William Cromwell, MD @Lipoprotein Twitter profile

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William Cromwell, MD

@Lipoprotein

1 year

Both insulin resistance (IR) and ApoB are significantly associated with ASCVD risk. Whether one factor adds significant incremental risk information to the other has been the subject of brisk debate. To address this issue, two fundamental questions must be asked: 1. Are IR and

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William Cromwell, MD

@Lipoprotein

9 months

Substantial LDL cholesterol elevations are well documented among some lean individuals on a low-carb, ketogenic diet. This “metabolic demonstration” illustrates how robust and rapid LDL reductions can be in an individual experiencing this phenotype when carbohydrates are added

Nick Norwitz

@nicknorwitz

9 months

🚨 #OreoVsStatin - PUBLISHED!🚨 @Oreo cookies were 💥2X as potent💥 at lowering my LDL cholesterol (LDL-C) compared to high-intensity statin therapy! What you NEED to know... 👉This was a metabolic demonstration, a 'do not do this at home' experiment

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William Cromwell, MD

@Lipoprotein

1 year

Several recent posts have asked for references elucidating the relationship between increased saturated fatty acids and dietary cholesterol and decreasing LDL receptor (LDL-R) quantity. I recommend starting with this review: Feingold KR. The Effect of Diet on Cardiovascular

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William Cromwell, MD

@Lipoprotein

1 year

Whether statins meaningfully increase Lp(a) has been the topic of spirited discussion. Last year, de Boer LM et al. published a comprehensive review and meta-analysis of the effect of statins compared to placebo on Lp(a) in the European Journal of Preventive Cardiology. Their

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William Cromwell, MD

@Lipoprotein

4 months

Depending on the data analysis employed, conflicting data have been reported over the past 30 years regarding the relationship of LDL particle size, particle number, and quantities of small LDL or large LDL particles with various ASCVD outcomes. The interrelationships of

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William Cromwell, MD

@Lipoprotein

1 year

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William Cromwell, MD

@Lipoprotein

4 months

This short video illustrates how our thinking regarding various drivers of fatal and non-fatal outcomes has matured. Having Jim Otvos as my research partner for over 25 years has been an honor. Our team has had the unique opportunity to explore the clinical relevance of analytic

Nick Norwitz

@nicknorwitz

4 months

☠️ApoB and All-Cause Mortality☠️ 🚨My Most important Tweet (and video) of the Week WATCH (10m): High level: There is controversy over the relationship between ApoB and All-Cause Mortality (ACM), with some noting a J-curve whereby at lower levels of ApoB

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William Cromwell, MD

@Lipoprotein

8 months

@drpablocorral @AllenGreenMD1 @MichaelAlbertMD @ethanjweiss @DrNadolsky @lipiddoc @Drlipid I appreciate the discussion. This video clip is a small section of a much longer discussion. To get a complete representation of my thoughts, please watch the WHOLE conversation, in which I discuss the following concepts. 1. ApoB lipoproteins are a causal component in the

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William Cromwell, MD

@Lipoprotein

8 months

@drpablocorral @ianriddockmd @AllenGreenMD1 @MichaelAlbertMD @ethanjweiss @DrNadolsky @lipiddoc @Drlipid @ianriddockmd , @AllenGreenMD1 , @drpablocorral , @DrNadolsky Despite my clarification in this thread, I fear I have not been understood. To the extent that you are including me in your commentary, let me reassure you of the following: Over the past three decades, I have affirmed

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William Cromwell, MD

@Lipoprotein

1 year

@NutritionMadeS3 @TotalCytopath @Tellit007 @nosandltrs @Drlipid Analytically, the relationship of small LDL with CVD risk is confounded by inter-relationships of particle size and particle number and inter-relationship between small and large LDL particles. When LDL particle size and LDL particle number are adjusted for one another, only LDL

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William Cromwell, MD

@Lipoprotein

1 year

@dreamer_legal @Tellit007 @Drlipid @degriffin10 @MohammedAlo @hightouchinv @trailrunner402 @Bernard22190947 A couple of thoughts: 1. While insulin resistance (IR) and inflammation accelerate atherosclerosis, these are not needed for persistently elevated ApoB to cause ACCVD.

