Sam Tsimikas, MD @Lpa_Doc Twitter profile | Pikagi

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Sam Tsimikas, MD

@Lpa_Doc

13,278

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95

Following

625

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4,285

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Professor Cardiology - UC San Diego. @UCSDHealth , @stsimikas , @OxPL_apoB . Educational forum on Lp(a) and related areas-unable to give personal advice on twitter

San Diego, CA

Joined October 2016

Don't wanna be here? Send us removal request.

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@Lpa_Doc

Sam Tsimikas, MD

3 years

For those interested in the Saturday Morning Lp(a) Class, the course is now linked to my bio and is open access. Big thanks to @TheBhupiThakur for organizing the twittorials. It is ~500 tweets in 24 classes. Syllabus enclosed. I wish to all the joy of learning.

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@TheBhupiThakur

Bhupinder Thakur

@TheBhupiThakur

3 years

All Sat morning classes by @Lpa_Doc is now linked to this updated thread. Enjoy

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@Lpa_Doc

Sam Tsimikas, MD

4 years

Today's topic will be "Lp(a) and the “real” LDL-C". If at least 1 person is interested in this I will continue it, if no interest, the show will be over. 6/6

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@Lpa_Doc

Sam Tsimikas, MD

2 years

BIG news: Lp(a) HORIZON is fully recruited (8325 pts)- a 20 yr journey for so many people to get here. The "Lp(a) Hypothesis" gets tested: in pts with optimally treated risk factors, does ⏬⏬ Lp(a) lead to clinical benefit? Will know in 2.5 yrs. $IONS

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@Lpa_Doc

Sam Tsimikas, MD

9 months

Two new articles came out in @JACCJournals today: Each suggested Lp(a) is ~6x more atherogenic than LDL-C when evaluated per apoB. Vera Bittner and I provide commentary how to put this in clinical context with atherogenicity vs # of particles.

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@Lpa_Doc

Sam Tsimikas, MD

3 years

In trying to understand the purely carnivorous diet of the Inuit/Eskimo and Lp(a), I have moved on from Vil S onto a new book: remarkably, the reputable investigators claim Inuit in the wild in 1908 could eat up to 14 pounds!! of seal meat in 24 hr- there goes your diet.....

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@Lpa_Doc

Sam Tsimikas, MD

5 years

New EU Lipid guidelines are out. Kudos to EU for recommending everyone get an Lp(a) level once: "A one-off measurement of Lp(a) may help to identify people with very high inherited Lp(a) levels who may have a substantial lifetime risk of cardiovascular disease,"

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@Lpa_Doc

Sam Tsimikas, MD

2 months

Nice paper today in @JAMACardio led by @BenoitArsenault - higher Lp(a) predicts faster progression in AS. Clinical pearl: if you measure Lp(a) in your pts with pre-existing AS, you can predict who needs more close f/u and testing, and look very smart to your referring MDs!

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@Lpa_Doc

Sam Tsimikas, MD

4 years

Saturday Morning Class: Hi all, with the increasing attention on Lp(a) and need for both patient and physician education, I decided to create a short monthly Twittorial. 1/6

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@Lpa_Doc

Sam Tsimikas, MD

11 months

AHA starts tomorrow- lots of material on Lp(a), will cover as we go.... Keto is also on menu:

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@Lpa_Doc

Sam Tsimikas, MD

11 months

The issue of Lp(a) and platelet fnx has not had lots of attention. In view of the lack of effects of Lp(a) on fibrinolysis in vivo, we make a case that Lp(a)'s effects on platelet function may explain some its atherothrombosis. @hsbhatia @PaulLacaze $

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@Lpa_Doc

Sam Tsimikas, MD

6 months

Big day today for patients with elevated Triglycerides with reduction in apo C-III, TG and pancreatitis. And a double whammy for our group and @ionispharma . 2 important trials presented and 2 back-to-back NEJM papers!. Big thanks to Brian Bergmark and Erik Stroes. Can it get

