59to bring your blood pressure down again
278. 10:01it's not a replacement for any of the
279. 10:02lifestyle factors mentioned in this
280. 10:04video and I highly recommend you check
281. 10:06out the next video here that goes into
282. 10:08great detail about cholesterol lowering
283. 10:10medications their benefits and potential
284. 10:12side effects and a massive thank you to
285. 10:14all of the patrons supporting the
286. 10:16channel