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William Cromwell, MD

@Lipoprotein

1 year

@_earthling74 @lipo_fan @Drlipid

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William Cromwell, MD

@Lipoprotein

1 year

@aCarnivoreDiet @Drlipid Your statement, "Nothing will permeate through the artery wall unless it's damaged," is incorrect. Please read the references below for a complete discussion of my summary. 1. Tabas I, et al. Circulation 2007;116:1832-44. 2. Borén J, et al. Eur Heart J 2020;41:2313-30.

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William Cromwell, MD

@Lipoprotein

1 year

@dreamer_legal Thanks for your feedback. The first step in addressing high LDL is seeking to understand. How high is the LDL? How long has high LDL been present? What comorbid factors are contributing to high LDL? Is this likely familial hypercholesterolemia? Does the individual have known

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William Cromwell, MD

@Lipoprotein

4 months

Like many today, I pause to reflect and honor those who made the ultimate sacrifice so that we can live in freedom. Thanks to all my brothers and sisters who answered the call. It was an honor to serve. 🇺🇸

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William Cromwell, MD

@Lipoprotein

1 year

@realDaveFeldman Thanks, Dave. We share a similar desire to understand complex cardiometabolic issues. I appreciate your thoughtful approach and care in presenting hypotheses under consideration. I look forward to continuing the push toward optimal individual health!

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William Cromwell, MD

@Lipoprotein

1 year

@dreamer_legal @Tellit007 @Drlipid @degriffin10 @MohammedAlo @hightouchinv @trailrunner402 @Bernard22190947 2. Plaque stabilization occurs in proportion to the magnitude and duration of ApoB reduction. Stabilization includes increasing plaque cap thickness and decreasing plaque volume. Significant changes occur after 50 weeks of significant atherosclergenic particle reduction.

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William Cromwell, MD

@Lipoprotein

1 year

@CRYPT0N1TE @Dralo @Drlipid @ifixhearts @KenDBerryMD @SBakerMD Your statement is correct for LDL-C as an analyte but not LDL as a particle. Remember, LDL is a particle that can be estimated by LDL-C or measured by apoB. Given that apoB, but not LDL-C, is significant in this analysis, we should be careful not to conflate LDL with LDL-C.

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William Cromwell, MD

@Lipoprotein

1 year

@CBallantyneMD @nationallipid @society_eas For balance, I recommend reading the invited editorial from Allan Sniderman: "Apolipoprotein B versus non-high-density lipoprotein cholesterol: contradictory results in the same journal" ()

Apolipoprotein B versus non-high-density lipoprotein cholesterol: contradictory results in the same...

This editorial refers to ‘Discordance of apolipoprotein B with low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol and coronary

academic.oup.com

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William Cromwell, MD

@Lipoprotein

1 year

@Drlipid @nationallipid @society_eas Tom is absolutely correct. Here is another graphic that demonstrates the cholesterol content of LDL particles is variable at various triglyceride levels. Cromwell WC, Otvos JD, et al. J Clin Lipidol 2007;1:583-592.

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William Cromwell, MD

@Lipoprotein

1 year

@realDaveFeldman

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William Cromwell, MD

@Lipoprotein

1 year

@Drlipid @MichaelAlbertMD I agree, Tom. Again, the key is exposure over time. The longer individuals are exposed to elevated concentrations of atherogenic lipoproteins, the greater the ASCVD risk. No data demonstrate that TG lowering or HDL-C raising has protective effects versus elevated ApoB.

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William Cromwell, MD

@Lipoprotein

1 year

@realDaveFeldman @dreamer_legal @Tellit007 @Drlipid @degriffin10 @MohammedAlo @hightouchinv @trailrunner402 @Bernard22190947 Prospective data from FH populations demonstrate high ASCVD risk even without IR, inflammation, or other ASCVD risk factors. The presence of IR or risk factors definitely increases ASCVD risk in FH patients.

