The China Study vs Don Layman
I am trying to make sense of the two polar recommendations. The findings of the China Study suggest that avoiding all animal protein has a tremendous impact on prevention of cancer and heart disease. Whereas the research quoted by Dr Layman's was very convincing in terms of the need for animal protein in maintaining muscle function during ageing. How do I reconcile the two? Which one is the lesser evil? Many thanks!
Cardiovascular help in Canada
I am interested in progressive treatment for atherosclerosis. I have implemented many non pharmaceutical strategies to improve heart health including nutrition, exercise and quality sleep. I remain unconvinced that statins provide a significant benefit and understand that there are negative outcomes from the broad approach at a systemic level to reduce ldl cholesterol. I have apo(b) of 91 and understand that you feel it is prudent for someone with cardiovascular risk to try to get their apo(b) in the 30 to 40 range. I am interested in the use of Repatha and Ezetimibe for this purpose. Do you know how I would go about finding a physician in Canada who would review my situation and be open to prescribing this treatment if appropriate.
Best biomarker for ASCVD risk -- sdLDL rather than your "go to," apoB?
Small dense low-density lipoprotein cholesterol (sdLDL) is the most atherogenic lipoprotein parameter per the prospective Framingham Offspring Study. JAHA Vol 10, Issue 5, 3/2/21. See also sdLDL and risk of ischemic stroke, concluding "Higher sdLDL cholesterol levels were robustly associated with increased risk of ischemic stroke. In contrast, this was not the case for large buoyant LDL." ANN NEUROL 2023:00:1-13. In light of the growing body of evidence, why do you not mention or prefer sdLDL to apoB as a measure of ASCVD risk? Note that one of your preferred lipidologists, Dr. Ron Krauss (UCSF), orders tests for his patients that measure sdLDL and some other particle parameters but not apoB.
2019 Mendelian Rand. Study showing PCSK9 inhibition association w/ Alzheimers
Hi Dr. Attia and Team, Clinical pharmacist here, specializing in DM/lipids/HTN management. I've been making my way through the Sept 2023 review article published in AHA's journal Arteriosclerosis, Thrombosis, and Vascular Biology that evaluates relationship between lipid-lowering therapies and the risk for dementia + hemorrhagic stroke. (To your assurance, they generally take stance in support of chronic use of lipid-lowering therapies in context of dementia/hemorrhagic stroke). However, this review brought to my attention a 2019 Mendelian Randomization study (Williams et al., https://doi.org/10.1002/ana.25642) that demonstrated genetic variants of PCSK9 inhibition had statistically significant increased risk of Alzheimers Dementia, OR 1.45. No changes in risk with other genes evaluated (APO B, HMG CR, NPC1L1). This made me nervous about chronic use of PCSK9 inhibitors, mainly since we don't have decades of post-marketing data yet, so I feel like MR data probably is best we have. I would greatly appreciate your thoughts/comments on this, as I think it will inform treatment decisions of what lipid-lowering therapy to use for my patients, and that of other providers managing lipids. Thanks!