Gruentzig's Ghost

If your "metabolic health coach" is using the words "mogs," run away. Statins rule.

@Marion436842126 @DIY_Tardis @mccloud_ra42048 New conspiracy theory unlocked. People coming with truth are pharmacy bots. Go back under your rocks and get back on that QAnon train.

@DIY_Tardis @GruentzigG @mccloud_ra42048 How can you tell ?

1/13 Statins don’t “lower cholesterol.” They cripple the mevalonate pathway, the body’s core engine for energy, repair, and longevity. What follows is the science Big Pharma left out: /2

@Marion436842126 @mccloud_ra42048 Screw your stupid mevalonate pathway. What dumb logic. Trials show death drops. Trials show MIs drop. Trials show strokes drop. Why would I care about the mevalonate pathway? No one ever felt the mevalonate pathway. It has no clinical relevance. Go away.

@GruentzigG @mccloud_ra42048 Trials show LDL drops. Raw data ? Locked away. Meanwhile, the science behind the mevalonate pathway tells a different story.

@Marion436842126 @mccloud_ra42048 You're the one on here spouting nonsense. Read the trials. 4S, HPS, CARE, LIPID, PROVE-IT TIMI 22, TNT. All showed lowering LDL with statins vs placebo or more intense statins vs weaker ones improved CV outcomes in pts with CAD. It's not a debate. Go find another conspiracy.

@GruentzigG @mccloud_ra42048 especially when CAC can still rise on treatment ? For the record, I’m not selling anything - just asking about the evidence.

@Marion436842126 @mccloud_ra42048 Don't need to prove myself to dimwits on here trying to sell potions and elixirs and dimwit lifestyles that have no effect. Lower LDL doesn't reduce a CAC score. It reduces the risk of heart attack, stroke and mortality in people with CAD. You know, like what we care about.

@GruentzigG @mccloud_ra42048 Also, can you explain how driving LDL lower in someone with an otherwise normal lipid profile addresses - or reduces a high CAC score ?

@rational_doc @mccloud_ra42048 @Marion436842126 In fact, we make more money if they don't take statins.

@GruentzigG @mccloud_ra42048 @Marion436842126 Yes and it’s 4$/month. No doc get rich by prescribing statins, on the other hand everyone has wasted time arguing with some pts who believes docs prescribe statins to benefit themselves

Other than yellow fever, which is transmitted by mosquitoes and not human-to-human, these are all bacterial infections. Now do viruses. You can't honestly downplay the importance of vaccines in the safe lives we get to lead today.

@DrJMarine Revisionist history. 1st, patients with HIV/AIDS were treated as vectors of disease all throughout the 80s and beyond. They were stigmatized, looked down upon and treated with extreme prejudice. 2nd, you can't contract HIV by being in the room with someone. Very different.

I started medical school in San Francisco Bay area in 1988, when AIDS was decimating the gay male population of the region and the disease was 100% fatal. We approached that pandemic very differently. Patients and at-risk people were not treated as “vectors of disease,” though there were some who wanted to. Other than temporarily closing a few super-spreader sites, we did not abridge their rights and freedoms, though there were some who wanted to. Public health leaders, including Fauci, stood up for them and against panic and authoritarianism. And we emerged from that pandemic a more humane country. We handled the covid pandemic very differently. And we achieved the opposite outcome. The War on Covid became a quiet civil war. I am glad that we have @DrJBhattacharya at @NIH working to bind the nations wounds. Godspeed.

That tracks

I approve this message.

@farkomd Accept frequent reminders.

Got this memo in my clinic this morning from my team. How would you react?

How can I sign up for STEMI call at this hospital?

@drjohnm @djc795 @rwyeh Obs studies still rubbish trying to answer questions like this. Sure you're not bullish on this one because it fits your priors? Careful ...

ahajournals.org/doi/10.1161/CI… I need to study the methods of this paper. It's pretty complex, but the gist is that they did a better job matching the pLAAO vs DOAC group. And then of course there is no difference in mortality. Which is true and shown in LAAOS-3. cc @djc795 @rwyeh

Previous obs studies suggest that left atrial appendage occlusion reduce mortality @MRuzieh et al do a more careful analysis of the same Medicare database and confirm the findings of RCTs that pLAAO does not reduce mortality at one year. Impressive work

Don't understand the point of this terminology, really. Real question with an ECG is "To the cath lab now or not?" And the answer here is a resounding yes. Yesterday.

Hmmmmm, what could the difference possibly be between a patient under 60 who gets a TAVR vs a SAVR? Couldn't be that they're sicker! Naaaaaaaah. But we adjusted ... blah blah blah. Surgeons thinking like surgeons here.

Ovary in the colon

There are many previously reputable cardiac surgery divisions around the country that are struggling or have already sustained significant reputational damage because the operative skills of the chief they hired is not commensurate of the national exposure they had been afforded.

@djc795 @benhibbertMDPhD Totally reasonable, I think. Can't tell if flow there is impaired because of recent infarct, collaterals or intramyocardial course that would make surgery more risky or impossible.

@GruentzigG @benhibbertMDPhD For a case like this, would anyone get a CTA to make sure the septal portion of the twin LAD is reasonably accessible for CABG?

Neither. Bypass. [throws up in mouth a little]

@benhibbertMDPhD Totes agree. Same for TAVR. But the more we do perc, the more we often think things like, "Well I'll just try this and if it doesn't work, we can do surgery." Sometimes when you try it, bad things happen. And surgery is off the table, too.

@GruentzigG For sure - just thought it was the first time you’ve recommended it. Low surgical risk high anatomical complexity is the sweet spot - but ppl often forget the clinical component and only see anatomy.