Coming up on today's show.

Atherosclerosis is a lifelong disease. It can start in utero, can start before you're born. But you typically don't present to a doctor with symptoms until you're in your 40s, 50s or 60s. And people can live their entire life, have these plaques and not know that they're there until one or two things happens. The plaque builds up to where it's occluding the artery, 70%. The arteries occluded 70%. People tend to have symptoms while they're exercising because they can't get enough oxygen nutrients past the obstruction. Or they have a plaque that ruptures. The plaque ruptures is like a pimple in the wall of their artery popping. All the cellular debris spills out into the bloodstream, the blood clots, and a person's having a heart attack. If they have a rectal dysfunction as a man, that's the canary in the coal mine that the blood vessel isleisle of the sectional organs aren't working well. You likely have vascular disease in your coronary arteries. You need to go looking. The thing that you're treating is that it's the plaque that is more soft or more immature, that placket that hasn't fully gotten a thick cap over it or calcified. You want those softer plaques to what's known as delipidate.

You want the cholesterol to be basically pulled out of that plaque.

So you're thinking of like shrinking a balloon down.

So if you can delipidate a plaque, then the plaques can start to regress or shrink.

Dr. Twyman, as a cardiologist, the first thing I want to get into with you is arterial

plaque. And let's start with the risk factors. If we go to the root here, what is causing it?

There's over 3 to 400 different risk factors that drive vascular disease, but it always starts with endothelial dysfunction. So the endothelium is the inner lining of your arteries. If you took out your endothelium from your arteries, which there's nearly 60,000 miles of arteries, you'd have the surface area of six tennis courts. So the endothelum is one of your largest organs that you had no idea that you probably had. But if something damages that lining, that's setting you up to develop plaque. And this can start in your teens, you're 20. So you've got to go looking well before the person shows up at the hospital with chest pain and shortness of breath. All right. Well, let's go back even further then. The endothelium, this is where the problem starts. What are the biggest things causing damage there?

I mean, the top five are still the top five.

It's high blood pressure, smoking, high cholesterol, which we'll talk more about, obesity,

and obesity, smoking, high blood pressure lipids, and diabetes.

Those are a big top five.

All right.

Well, let's get into mechanism.

Obviously, you've named five.

And the mechanism is potentially different depending on which one we're talking about.

But let's start with the metabolism piece, metabolic health. you mentioned diabetes, different words for a very similar thing.

This is a big one, and one a lot of people don't realize when they're having too many sugars and carbohydrates,

insulin's going up in response, and that can cause damage to the endothelium.

So let's start there.

So it actually damages the thing that protects the endothelium.

It's damaging the glycochalix.

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