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@Lpa_Doc

Sam Tsimikas, MD

4 years

3 suggestions on LDL-C, and this will be it for a while so we can focus on Lp(a): 1- keep your and your patients LDL-C as low as you can throughout life by any method you have 2- Avoid diets that raise LDL-C 3- If you have to go on a LC/HF diet, take a statin to keep LDL-C <70

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@Lpa_Doc

Sam Tsimikas, MD

5 years

A seminal event has occurred, which is the listing of the Novartis Lp(a) CVOT on . NCT04023552. Details can be found here: . The study will be called Lp(a) HORIZON and will have entry criteria Lp(a)> 70 mg/dL with hx CVD events.

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@Lpa_Doc

Sam Tsimikas, MD

8 months

We have new data in todays @NEJM from @ionispharma on volanesorsen reducing pancreatitis events, first time a TG-lowering drug has been shown to reduce risk of pancreatitis.

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@Lpa_Doc

Sam Tsimikas, MD

2 years

For perspective on strength biological markers for risk prediction

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@Lpa_Doc

Sam Tsimikas, MD

4 years

"All" types of LDLs are associated with higher risk. Its a propagated fallacy that buoyant LDL is somehow safe. If you look at a pure model of buyant LDL, homozygous FH, they have MIs in teens and 20s. Particle number is many times more important than subtypes of LDL.

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@Lpa_Doc

Sam Tsimikas, MD

6 months

Anyone know this famous Canadian cardiologist and his contribution to the field? Hint…___B.

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@Lpa_Doc

Sam Tsimikas, MD

4 months

Dr Akiro Endo, discoverer of mevastatin that opened the way for one of the most effective methods to reduce risk of heart attack/stroke, died today at age 90. Impact to human health benefits is incalculable, it is estimated 200,000,000 people are on statins. You can read more

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@Lpa_Doc

Sam Tsimikas, MD

2 years

And for the second great news of the day for Lp(a) world, an aortic stenosis trial is now underway with pelacarsen. Its a brave new world to develop a medical therapy for aortic stenosis. @ionispharma @NovartisUS

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@Lpa_Doc

Sam Tsimikas, MD

3 years

Lp(a) HORIZON- nearly 4000 pts enrolled in the trial, halfway there and counting... hope for a therapy to treat elevated Lp(a) is on the way @ionispharma @Novartis

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@Lpa_Doc

Sam Tsimikas, MD

3 years

Lp(a) papers are coming our fast and furious from @JACCJournals . Mehta et al performed an elegant study on risk of elevated Lp(a) and CAC in MESA and DHS. See my take and how a primary prevention CVOT might be performed.

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@Lpa_Doc

Sam Tsimikas, MD

4 years

The Canadian LIpid guidelines just came out: "We recommend measuring Lp(a) level once in a person’s lifetime as a part of the initial lipid screening. (Strong Recommendation; High Quality Evidence)." Big congrats, hopefully US will catch up with EU/Canada

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@Lpa_Doc

Sam Tsimikas, MD

4 years

Someone ? level of LDL-C in animals- see Brown and Goldstein Novel Prize lecture in 1985. The CVD threshold is outdated and likely lower than 125 mg/dl, but note most animals and newborn humans have LDL 25-50. My rule is the "Rule of 50" for LDL-C/Lp(a)/TG for optimal CV health

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@Lpa_Doc

Sam Tsimikas, MD

6 months

A new and important paper from JACC on EPA and Lp(a) from REDUCE-IT. Baseline Lp(a) was highly predictive of events in people with high TG and controlled LDL-C, and risk was linear, not threshold. EPA was a/w benefit irrespective of Lp(a) levels. Expands data to people with high

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@Lpa_Doc

Sam Tsimikas, MD

3 months

More data on aspirin and Lp(a). This paper was led by ASPREE friends @PaulLacaze . Next step is the need Lp(a) levels to confirm and assess if there is a threshold effect, and if so, at what level. If data continues to accumulate on potential risk/benefit of aspirin in pts with

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@Lpa_Doc

Sam Tsimikas, MD

2 years

1/9 Summary of ESC 2022 highlights: @escardio Lp(a) topics- 5 sessions, 2 industry sessions, ~25 abstracts: 1- Big news was @society_eas consensus statement (not guideline). Nice overview of the field in last 10 years. Bottom line, measure Lp(a) in all adults once.