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William Cromwell, MD

@Lipoprotein

1 year

@DanClintonRN @jacobmhands @DrewStearns @Drlipid @nationallipid @lipiddoc @Lpa_Doc All of the answers to your questions have been provided. Nothing has been ducked or avoided. I wish you well as you wrestle with the data.

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William Cromwell, MD

@Lipoprotein

1 year

@DanClintonRN @MohammedAlo @DoctorTro @Drlipid @professionaldog @dreamer_legal @trailrunner402 @degriffin10 @realDaveFeldman @Tellit007 @hightouchinv @Bernard22190947

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William Cromwell, MD

@Lipoprotein

1 year

@DanClintonRN @Drlipid @nationallipid

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William Cromwell, MD

@Lipoprotein

1 year

@Drlipid @drpablocorral @soonergise @lipo_fan @JohnKastelein @lipiddoc @society_eas @LipidosSal @alavallecobo @lschreier1 @realDaveFeldman Tom is correct. ApoB lipoproteins up to 75 nm in size traverse the endothelium and can incite atherosclerosis. This includes all LDL particles (size range ~18-25 nm) and various remnant lipoproteins (size range ~ 25-75 nm). This is why patients with dysbetalipoproteinemia, a

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William Cromwell, MD

@Lipoprotein

1 year

@NutritionMadeS3 I really enjoyed my conversation with @NutritionMadeS3 and look forward to posts of the rest of our discussion!!

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William Cromwell, MD

@Lipoprotein

3 years

DoctorTro

@DoctorTro

3 years

@Lipoprotein @MaBMortensen @khurramn1 @ethanjweiss @AngryCardio What I’d like to know is what are the undying characteristics of the people who had LDL>190 CAC=0 CCTA positive

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William Cromwell, MD

@Lipoprotein

1 year

@DoctorTro @Drlipid @professionaldog @dreamer_legal @trailrunner402 @degriffin10 @MohammedAlo @realDaveFeldman @Tellit007 @hightouchinv @Bernard22190947

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William Cromwell, MD

@Lipoprotein

1 year

@DudzLightLime Thanks for your kind words. Together, we can help each other tackle the complexities of cardiometabolic risk to optimize individual health!

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William Cromwell, MD

@Lipoprotein

4 months

@Drlipid Thanks, Tom. It's been a fantastic journey. I'm glad we've traveled the road together. I remain inspired by Warren Weaver's quote (1960) as we seek to integrate new learnings to optimize individual care. "Science is not technology, it is not gadgetry, it is not some mysterious

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William Cromwell, MD

@Lipoprotein

1 year

@DanClintonRN @MohammedAlo @DoctorTro @Drlipid @professionaldog @dreamer_legal @trailrunner402 @degriffin10 @realDaveFeldman @Tellit007 @hightouchinv @Bernard22190947

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William Cromwell, MD

@Lipoprotein

3 years

I really enjoyed the time spent with @realDaveFeldman discussing how @PreciseHlthRpt combines all the information needed to clarify YOUR personal cardiometabolic disease risk. It also shows how dietary & lifestyle choices impact YOUR cardiometabolic risk over time.

Dave Feldman

@realDaveFeldman

3 years

1/ Hi guys! Just dropped a new interview with Bill Cromwell ( @Lipoprotein ) on Youtube regarding their Precision Health Report platform. I really love their model and suggest you check it out... ()

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William Cromwell, MD

@Lipoprotein

1 year

@DanClintonRN @DrewStearns @Drlipid @nationallipid Being a clinical trialist, I can assure you that in a randomized, double-blind, placebo-controlled trial, all investigators and data analysts are blinded. At every level of the trial, from the clinical trial site to the group analyzing the data, no one is cooking the books.

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William Cromwell, MD

@Lipoprotein

3 years

Triglyceride (TG) associations with vascular risk is a complex topic. Hinges on the individual’s history of triglyceride values, ApoB levels, any co-morbid conditions affecting TG, differential diagnosis of the high TG, and non-invasive imaging information.

