Greg

Response to Rebuttals on: "Seven Years of 700 Cholesterol Without Coronary Atherosclerosis". It’s been really interesting to watch the first 24-hour response to this new paper. The overwhelming majority has been, if not fully enthusiastic, at least curious. And I sincerely appreciate that. That said, some of the pushback has also been revealing… even comical. So let me address the most common retorts. ⏳1. “He’s too young.” Asked and answered. HoFH Children with similar LDL and ApoB levels can develop measurable plaque within the first few years of life and even heart attacks by age 8 or 10. Other people around my age, using similar imaging technology, also show measurable plaque. “He’s young” is not a good explanation. 🙄2. “You have a conflict of interest because you’re the patient.” LMAO! This one might be my favorite. What exactly did I do? Go into the CT scanner and suck in my plaque like I was sucking in my gut? Ask the AI algorithm, “Hey, I’m the patient — do me a solid?” If you think this is a rebuttal, I suggest you don’t join any debate teams. 🦓3. “He’s an outlier.” Yes. At a population level, I am an outlier. I don’t have obesity, prediabetes, or metabolic syndrome. But that’s one of the broader points: We have a paucity of data on the risks of elevated LDL in metabolically healthy people without underlying genetic lipid disorders. Outliers are not reasons to stop thinking. They’re opportunities to learn. 🤷‍♂️4. “It’s a fluke. He’s a one-off.” What a remarkably uncurious response. Imagine an oncologist had a patient with stage IV pancreatic cancer (~3% five-year survival rate). And that patient somehow cured himself, then went on to win the 100 meters at the Olympics 12 years later. Would the oncologist say: “Meh… What’s for lunch?” Of course not. A good scientist or doctor (or curious human) would ask: what happened here? 🧬5. “Oh, you probably just have protective genetics.” Oh, really? My father had a 99% occlusion of his left anterior descending artery at age 44. My Lp(a) runs between 100 and 194. And on top of that, I have a history of inflammatory bowel disease, a condition associated with chronic systemic inflammation. 🫀6. “But what about the Keto-CTA paper?” If you’re trying to beat this drum like it’s a trump card, I’d guarantee you’re stuck in an echo chamber and have incomplete information. It has now been clarified repeatedly that the original CLEERLY dataset published on April 7th was not reliable. CLEERLY had unblinded scans, anomalously results, and refused to perform a quality-control check. And multiple independent analyses have since shown that the KETO-CTA group do not appear to be a high-progression group. This is why we, the authors, took the initiative to retract the paper (NOT the study). The KETO-CTA Heartflow and QAngio data are available as a pre-print. And I’ve seen nobody legitimately try to defend the CLEERLY dataset. Also, the data show that LDL and ApoB did not predict plaque progression, and even at high LDL and ApoB levels, confirmed regression was observed. 👇 For supporters, feel free to link this the next time you see someone try to deploy these arguments. For critics, I suggest taking a read and thinking carefully… either to avoid falling onto the pyramid… or to avoid giving me reason to expand it.

The most exciting longevity trend right now is that we are actually beating dementia. At a given age—70, 75, 80, etc.—the prevalence of dementia is down compared to what it was decades ago. Today's 90-year-olds have less than half the risk of dementia that ones in 1984 did!

I don’t know who needs to hear this, but the mass prescribing of statins has not brought down rates of heart disease In fact, they are higher than they have ever been— and most people being admitted to hospital with heart issues are already on statins Ask more questions, folks!

Thoughts on officiating: - Fans always feel their team gets screwed, but universally, everyone watching OKC feels like something is off in how they're officiated. That matters. It just does. OKC Fans will claim jealousy or hate because the alternative is untenable for them. But there is a genuine feeling among all fans that the disparity in SGA's whistle to their defensive whistle is incongruous - The next step is the "So you think the league is rigging for a small market team?" and I understand the consequential thinking, but I think it's healthier to just focus on the problem. I think there's no grand conspiracy but there IS an incongruity in officiating. - Last year, we had an awesome first round, in which the players were openly pleading to be less physical because they felt it was dangerous. So now we've gotten a regular-season whistle. And it sucks. As fans, we hate it. I don't know what that balance should be because it's not my body on the line, but it sure feels like there's a way to have a physical contact sport set of officiating perameters that also deters dangerous play - Finch was campaigning to try and politic a win, but he also wasn't wrong when before Game 2 he made the point that the call should be based on what happens at point of contact and not what happens afterward (flop/flail/fall). The contact is what needs to matter and not the sell job after it. - Shai is genuinely difficult to officiate because he IS incredible at driving and controlling where he goes to challenge direct path defense. It's a genuine skill he has. - He also sells because otherwise he doesn't get the call. This is maybe the biggest problem of all: if you legitimately create the contact but don't performatively exagerate it, you will not be rewarded. That's a problem. - We always find something to say is a problem with the NBA, and more so in the playoffs when it's in the spotlight. But this is a genuijne issue for watchability. Fans don't want this. The league needs to listen.

🧵 Statins vs Mediterranean Diet. Head-to-head. Same outcome. Let the studies speak. STATINS (primary prevention): → Absolute risk reduction: ~1% → NNT: 200+ people treated to prevent 1 event → Side effects in 20%+ of patients → $15 billion annual market (Taylor et al., Cochrane, 2013) MEDITERRANEAN DIET: → ~30% reduction in cardiovascular events → No side effects → Costs: olive oil, nuts, vegetables, fish → Market value: $0 (can't patent food)

I wonder how much of medicine is driven by drugs. For example, why did they decide that LDL cholesterol is the main marker for heart disease, rather than triglycerides or insulin? After all, triglycerides and insulin are better markers of heart disease risk. The reason? Probably because LDL cholesterol is "targetable"--there's a drug (statins) that will lower it. So it matters less that LDL is a good marker, and more that it's a number we can change with a drug. And of course, make money in the process. If there were a drug that lowered triglycerides really well, I suspect mainstream medicine would focus more on triglycerides. (Incidentally, the best way to lower triglycerides and insulin is to control consumption of refined carbohydrates.)