But, yes, Alzheimer's disease is one of the neurodegenerative diseases that are up in
the top four or five, like you mentioned, cause...
[Peter]: Well, it's the top.
It's the only neurodegenerative disease that's on the top 10 list of death.
[Rhonda]: Top 10, yeah.
So cardiovascular disease...
[Peter]: So cardiovascular is far and away number one.
It's not even...I mean, cancer in an aggregate is number two, but as an oncologist I, sort
of, take an issue with that because cancer's a completely heterogeneic form of diseases.
So to put this in perspective, right...so breast cancer, who's not afraid of breast
cancer if you're a woman?
Breast cancer accounts for 3% of deaths in women.
I was shocked to learn that, very low.
I would have thought much, much higher.
Now, cancer in women, all cancers, 20%, 21%.
Cardiac disease, 22% 23%.
So if you're woman, if you ask any woman in the street, "Are you more afraid of heart
disease or breast cancer?"
I think most women would understandably say breast cancer.
And yet, it's dwarfed by cardiac disease by a factor of seven and a half to one.
[Rhonda]: And we definitely know that diet and lifestyle play a major role in your risk
for cardiovascular disease.
[Peter]: Yeah.
I mean, I think there's no place where that's more obvious than actually in Alzheimer's
disease for other reasons, which is...
[Rhonda]: Really?
Alzheimer's?
[Peter]: Yeah.
I think so.
[Rhonda]: More than cardiovascular?
[Peter]: Well, I mean I say that just based on what I called the existence principle,
right?
So cardiac disease, I mean I think that's entirely true.
I think cardiac disease is inevitable.
Right?
And, while we've had a deterioration in our lifestyle over the past 40 years, a pretty
precipitated and accelerated, sort of, move in the wrong direction on that, it's been
largely offset by pretty amazing medical advances.
So the three things that have, I think, allowed cardiac disease to remain...in fact, it's
actually come down.
If you look at the death rate from cardiac disease, it's come down.
So it's still the number one killer but it's actually on a downward slope, I mean it's
sort of plateauing.
But when you look at what, sort of, the three biggest drivers are of cardiac disease, the
first one is not disputed.
It's smoking.
So the data are really clear that if you could only make one behavioral change to reduce
your risk of heart disease, it's don't smoke.
The next two are actually, because they are so cross-correlated you can't actually distinguish
which one is more important, are hypertension and elevated ApoB or LDL particle number.
And, again, ApoB is the single best biomarker or LDL-P to distinguish your risk of cardiac
disease.
It trumps LDL cholesterol, it trumps non-HDL cholesterol, it trumps triglycerides, HDL
cholesterol.
Those things don't hold a candle to LDL particle number ApoB.
Well, think about it.
Think about the advances we've made in the last 40 years on all of those, right?
So smoking has gone from 45% of the population to 18% of the population.
So we reduced smoking.
[Rhonda]: In the U.S.? [Peter]: In the U.S. that's right.
Obviously, we haven't done the same in the developing world.
Think of the litany of drugs we have for controlling hypertension and think about the litany of
drugs we have to bring down ApoB.
So despite enormous improvements in the three big picture drivers, it's still the number
one killer.
So it's got to be lifestyle-driven but we're blunting the effect of that.
Whereas in Alzheimer's disease, we don't really have any pharmacotherapy plays.
Like, we're still arguing about what the environmental trigger is.
Is it all diet-driven, is it sleep-driven, is it stress-driven, what's the combination
of factors?
Is it is a virus?
Is it prions?
I mean I've heard every argument under the sun, right?
But here's what we do know.
We know that in the last 50 years, the prevalence of Alzheimer's disease has gone up about 2.5%...per
year, by the way.
I'm sorry.
That's per year.
Whereas we know that our longevity has increased at about 0.6% per year over that same period
of time.
Now, over a 50-year period, a 2% spread per year of prevalence.
Actually, I think that might be incidence, now when I think about it.
I think it's incidence.
And longevity suggests that Alzheimer's disease isn't just the natural response of getting
old.
There's something driving it.
And even if you accept that part of that increase in incidence is a greater appreciation for
the diagnosis, it's hard to argue that makes up the full 2% spread.
And to me, that's the most convincing case for why there is something in our environment
that's triggering Alzheimer's disease and it is not just the natural consequence of
aging.