The Real Dr. Steven Horvitz

@IMWHorvitz

3 years

Elevated Trigs on LowCarb with coffee. If other Insulin Resistance markers are in good shape, are the Trigs a true risk factor for vascular health? Can you link me to further discussion if any on vasc health in above situations? @siobhan_huggins @realDaveFeldman

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William Cromwell, MD

@Lipoprotein

3 years

I truly enjoyed talking with my friend @RobbWolf about a variety of topics related to unpacking just a few of the many intricacies of identifying individuals’ cardiometabolic disease risk. We’ll certainly do it again! If you listened, what did you learn?

Precision Health Reports 📑❤️

@PreciseHlthRpt

3 years

What’s Your Cardiovascular Disease Risk?🤔🤷 You can't miss @robbwolf 's most recent podcast episode with our own Dr. Bill Cromwell, @Lipoprotein , recorded to help you answer this question. Feel free to slide into our DMs with your questions. 🎙️

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William Cromwell, MD

@Lipoprotein

4 months

@Drlipid @drpablocorral I totally agree. There’s not a lack of data. There’s a lack of willingness to action the data.

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William Cromwell, MD

@Lipoprotein

4 months

@TotalCytopath The largest data set related to your question comes from the Heart Protection Study. (1) This was a 5.3 year-long randomized, double-blind, placebo-controlled trial of simvastatin 40 mg versus placebo in 20,536 men and women with one of the following: 1. Previous diagnosis of

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William Cromwell, MD

@Lipoprotein

1 year

@Drlipid @professionaldog @dreamer_legal @trailrunner402 @degriffin10 @MohammedAlo @realDaveFeldman @Tellit007 @hightouchinv @Bernard22190947 Agree with Tom. There is no "too low" for ApoB to optimize future event reduction.

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William Cromwell, MD

@Lipoprotein

1 year

@nicknorwitz @realDaveFeldman @JohnKastelein @soonergise @drpablocorral @lipo_fan @Drlipid @lipiddoc @society_eas @LipidosSal @alavallecobo @lschreier1 Thanks, Nick and Dave. Your statements are well received. I agree that we need to have a more refined view of atherosclerosis. Yes, for most people increased particle number over time translates into increased atherosclerosis. In some cases, prolonged exposure to elevated

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William Cromwell, MD

@Lipoprotein

1 year

@TotalCytopath @NutritionMadeS3 @Tellit007 @nosandltrs @Drlipid Here is the direct quote from the third reference (Lamarche B, et al. Circulation. 1997;95:69-75.) at the end of the results section: "Among lipid, lipoprotein, and apolipoprotein variables, apo B came out as the best and only significant predictor of IHD risk in multivariate

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William Cromwell, MD

@Lipoprotein

3 years

Shared decision-making is when you and a medical provider work together to decide the best care plan for your risk. Cardiometabolic Risk (CMR) is all factors that together impact your risk for heart attack, stroke, and type 2 diabetes. Stay tuned to see why it’s hard to do.

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William Cromwell, MD

@Lipoprotein

1 year

@NutritionMadeS3 Thanks, Gil. That’s an important observation to keep in mind. The largest repository of cholesterol in the body is cell membranes. All nucleated cells can satisfy their cholesterol needs via local synthesis, cell signaling, and homeostatic mechanisms.

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William Cromwell, MD

@Lipoprotein

8 months

@drpablocorral @ianriddockmd @AllenGreenMD1 @MichaelAlbertMD @ethanjweiss @DrNadolsky @lipiddoc @Drlipid Please do not conflate my quote as an endorsement to ignore high ApoB. There is more to learn about this physiology. Some individuals choose to persist in a high LDL-C state, awaiting data demonstrating the CTA response to such a decision. That does not mean I endorse prolonged

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William Cromwell, MD

@Lipoprotein

1 year

@realDaveFeldman @dreamer_legal @Tellit007 @Drlipid @degriffin10 @MohammedAlo @hightouchinv @trailrunner402 @Bernard22190947 A key factor regarding high ApoB levels and ASCVD risk is time. The longer ApoB levels are high, the greater the impact on atherosclerosis. How long it takes for new-onset high ApoB levels to significantly impact plaque formation in various populations is a different question.