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@Lpa_Doc

Sam Tsimikas, MD

5 years

The long-awaited phase 2b ASO Lp(a) trial is now out: Lipoprotein(a) Reduction in Persons with CardiovascularDisease. Full detaials are in in NEJM Phase 3 is now starting this month...

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Lipoprotein(a) Reduction in Persons with Cardiovascular Disease | NEJM

Lipoprotein(a) levels are genetically determined and, when elevated, are a risk factor for cardiovascular disease and aortic stenosis. There are no approved pharmacologic therapies to lower lipopro...

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@Lpa_Doc

Sam Tsimikas, MD

5 years

I have gotten several queries from patients and providers with elevated Lp(a) and risk of COVID-19 if infected, particularly with cytokine storm potentially increasing Lp(a) and CV events. I have drafted a generic letter and making it public if it will help anyone stay safer.

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@Lpa_Doc

Sam Tsimikas, MD

1 month

The statin increase is often not trivial, on average increase is 30%. In our meta-analysis of 5280 patient level data, there were some patients with >100 mg/dL (~250 nmol/L) increase. This also reflects my practice experience. I think this is (reluctantly) accepted now. Unless

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@Drlipid

Thomas Dayspring

1 month

@samram999 @suprfli23 @Lpa_Doc The statin increase in Lp (a) is trivial and negated by its ability to lower apoB

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@Lpa_Doc

Sam Tsimikas, MD

8 months

The goal is to keep LDL-C and Lp(a) as low as possible. If LDL-C is an issue, almost always statin. However, many pts with high Lp(a) have normal LDL-C. I am using more PCSK9i (if I can get it approved), then ezetimibe as it keeps Lp(a) and LDL-C as low as possible and does not

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@Lpa_Doc

Sam Tsimikas, MD

6 years

The Lp(a) journey has reached a timing point. The Lp(a) ASO has now been licensed to Novartis and phase 3 is on its way! . Ionis has always kept sick patients as #1 on responsibilities, and this is a great example. One step to go, FDA approval!

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@Lpa_Doc

Sam Tsimikas, MD

28 days

I am at ESC. Lots of interest in Lp(a). I will summarize meeting on Lp(a) topics when it's over. Hoping our Brazilian friends get X back @pabeda1

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@Lpa_Doc

Sam Tsimikas, MD

4 years

Saturday Morning Class #10 Lp(a) and diet 1/19 1/x Let’s start with the basics- what are the different types of fats: saturated, monounsaturated and polyunsaturated. These are defined by the # of carbon-carbon double bonds of the fatty acids that are amenable to reactions.

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@Lpa_Doc

Sam Tsimikas, MD

2 months

Nothing is stupid in this forum and it's actually an insightful question. Yes, apoB is "total" counts apoB on LDL, Lp(a), VLDL and IDL. There is a way to figure out what proportion it is if you know the Lp(a) in nmol/L, its in this paper.

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@secantmodulus

Antonio

2 months

@Lpa_Doc When I see my ApoB number in mg/dL, does that include the ApoB attached to lp(a) as well? Since it’s ApoB and not ApoB-c, does the assay isolate only the ApoB protein? Sorry if it’s a stupid question 😂

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@Lpa_Doc

Sam Tsimikas, MD

1 year

I am on a trip of a lifetime on only the 342nd crossing of the Nortwest Passage, inspired by Inuit diet/culture. We are 2/3rd way through visiting Inuit villages, Franklin sites and observing polar bears on ice. Will report observations in late August (if we make it through..)

