Avi Aronov

@Drlipid @MichaelAlbertMD @Drlipid Do you mind explaining why?

This has been known for many years. In 2024, the only way we reduce LDL-P (apoB) and MACE is not to decrease apoB-particle production but rather increase apoB particle clearance by upregulating LDLR or extending hepatic residence time of LDLR: statins, ezetimibe, bempedoic acid, bile acid sequestrants or PCSK9i. IT IS ALL ABOUT PARTCLE CLEARANCE. Drugs that have little effect on LDLR but reduce production do not reduce MACE (fibrates, niacin) @nationallipid @society_eas

Re: ApoB/LDL and heart disease 🧵 “While both statin and established non-statin therapies (PCSK9i and ezetimibe) reduced CV risk per decrease in apoB, interventions which reduce apoB independently of LDL-R were not associated with cardiovascular benefit.” journals.sagepub.com/doi/abs/10.117…

@Drlipid @CVOMed @alanbrownmd @CBallantyneMD @EugeniaGianos @lipiddoc @dan_soffer But why does upstream inhibition in cholesterol synthesis pathway (i.e. bempedoic acid) lead to such markedly reduced LDL compared to downstream inhibition (i.e. statins)? Alternative pathway? What am I missing?

@CVOMed @alanbrownmd @CBallantyneMD @EugeniaGianos @lipiddoc @dan_soffer Hyper-response to a cholesterol synthesis inhibitor like a statin or bempedoic acid usually occurs in patients with increased cholesterol synthesis (sterol testing would reveal high lathosterol and desmosterol levels).

Bempedoic acid super-responder? 38 yo M PMH HeFH (LDLr variant unknown sig), CABG x4 1 yr ago 🚨Baseline LDLc 299 mg/dL Rosuva 40 mg daily, Repatha, Ezetimibe 🚨LDLc 265 🫀➕Bempedoic acid ➡️ LDLc 87 @alanbrownmd @CBallantyneMD @EugeniaGianos @lipiddoc @Drlipid @dan_soffer

Optimal Prescribing of Statins to Reduce Cardiovascular Disease - The American Journal of Medicine amjmed.com/article/S0002-… Agreed!

Nontraditional Risk Markers for Incident CAC Among Persons ≥65 Years of Age @JACCJournals #JACCAdvances #undfig1" target="_blank" rel="nofollow noopener">sciencedirect.com/science/articl… Identification of albuminuria or extracoronary atherosclerosis may help guide the timing of repeat CAC scoring in older persons with baseline CAC=0

REPRIEVE: Significant decrease in major adverse cardiovascular events with pitavastin. RCT trial enrolled only low-to-moderate CV risk PWH, for whom a statin might not otherwise be prescribed. Important clinical trial with direct relevance to pt care. #article_discussion_sc3" target="_blank" rel="nofollow noopener">nejm.org/doi/full/10.10…

Lipoprotein(a) and coronary artery calcium in comparison with other lipid biomarkers: The multi-ethnic study of atherosclerosis @nationallipid @CandaceLJackson @Lpa_Doc @hsbhatia 👉lipidjournal.com/article/S1933-…

Critically important data. ncbi.nlm.nih.gov/pmc/articles/P…

#EPeeps #CardioTwitter This deserves A LOT more attention It's equally promosing and controversial @CircAHA Article by rising star🌟 @lucas_yxing: ahajournals.org/doi/epub/10.11… Also an example on how to properly conclude on a study @djc795 @drjohnm Short🧵 1/

@anish_koka Observational studies are great for prognostics and natural disease course.

🔥🔥🔥Wow!!!! In a phenomenally bold wager our Doctor’s Dilemma team won the ACP ILN competition for the 2nd year in a row!!!! Look out San Diego here they come!!! 🎉👏@IllinoisACP @ACPinternists @UICIMChiefs @UIHealth #UICfamily

Such a good one. "Some observational studies are correct-- I just don't know which ones." Study of the Week - Lessons from a Serious Medical Mistake sensiblemed.substack.com/p/study-of-the…

Percutaneous Revascularization for Ischemic Left Ventricular Dysfunction | NEJM nejm.org/doi/full/10.10…

(1/ )Summaries of the average high impact trial by field: #EBM #medtwitter #epitwitter #FOAMed #Cardiology:We enrolled the entire population of Europe in a trial to detect a composite endpoint occurring in 3% of patients. The relative risk reduction was 20%. The NNT is 12,000

Let’s go!!!! 🔥🔥🔥🔥

@pnatarajanmd @NEJM Such important info — risk prediction in childhood. Would love to see the inclusion of SDOH in childhood on long term outcomes in this cohort.

Incorporation of childhood CVD risk factors (youth smoking, BMI, and lipids) boosts adult CVD risk prediction, on top of adult CVD risk factors nejm.org/doi/full/10.10… @NEJM Important implications for childhood risk factor assessment & lifelong CV health promotion

@MSAmbalavanan @UIHealth @uiccom @ACCinTouch @PSreepathyMD @UICIMChiefs @NoreenNazirMD @KhalilIbrahimMD @spiritus_bah @StephDwyer21 @avi_aronov @CarlosDohse Need to add a few more photos to the celebration of @uiccom @UIC_CathLab @UICDom @UICPharm @UICPharmacology @UICPharmacy @StephDwyer21 @VickiGrooPharmD @MSAmbalavanan

Inhibiting Interleukin-6 to Reduce Cardiovascular Event Rates: A Next ... sciencedirect.com/science/articl…

Socioeconomics of coronary artery calcium: Is it scored or ignored? - Journal of Cardiovascular Computed Tomography journalofcardiovascularct.com/article/S1934-…