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William Cromwell, MD

@Lipoprotein

1 year

@lipo_fan Both are correct. The number of LDL particles drives LDL entry into the artery wall. The higher the number, the greater the concentration in the artery wall. Retained LDL particles undergo modification and are taken up by macrophages to form foam cells that start atherosclerosis.

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William Cromwell, MD

@Lipoprotein

11 months

@realDaveFeldman I thoroughly enjoyed our conversation! We always learn from one another, and I look forward to future conversations. It’s a pleasure to travel the road of discovery alongside you.

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William Cromwell, MD

@Lipoprotein

2 years

By integrating a person's clinical history, over 30 risk-enhancing factors, biometrics, outcome-proven biomarkers, and harmonization with multiple US/International guidelines, PHR provides a patient-specific solution to improve shared decision-making for cardiometabolic risk.

Precision Health Reports 📑❤️

@PreciseHlthRpt

2 years

Learn more about @Curative 's approach to using advanced screenings like our Cardiometabolic Risk Assessment in their employer health plans to deliver personalized interventions for their insured lives. Early detection = ⬇️ disease = ⬇️ healthcare costs

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William Cromwell, MD

@Lipoprotein

1 year

@PreciseHlthRpt @realDaveFeldman @ownyourlabs Thanks, Dave. We're all in this together. A framed copy of the quote below was given to me by Dr. Maurice Eftink, my first research mentor, in 1983. It has been in my office ever since and reminds me how blessed I am to do this work. I look forward to continuing the dialogue.

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William Cromwell, MD

@Lipoprotein

1 year

@nicknorwitz To my review, this trial didn't show any meaningful change in Lp(a). Using data from the publication and the supplemental data available online, I constructed the data table below. Note that: 1.Baseline Lp(a) values were normal (< 30 mg/dL) for all groups before the

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William Cromwell, MD

@Lipoprotein

3 years

🧵 5/5 Get more details at:

Precision Health Reports: Helping You See Your Cardiometabolic Risk

We use the latest biomarkers and clinical guidelines to identify individuals' risk for heart attack, stroke, or developing type 2 diabetes.

precisionhealthreports.com

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William Cromwell, MD

@Lipoprotein

1 year

@MohammedAlo @DoctorTro @Drlipid @professionaldog @dreamer_legal @trailrunner402 @degriffin10 @realDaveFeldman @Tellit007 @hightouchinv @Bernard22190947 Thanks for posting this. I agree, “Evidence-based medicine should not be about withholding interventions until they have been proven to reduce overall mortality.” Significant reduction in ASCVD events is sufficient to use outcome proven therapies in appropriate patient groups.

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William Cromwell, MD

@Lipoprotein

1 year

@WillBrink @JohnKastelein @NutritionMadeS3 @Drlipid @MedCramVideos @PeterAttiaMD @MohammedAlo @drpablocorral Since ApoB and LDL-P are alternate measures of atherogenic particle number, either can be used to determine the adequacy of therapy. If the number of atherogenic particles is not at goal, then intensification of therapy should be considered regardless of LDL-C or non-HDL-C

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William Cromwell, MD

@Lipoprotein

1 year

@swapneilparikh Thanks, Dr. Parikh. Working together, we can all move forward.

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William Cromwell, MD

@Lipoprotein

8 months

@robbwolf @realDaveFeldman Thanks for the kind words, Robb! I hope these discussions motivate folks to use all available information (clinical history, biometrics, biomarkers, risk-enhancing factors) to assess their cardiometabolic health and options for improvement.

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William Cromwell, MD

@Lipoprotein

1 year

@drjkahn I appreciate your comment. Regarding the impact of statins on Lp(a), earlier today I posted a link to a comprehensive review and meta-analysis showing statin therapy does not lead to clinically important differences in Lp(a) compared to placebo in patients at risk for CVD.

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William Cromwell, MD

@Lipoprotein

5 months

Success!! Congratulations Nate!! #Baylorgrad

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William Cromwell, MD

@Lipoprotein

3 years

DYK: Chronic, low-grade inflammation is present in many metabolic conditions & can be significantly predictive of risk for cardiovascular events & diabetes. Using GlycA gives a superior understanding of your systemic inflammation.