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@Lpa_Doc

Sam Tsimikas, MD

4 years

See our latest paper with collaborators from Erik Stroes group. It shows that in pts with elevated Lp(a), the apo(a) ASO markedly reduced monocyte inflammation/transmigration. PCSK9i had no effect despite 65% reduction in LDL-C. This is a big wow!!

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@Lpa_Doc

Sam Tsimikas, MD

3 months

In this issue of @JACCJournals , @calvinyeang , Florian Kronenberg and I review the emerging issue of the contribution of Lp(a)-cholesterol to what is called "LDL-C". It quite curious that the metric most commonly used to Dx/Rx risk of CVD has serious limitations and inaccuracies.

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@Lpa_Doc

Sam Tsimikas, MD

4 years

Finland made a countrywide effort to reduce sat fat from 20% to 12%. TC ⬇️ ~30%, and a 20% reduction was associated with 40% decrease in mortality. 1 mmol/L= 38.7 mg/dL. Keto with high sat fat for the masses may take CVD back to Finland 1972

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@Lpa_Doc

Sam Tsimikas, MD

4 years

I don't use ratios. Ratios are deceiving, particularly when HDL is high and apoB/LDL/Lp(a)/TG is also high, gives false sense of security. The absolute values are what matter. When HDL-C was not shown not to be causal, ratios became irrelevant and even dangerous for some pts.

@LaEstanciaVilla

Brad Aronson

@LaEstanciaVilla

4 years

@Lpa_Doc I see a lot of folks talk about ratios of lipid profiles. In your opinion, what are the most important and generally accurate ratios? Apoa/Apob? TG/HDL? etc.

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Sam Tsimikas, MD

5 months

There are now 4 papers on the topic, where the evidence suggests, but does not prove, aspirin may reduce risk of future CVD events in patients with elevated Lp(a). However, they need validation in studies where aspirin was randomized at entry in modern cohorts. ASPREE did not

@AlexRazavi

Alexander C. Razavi

5 months

Excited to share our new paper in @AJPCardio : Aspirin Use for Primary Prevention Among US Adults With and Without Elevated Lp(a) Regular aspirin use was associated with a 52%⬇️ risk of ASCVD mortality among adults without ASCVD and Lp(a) ≥50 mg/dL

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@Lpa_Doc

Sam Tsimikas, MD

3 years

My last comment on eggs. If you are a patient with FH, don’t fall into social media trap that you can eat cholesterol rich foods. Even small amts can lead to poor LDL Control, and they usually come with saturated fat, double hit

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@Lpa_Doc

Sam Tsimikas, MD

2 years

The Lp(a) Heritage study, in prep for Lp(a) HORIZON, is now out- 48,129 pts eligible otherwise for Lp(a) HORIZON, with survey of Lp(a) levels. Data shows a higher prevalence of ⏫levels in pts with ASCVD vs general population at >70 mg/dL/>150 nmol/L

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@Lpa_Doc

Sam Tsimikas, MD

13 days

Did you know that elevated Lp(a) has the strongest association with aortic stenosis, followed by MI?. But the association seems to occur at higher levels. See latest paper and editorial, and case for universal testing of Lp(a) in aortic stenosis. @OxPL_apoB @JACCJournals

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@Lpa_Doc

Sam Tsimikas, MD

6 months

This is a medical first- despite drug approvals for TG >500, none were shown to reduce pancreatitis. The Balance study required great science, a great drug, great study design, and great execution to succeed. Congrats to @ionispharma for 15 yrs of dedication and perseverance to

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@Lpa_Doc

Sam Tsimikas, MD

4 months

And for the last treat of the day, Lp(a) and @OxPL_apoB are moving into the heart failure field. Lp(a), likely via its OxPL content, is associated with progression of heart faluure and CVD death. Study led by @JJheart_doc and @pnatarajanmd There is also data from MESA, more to

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@Lpa_Doc

Sam Tsimikas, MD

4 years

1/17 Saturday Morning Class #7 Lp(a) and kringles Let’s define what Lp(a) is: 2 major proteins stuck together like conjoined twins, apolipoprotein(a) and apolipoprotein B-100. The ratio of each is 1:1- if you know how much apoB is on Lp(a) then you know how much apo(a) is on it

