Greg Katz, MD

off topic from current discussion but relevant still. this is why i'm not truly worried about "AI will replace doctors" cuz in the real world where I live and practice medicine, most patients in my experience want a doctor who can not only do math but also has these silly useless "skills" we call social skills, empathy, emotional intelligence etc etc yes, there are doctors who sorely lack in people skills but it doesn't mean we should push for a future where our "doctors" don't have them at all

A greatly under-appreciated side effect of niche academic debate on twitter is that everyone else (aka gen public) can see it too. While other docs rightly call out obvious misinformation, John comes out and says well actuallyyyyyy, if you look at the data, he’s not *actually* wrong! See?! What others see: hmm Aseem Malhotra is making sense… hey look an esteemed cardiologist using papers to support Aseem Malhotra’s claim, looks legit! 🤔 Do you think people realize the nuance that the actual problem (the “fuss”) is not that data itself but the fact that it is being intentionally misused to push a dangerous and misleading narrative that might influence people who actually need their statin the most, to stop taking them? No. Why should they either? John could have used this opportunity to really highlight that, but he didn’t. Interesting. The problem is not the data, it is the messaging and narrative.

major life hack: don't bother reading any article whose title includes the word "associated" there are ~1 million medical publications per year, don't spend your time reading retrospective associative studies

Dr. Aseem Malhotra: "If you take a statin for 5 years after a heart attack... in that 5 year period, how much would you think or hope it would add to your life expectancy?" Joe Rogan: "25%? 30%?" Malhotra: "Just over 4 days."

🫀📉 Can more intensive LDL-lowering improve CT-FFR in stable chest pain? This new JACC study evaluates whether intensive lipid-lowering therapy (statin + ezetimibe) alters CT-derived fractional flow reserve (FFR-CT) — a noninvasive marker of lesion-specific ischemia — in patients with stable chest pain and coronary atherosclerosis. 🔍 Study essentials Patients with stable angina and coronary plaque on CT angiography were managed with aggressive lipid-lowering using statins plus ezetimibe, targeting substantial LDL-C reduction. FFR-CT was measured at baseline and on follow-up to assess functional changes in coronary physiology attributable to therapy. 📈 Key message The core focus — integrating structural and functional imaging — points to a key concept: lipid-lowering can potentially improve lesion physiology, not just plaque burden. By using FFR-CT (a validated surrogate for invasive FFR), the authors are examining whether aggressive LDL-reduction actually shifts physiological indices toward less ischemia. 🧠 Why this matters Lipid-lowering benefits have traditionally been shown at the event level (MI, death). Structural plaque regression with statins/ezetimibe is documented in IVUS and CT studies. But fewer data exist on functional improvement in coronary blood flow with therapy. Linking lipid therapy to improved FFR-CT suggests that LDL-lowering may not only slow plaque progression but also improve coronary physiology — a potential mechanistic bridge to clinical benefit. 📌 Bottom line: Intensive lipid-lowering might influence not only plaque morphology but lesion-specific ischemia as assessed noninvasively, expanding our understanding of how therapies translate into physiological improvement.

Just a PSA about treating high cholesterol: I recently helped two young women who were told to take meds for high cholesterol calculate their 10-year ASCVD risk Both had 10-year risk less than 3%. Why aren't primary care clinicians using a risk equation?

RFK Jr: HHS Launches Program Rewarding Doctors for Healing, Not Profiting from Sickness HHS is creating incentives for healthcare to focus on patient recovery rather than profits. Currently, hospitals, doctors, insurers, and pharmaceutical companies benefit by keeping people sick