Quantify Systemic Inflammation & GlycA Measurement — Precision Health Reports

Chronic inflammation is strongly associated with increased risk for cardiovascular events, increased risk for developing diabetes, and increased mortality. Among tests that measure systemic inflamm...

precisionhealthreports.com

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William Cromwell, MD

@Lipoprotein

1 year

@DanClintonRN @DrewStearns @Drlipid @nationallipid

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William Cromwell, MD

@Lipoprotein

1 year

@MattBMartin @realDaveFeldman @nicknorwitz @eamundson17 @theproof I’m ready. Let’s find a time 😀

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William Cromwell, MD

@Lipoprotein

1 year

@Nerd_Abroad @Drlipid

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William Cromwell, MD

@Lipoprotein

9 months

@realDaveFeldman @jimgris @nicknorwitz Given the half-life and steady state, kinetics of rosuvastatin, a six week timeframe was selected.

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William Cromwell, MD

@Lipoprotein

9 months

@SGoldenC I appreciate that chronic can mean more than one thing. I do not see nutritional ketosis as an illness or a problem. Rather, I use the term “chronic” to indicate something that continues over an extended period of time.

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William Cromwell, MD

@Lipoprotein

1 year

@Drlipid I agree Tom. That's why the NMR LP-IR score can be helpful. Beyond identifying the magnitude of insulin resistance, the LP-IR score is significantly, independently predictive of new onset (incident) diabetes mellitus, even after adjustment for glucose, insulin, HOMA-IR, waist

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William Cromwell, MD

@Lipoprotein

1 year

@nicknorwitz @realDaveFeldman @JohnKastelein @soonergise @drpablocorral @lipo_fan @Drlipid @lipiddoc @society_eas @LipidosSal @alavallecobo @lschreier1 Yes indeed. Sounds like this would be the topic of a good podcast.

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William Cromwell, MD

@Lipoprotein

5 months

@theproof Thanks for the opportunity to have this conversation! It was a pleasure and I look forward to additional discussions on a future podcast 😀

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William Cromwell, MD

@Lipoprotein

1 year

@lipo_fan This is consistent with data from our laboratory demonstrating the cardioprotective associations of small and medium, but not Large, HDL particle number with cardiometabolic risk.

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William Cromwell, MD

@Lipoprotein

1 year

@drscottyk Thanks, Scotty. I concur with one additional thought. If persistent ApoB elevations occur and the patient has no history of prior high ApoB, CAC or CTA imaging could be helpful to guide the discussion for medical therapy.

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William Cromwell, MD

@Lipoprotein

1 year

@Drlipid Totally agree. Individual cardiometabolic risk depends on a person’s history, biometrics, biomarkers, and over 30 risk enhancing factors. Knowing all this allows for an informed decision making conversation.

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William Cromwell, MD

@Lipoprotein

1 year

@Drlipid @nationallipid Thanks, Tom. You are a leading voice in lipoprotein education, and I look forward to continuing our work together😀

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William Cromwell, MD

@Lipoprotein

1 year

@moudyk1 @dreamer_legal @Tellit007 @Drlipid @degriffin10 @MohammedAlo @hightouchinv @trailrunner402 @Bernard22190947 Most recent reference: Nicholls, SJ, et al. Effect of Evolocumab on Coronary Plaque Phenotype and Burden in Statin-Treated Patients Following Myocardial Infarction. JACC: Cardiovascular Imaging, 15(7), 1308-1321.

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William Cromwell, MD

@Lipoprotein

1 year

@realDaveFeldman @JohnKastelein @soonergise @drpablocorral @lipo_fan @Drlipid @lipiddoc @society_eas @LipidosSal @alavallecobo @lschreier1 The key dynamic in both cases (HoFH and LMHR) is atherogenic lipoprotein concentration over time. The longer elevated atherogenic lipoproteins are present, the greater the consequences (increased particle retention, lipoprotein modification, foam cell formation, and macrophage

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William Cromwell, MD

@Lipoprotein

1 year

@theproof @DudzLightLime @davidludwigmd @realDaveFeldman @nicknorwitz @lipo_fan It would be my pleasure.