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@Lpa_Doc

Sam Tsimikas, MD

4 years

Twittorial #1 ; Lp(a) and the real “LDL-C”: When one looks at your lab report, note the LDL-C says “calculated”. So, believe it or not, the most important risk factor for CVD is actually an estimated value. Hard to believe but true. 1/17

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@Lpa_Doc

Sam Tsimikas, MD

3 years

Here an interesting snippet from AHA: Highest dose of antisense PCSK9i developed by @ionispharma and licensed to AZ lowers LDL-C 83%! Just when you thought PCSK9i could not get more potent. Can you imagine?

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@Lpa_Doc

Sam Tsimikas, MD

5 years

The debate on niacin and Lp(a) has taken on a religious fervor, which usually means there is no right answer, so everyone should keep this in mind before deriving definitive conclusions: Here are my opinions in the thread:

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@Lpa_Doc

Sam Tsimikas, MD

2 years

A paper from Nordestgaard group showing Lp(a) increases around the time of menopause by 27%, so that CVD risk (at >40 mg/dL) becomes equal to men post age 50. Re-measuring Lp(a) peri-post menopause may pick up additional risk not previosuly recognized.

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@Lpa_Doc

Sam Tsimikas, MD

11 months

1/18 AHA 2023: OK folks, the days are over when very few people tweeted about Lp(a), but no everyone is doing it 😀. Nonetheless, one still needs interpretation than simple reporting- so here goes my view of AHA.

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@Lpa_Doc

Sam Tsimikas, MD

5 years

A new analysis is out on estimation of Lp(a) lowering needed to see a 20% reduction in events (similar to LDL-C reduced 38.67 mg/dL). The "magic" number is 65.7 mg/dL. Previously the estimate was a reduction of 100 mg/dL was needed.

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Association of LPA Variants With Risk of Coronary Disease and the Implications for Lipoprotein(a)...

The clinical benefit of lowering Lp(a) is likely to be proportional to the absolute reduction in Lp(a) concentration. Large absolute reductions in Lp(a) of approximately 100 mg/dL may be required to...

pubmed.ncbi.nlm.nih.gov

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@Lpa_Doc

Sam Tsimikas, MD

9 months

1/12 Saturday Morning Class #27 Update on ongoing trials for treatment of elevated Lp(a): We will review Lp(a) drugs in development. Pelacarsen- brief story: The field of RNA therapeutics for Lp(a) started with this paper from a collaboration of our lab at UCSD and

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@Lpa_Doc

Sam Tsimikas, MD

6 years

A few more details on the FOURIER Lp(a) paper : 1-33% of pts had Lp(a) >120 nmol/L (>50 mg/gL) 2- The median % Lp(a) eduction was 27%, but only 16% in 4th highest quartile, thus the higher the Lp(a) the less effective PCSK9i is in lowering it,

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Lipoprotein(a), PCSK9 Inhibition, and Cardiovascular Risk - PubMed

URL: https://www.clinicaltrials.gov . Unique identifier: NCT01764633.

pubmed.ncbi.nlm.nih.gov

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@Lpa_Doc

Sam Tsimikas, MD

9 months

Ther is a 1:1 relationship of apoB to Lp(a), so an Lp(a) level of 125 nmol/L means the apoB on Lp(a) is also 125 nmol/L. To convert apoB of Lp(a) to mg/dl divide by 19.49. In this case apoB of Lp(a) is 125 nmol/L/19.49= 6.4 mg/dL. If your apoB is 70 mg/dL, it means 63.6 mg/dL is

@johngregory80

John Gregory

9 months

@Lpa_Doc What is the correct calculation of apoB on Lp(a) ? For example, an Lp(a) of 125 nmol/L (I can adjust the math from there) would add an additional apoB of ? mg/dL

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Sam Tsimikas, MD

3 months

@atvbahajournals has a Centennial Collection highlighting the American Heart Association's 100th anniversary. This is also Lp(a)'s 61st yr anniversary. So a good topic to look back and forward, and try to predict the future.... Enjoy.

