AMA on cancer screening
The category that scares me the most to do without an expert on the topic, is cancer screening. An AMA on low/mid/high budget what screening you would do and how often, and what to do when something comes back flagged. How to decipher if its a false positive, or something potentially benign that should just be monitored, instead of turning your life upside down... (I saw that Zubin recently did an episode where he was pretty negative on preventative testing in general, partially for these reasons)
The thrombogenic hypothesis of cardiovascular disease
Have you considered the thrombogenic hypothesis of cardiovascular disease as proposed by Malcolm Kendrick? I would very much like to hear thoughts of the subject. I would like to propose that you have a discussion with Malcolm, similar to the podcast you had with Dave Feldman on this subject.
Insulin effects on ASCVD plaques, LDL, and Lp(a)
My Lp(a) has been rising with LDL since I changed to Saladino style carnivore diet 18 months ago. Saladino theorizes that insulin is important, LDL is not. My excellent cardiologist recommends Repatha, which I used last summer with Crestor. My HDL had increased nicely (80s), insulin had declined to 4, and angina disappeared, so I took a new Boston Heart to baseline the effect and quit the Repatha and Crestor to better analyze the diet. I have a single ApoE4, so my highest priority is avoiding AD, which despite her advice and yours that they are low risk, are not zero risk. My cardiologist recommended your articles to convince me. I was impressed by your articles and subscribed, and agreed to her prescription to restart Repatha. I was impressed with your #200 with Arsenault on Lp(a) but noticed you don't mention effects of insulin, which Saladino posits is the primary driver for CVD, not LDL. And Saladino doesn't mention Lp(a). I'd love to hear your thoughts on whether insulin is a factor in the standard wisdom that LDL, ApoA, and Lp(a) are markers for ASCVD. It's a fascinating puzzle which I suspect doesn't have a well defined solution. Since my health has improved a lot and I currently have no symptoms, except some out of range blood tests, so I'm willing to explore less conventional solutions.
More on Lipids
Peter, I keep having the same conversation with my primary on lipids, trying to get him to see the value in ordering blood work beyond the standard basic panel and getting an apoB measure, as ASCVD is best addressed early and that I (36), as someone with familial history, should be screening for this and addressing any issues before they manifest into something more serious. Can you cover/develop a strategy and resource for addressing this issue?