James McCormack

What part are you disagreeing with? Do you have evidence that Apo B importantly improves numeric estimates of risk for individuals over and above using age, sex, total cholesterol, HDL, SBP etc. I can’t find any. Thanks.

fipco @fipco

@medmyths Respectfully disagree. UK Biobank is a lower risk population. Excluding baseline statin/ASCVD enriches for low events. Study does show risk tracks with apoB, not traditional lipid measures. At non-HDL-C 130mg/dL, 60% difference with high vs low apoB.

Thanks. Lp(a) would be likely very similar - the big difference is most of our conventional lipid treatments have no effect on Lp(a).

ORTHO CARE @bbhorthoopd

@medmyths well explained . thanks. what about Lipoprotein (a).

Apo B is being promoted as a “better” measurement of risk in the lipid arena. A paper just published shows what knowing Apo B does to 10-yr CVD risk estimates. Apo B likely is a “bit better” BUT you need to look at the actual #s - see my synopsis -happy for constructive comments. https://t.co/AFhTZ3sBVs

RT @MichaelMindrum: @medmyths Can take a look here:

I think it is best to hope for medications that reduce CVD risk rather than lower cholesterol. In addition, I would also hope they aren't $7000 a year for an ~1%/year absolute benefit and only in people with a history of CVD.

André @OAndrePa

@ElvinaNegr55789 @medmyths Hoping for oral PCSK9 inhibitors in phase 3 trials to change that.

Haven't done an exhaustive look at this but here is one reference. Happy to see other info. https://t.co/bcjtwOMqSf

André @OAndrePa

@medmyths Are you sure about that high percentage? Besides, not all acute vascular events depend on atherosclerosis; that’s also an important point to consider.

Agree - 50% of people having a coronary event have SBP< 125mmHg and LDLs < 100 mg/dL (2.6). And so how do we practically use Apo B to improve our risk estimates to enhance shared decision-making. If we can't, it isn't ready/useful for prime time.

Steve Granier @DocSteveG

@medmyths Hi James, I suspect not on a population level because of the modest impact (most risk is captured with LDL). However a substantial proportion of people in lower risk groups develop CVD. I think using 30 yr QRISK in younger people with ApoB may help inform decisions.

Thanks Steve. Can you define nuance with numbers? How about - in patients without established CVD, does the addition of apo B meaningfully change cardiovascular disease risk estimation compared to standard risk estimates (e.g., age, smoking, SBP, TC, HDL) alone?

Steve Granier @DocSteveG

@medmyths For most LDL-C may be sufficient but some people who have discordant LDL-C and ApoB. For those with uncertainty eg. relatively low LDL C but some FH of CVD who are unsure about starting statin, measuring ApoB and Lp a can give nuance to a discussion about their individual risk.

That's what I think but would love to hear from the people who think we need to measure Apo B in addition to total cholesterol and HDL to make a reasonable CVD risk prediction. Happy to change my mind if there is evidence - it's an inexpensive test.

Tom Marshall @TomPMarshall

@medmyths The difference in risk prediction is likely to be marginal in a multivariable equation which is dominated by age (then sex, diabetic status, smoking status).

I keep reading/hearing that Apo B is a better CVD risk predictor than LDL. However, we use total chol and HDL in CVD risk calculators. Can anyone point me to evidence that shows Apo B adds important value to CVD risk estimations and if so, how do I use it to make risk% estimates?

We just updated our popular antibiotic sensitivity chart (May 2024). I think you'll find it useful. I believe it is the best one out there but of course I'm biased. Thanks. https://t.co/KGz2opc8BZ https://t.co/TRk3yMqrg8

RT @Ricky_Turgeon: It still blows my mind how the foundation of type 2 diabetes pharmacotherapy can be so shaky, with us still not really k…

RT @bmj_latest: Clinical guidelines give risk thresholds for starting #statins based on population benefit. Guidelines should focus more o…

The article states a + jump test = a 70% chance you have appendicitis. That is only correct if the pretest probability is ~45%. A post test probability depends very much on the prevalence. I may be wrong but I believe it is more a rule out than rule in test. Thoughts?

Dr. Jennifer Shu @DrJenniferShu

Jump test for appendicitis? Thanks, @NPR @SelinaSD for the interview https://t.co/RWEjpYgnCD

Gil: This is a beautiful and clever piece of research. However, context is always important. IMHO the differences seen between the groups in LDL and HDL are not big enough to change CVD risk estimates and interestingly they make no mention of blood pressure effects. Thoughts?

Gil Carvalho MD PhD🌈 @NutritionMadeS3

vegan vs omnivore study in TWINS!! I´m sure this won't cause ANY bickering AT ALL on social media 🤣🤣 calling it right now: veganJoe146- "this proves everyone should be vegan" meatySam38- "this study is useless garbage"

Was proud to be a part of putting this together. It's simplified but also very evidence-based and all about shared decision making. Check it out along with the new decision aid/calculator https://t.co/cTpELJwzEG and also https://t.co/A0qQHcxtUB.

The College of Family Physicians of Canada @CFPC_e

The 2023 PEER Simplified Lipid Guideline is now available! Find out everything you need to know about lipid management in 2023 by checking out this must have resource for family medicine practitioners: https://t.co/xgRDVt9li2 https://t.co/tBhbXTwssy

This is a really good response to a not so good NYT article. Placebo Effect Revisited | Science-Based Medicine https://t.co/vv1zv0K5jK via @sciencebasedmed If you ever want to "harness the placebo effect" without deception just start with a VERY low dose of a proven medication.