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@Lpa_Doc

Sam Tsimikas, MD

3 years

Eaters of red meat should also be aware of the sialic acid Nue5Gc hypothesis-Ajit Varki/UCSD- humans (but not other animals) lost the enzyme to make this 2-3M yr ago. It is absorbed from eating red meat, accumulates and causes autoimmune reactions and CVD

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Human risk of diseases associated with red meat intake: Analysis of current theories and proposed...

One of the most consistent epidemiological associations between diet and human disease risk is the impact of red meat consumption (beef, pork, and lamb, particularly in processed forms). While risk...

pubmed.ncbi.nlm.nih.gov

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@Lpa_Doc

Sam Tsimikas, MD

2 years

1/11 ACC 2022 Lp(a) Summary: @ACCinTouch 1- very high interest in Lp(a)- 2 live sessions and at least 10 abstracts. Lets see if @EASCongress in Milan in May can beat it! I will be there in person! Summary of key findings follows:

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@Lpa_Doc

Sam Tsimikas, MD

1 year

An area of Lp(a) research that is lacking is outcomes post PCI/CABG. Data suggests pts with ⏫ Lp(a) have worse outcomes. @hsbhatia @DavidErlinge and I outline 2 trials, one pragmatic, to assess if outcomes can be improved. TY to @LipidJournal for opportunity to share thoughts

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@Lpa_Doc

Sam Tsimikas, MD

8 months

At birth LDL-C in humans is 40-50 mg/dL, in herbivores and most species, it is 10-30. Chimps can have LDL 70-130 or so and live ~60 yrs, but they mostly eat fruits and burn up many calories climbing. So, 40-50 is likely a good number to live with, but it has to be in context of

@ch__nob

Chris

8 months

@Lpa_Doc So you have no lower limit on LDL-C? Thanks

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Sam Tsimikas, MD

6 years

Hi all, now that I have reached 999 followers, I thought I would change my photo so people can see who I am. If anyone dislikes my mug, can consider switching back to the Lp(a) particle. Thanks for following, and i hope to continue to provide Lp(a) insights useful to you in 2019.

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@Lpa_Doc

Sam Tsimikas, MD

2 months

If cost is not factor, PCSK9i is ideal at this point for elevated LDL and Lp(a) as it lowers both, on average. Some people with very high Lp(a) do not get a response to Lp(a) lowering from PCSK9i. PCSK9i seems to have an outside benefit in peole with elevated Lp(a).

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@nmorlock42

Danny Fuerstman

2 months

@Lpa_Doc In general (e.g. not with reference to any specific patient), under what conditions do you consider using a PCSK9i, either in addition to or in place of other lipid-lowering medication options for primary prevention of patients with elevated Lp(a)? Assume cost not a factor.

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Sam Tsimikas, MD

6 years

LDL-C is not synonomous with atherosclerosis. In PCSK9 trials, if one adjusts for Lp(a)-chol, 10-20% have true LDL-C of ZERO. Yet event rate is 3-4% per year. The CANTOS and Amarin trials, with noLDL effect, also go against "curing" athero by LDL alone.

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'LDL-C' = LDL-C + Lp(a)-C: implications of achieved ultra-low LDL-C levels in the proprotein...

As the new era of ultralow LDL-C levels ensues, it is imperative to understand the contribution of Lp(a)-C to measured LDL-C and the consequences of achieving ultralow or potentially absent LDL-C in...

pubmed.ncbi.nlm.nih.gov

@POhukainen

Pauli Ohukainen, PhD (pohukainen.bsky.social)

6 years

THIS IS PRETTY HUGE!

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Sam Tsimikas, MD

5 years

This is an important "big data" paper . In the Million Veteran Program that also included >31,000 subjects with PAD (and >211,000 controls) the LPA gene was the most potent in predicting PAD, stronger than all other genes.