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William Cromwell, MD

@Lipoprotein

5 months

@DrDeepMD @Drlipid @drpablocorral @Paddy_Barrett @realDaveFeldman @nicknorwitz @lipo_fan All cause mortality is an interesting endpoint. I discuss new learnings regarding the relationship of metabolic vulnerability and inflammation with all cause mortality in the lecture linked below. Toward the end of the lecture, I also review an

Is MVX the New Frontier in Predicting All Cause Mortality? – Dr....

Dr. William Cromwell discusses the complex interaction of metabolic and inflammatory factors in determining mortality risks, beyond traditional cardiovascula...

www.youtube.com

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William Cromwell, MD

@Lipoprotein

3 years

🧵1/5 Putting It All Together - Precision Reporting to Empower Shared Decision-Making in Cardiometabolic Risk (CMR)

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William Cromwell, MD

@Lipoprotein

9 months

@MattBMartin @lowcarbGP @rcgp @SteveBennettMhP @DoctorTro @drjasonfung @KenDBerryMD @SBakerMD @lowcarb_aus @GeorgiaEdeMD @ElieJarrougeMD Statin-associated T2DM risk scales with potency and dosage. I am not aware of data showing a significantly increased T2DM risk for rosuvastatin 10 mg. No significant increased diabetic risk has been demonstrated for Nexlizet. Although a signal for increased diabetic risk was seen

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William Cromwell, MD

@Lipoprotein

3 years

Shared decision-making (SDM) begins by knowing ALL FACTORS that impact your CMR. Guideline identified CMR factors (modifiable & non-modifiable) include: Traditional Risk Factors Insulin Resistance Factors Risk Enhancing Factors Biomarkers Stay tuned as I unpack each one.

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William Cromwell, MD

@Lipoprotein

3 years

@DoctorTro @MaBMortensen @khurramn1 @ethanjweiss @AngryCardio

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William Cromwell, MD

@Lipoprotein

12 days

@DrIngold @nationallipid @society_eas @escardio @ACCinTouch @ASPCardio @aafp @ACPIMPhysicians @NutritionMadeS3 @Drlipid Thanks, Brian. @Drlipid and I published two PocketGuides in this area about a decade ago. In many ways that was a forerunner to the Precision Health Reports Cardiometabolic Risk Assessment.

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William Cromwell, MD

@Lipoprotein

9 months

@SGoldenC Thanks for your question. “Chronic” was meant to indicate the long-standing nature of the baseline diet. In this trial, the subject has been on the low-carb, ketogenic diet described in the methods section for years.

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William Cromwell, MD

@Lipoprotein

1 year

@WholeFoodsEthic @Gibbo0 @aCarnivoreDiet @Drlipid Graft vascular disease is a different conversation. Repositioning a vein from a low pressure environment to a high pressure system (i.e., CABG) will change it’s physiologic properties in ways that can result in graft vascular disease. The reasons for this are still being studied.

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William Cromwell, MD

@Lipoprotein

1 year

@soonergise @drscottyk

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William Cromwell, MD

@Lipoprotein

1 year

@WillBrink Thanks, Will. I appreciate your question. The study cited in my post adjusted for CRP in all models. Thus, both HOMA-IR and ApoB were significantly predictive of CAC after adjustment for CRP. Also, the addition of ApoB to HOMA-IR, as well as the addition of HOMA-IR to ApoB,

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William Cromwell, MD

@Lipoprotein

1 year

@DanClintonRN @realDaveFeldman @dreamer_legal @Tellit007 @Drlipid @degriffin10 @MohammedAlo @hightouchinv @trailrunner402 @Bernard22190947 A key factor regarding high ApoB levels and ASCVD risk is time. The longer ApoB levels are high, the greater the impact on atherosclerosis. How long it takes for new-onset high ApoB levels to significantly impact plaque formation in various populations is a different question.

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William Cromwell, MD

@Lipoprotein

1 year

@Drlipid @society @nationallipid You’re absolutely correct. Atherogenic lipoprotein concentration is causality related to development of ASCVD. The cholesterol cargo of lipoproteins is a deeply flawed analyte of the quantity of those injurious particles. Perhaps we live to see the day when this analytic

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William Cromwell, MD

@Lipoprotein

8 months

@ianriddockmd @drpablocorral @AllenGreenMD1 @MichaelAlbertMD @ethanjweiss @DrNadolsky @lipiddoc @Drlipid Thanks, Ian. I appreciate your words, and I'm glad we're good. I want those with negative opinions on this thread to know where I stand and why. If someone has a problem, they should be more precise in directing their comments to the individual(s) with whom they have an issue.

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William Cromwell, MD

@Lipoprotein

1 year

@DanClintonRN @jacobmhands @DrewStearns @Drlipid @nationallipid @lipiddoc @Lpa_Doc I've provided you with multiple pages of context and explanation. We've hit the repeat cycle in this discussion. There are no new insights I can offer. Time for me to sign off.

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William Cromwell, MD

@Lipoprotein

1 year

@Gibbo0 @aCarnivoreDiet @Drlipid Proteoglycans are a significant structural element of the arterial wall, especially at branch points and areas of non laminar flow. These proteins are the sites for lipoprotein particle retention. Veins have much less proteoglycan and proteins to bind & retain particles.

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William Cromwell, MD

@Lipoprotein

1 year

@TotalCytopath @NutritionMadeS3 @Tellit007 @nosandltrs @Drlipid It appears confusing and that the authors are saying two different things. The key is to understand the type of data analysis being conducted. When handled as categorical variables, small LDL appeared significant. When handled as continuous variables, only ApoB was a significant

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William Cromwell, MD

@Lipoprotein

1 year

@DrewStearns @DanClintonRN @Drlipid @nationallipid Per Dan's request, I'm reposting the total response from earlier today.

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William Cromwell, MD

@Lipoprotein

1 year

@MattBMartin @tomp729 @NutritionMadeS3 Correct, with TG of 50, ApoB 90, and LDL-C of 130 you would not have TG-enriched LDL.

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William Cromwell, MD

@Lipoprotein

1 year

@WillBrink @MohammedAlo @DrMichaelSagner @Drlipid @JohnKastelein @drpablocorral @NutritionMadeS3 This topic is controversial due to nuances of the information provided by the examination. Carotid Intima-Media Thickness (CIMT) assessment involves a B-mode carotid ultrasound to assess: 1. Mean thickness of the distal common carotid (CIMT) 2. Quantification of focal

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William Cromwell, MD

@Lipoprotein

1 year

@DudzLightLime I appreciate your question. I understand this relates to the findings of Pechlaner R et al. (J Am Coll Cardiol 2017), which assessed the relationship of 13 apolipoproteins with incident CVD in a cohort of 688 individuals followed prospectively for 10 years. Among

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William Cromwell, MD

@Lipoprotein

1 year

@SanjayGill1 @agingdoc1 @Drlipid @ChristofferBN @trailrunner402 @MohammedAlo @PeterAttiaMD

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William Cromwell, MD

@Lipoprotein

1 year

@robertmaynord @Drlipid These factors influence transcytosis, but it is also true that the greater the number of circulating particles, the greater the transcytosis. Both concentration and factors affecting transcytosis are important.

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William Cromwell, MD

@Lipoprotein

3 years

🧵1/5 Before unpacking Cardiometabolic Risk (CMR) factors, let's review how guidelines are moving from a population to a precision ("tailored") approach for identifying and managing individual CMR.

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William Cromwell, MD

@Lipoprotein

1 year

@TotalCytopath @NutritionMadeS3 @Tellit007 @nosandltrs @Drlipid Great question. When outcome associations of alternate measures (particle number versus lipids) are assessed in the setting of discordance, ASCVD risk always tracks with particle number, not lipids. Two authors who speak eloquently about this are Allan Sniderman and James Otvos.

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William Cromwell, MD

@Lipoprotein

1 year

@DudzLightLime @theproof @davidludwigmd @realDaveFeldman @nicknorwitz @lipo_fan I'd be pleased to participate

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William Cromwell, MD

@Lipoprotein

5 years

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