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@Lpa_Doc

Sam Tsimikas, MD

2 years

The role of aspirin in primary prevention is a net neutral effect (CV reduction is offset by the same rate of bleeding). The ? is does a subset of pts in primary prevention benefit, maybe high Lp(a). See review. …

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@Lpa_Doc

Sam Tsimikas, MD

5 years

For those interested in Lp(a)-OxPL @OxPL_apoB and aortic stenosis, we have discovered that the fastest progression rate of aortic stenosis can be predicted by apoCIII-Lp(a)-OxPL complexes. It ties in metabolic syndrome, LPA genetics and oxidative stress.

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@Lpa_Doc

Sam Tsimikas, MD

5 years

My sympathies to patients with FH, but elevated Lp(a) is much more common as a genetic cause of heart disease, maybe 10-20x more common. About 40-50% of patients with FH also have elevated Lp(a), and its not fully appreciated yet.

@FamilyHeartFdn

Family Heart Foundation

@FamilyHeartFdn

5 years

FH is the most common genetic condition that causes early heart disease. Help everyone #KnowFH by sharing this #FHAwareness video.

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Sam Tsimikas, MD

2 years

1/13 With lots of food around for Holidays and with recent TikTok over the "lion diet" eating only ruminants and water/salt, I thought I would re-post my prior tweets on the Inuit diet- which is meat and water - there is very little new under the sun!! Good one to "ruminate" on.

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Sam Tsimikas, MD

1 month

This paper has a major flaw in that it did not adjust for Lp(a) or TGs- these are the 2 categories that raise apoB above and beyond LDL-C. Thus we are unable to easily translate to the clinic. I suspect its only needed 10% of time (not 100%) if the Lp(a) and Tgs are known. I do

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@Drlipid

Thomas Dayspring

1 month

"TO ARMS - TO ARMS" -- CITIZENS AND CLINICIANS OF THE WORLD - Beg borrow or steal to get this incredible new data from 100,000 people in the Copenhagen Study - The last 25 years of my teachings have been vindicated 😆. It is apoB alone - not LDL-C and for sure, not as so many

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Sam Tsimikas, MD

2 years

The question we are left with now is: in a patient with elevated Lp(a) and no CAD, should we treat with aspirin? We should confirm with plasma Lp(a) data before widespread use, as it may only be relevant to very high Lp(a).

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Sam Tsimikas, MD

5 years

Hot off the press in JACC, showing elevated levels of Lp(a) and OxPL-apoB are associated with increased cal=cification, hemodynamic progression and need for AVR. Work led by @MarcDweck using 18F-NaF PET, repeat computed tomography calcium scoring, and repeat echocardiography

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Sam Tsimikas, MD

6 years

Hot off the press at EAS. Lp(a) is a predictor of risk in FOURRIER and benefit of PCSK9 is greater in high Lp(a) vs lower Lp(a). More to come...

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Sam Tsimikas, MD

6 years

Hot Lp(a) paper coming out this evening from our group in Lancet, 23:30 UK time....tune in, answers an important question on Lp(a), concomitant statin therapy and outcomes.

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Sam Tsimikas, MD

4 years

For those interested in Lp(a) assays, we have developed a new monoclonal antibody to apo(a) that is isoform independent and hope it can be used in commercial assays so they dont over/under read values: . It was a very difficult task and took ~4 years....

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Sam Tsimikas, MD

2 years

1/7 AHA Day #1 summary (Saturday). Usually, we get 2-3 Lp(a) abstracts/talks, but on Day #1 , there were a total of 17!! The times they are a'changin... Here is a very brief summary: 1- @hsbhatia @UCSDHealth led the way with 3:

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Sam Tsimikas, MD

5 months

This is now a hot topic, first presented by our group in collaboration with ASPREE. The idea was: is there a subgroup of pts without a prior CVD event that might benefit. The answer is yes, those with a specific genetic variant in LPA gene called rs3798220-C. This is associated

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@nmorlock42

Danny Fuerstman

5 months

@Lpa_Doc I'm going to be busy at that time so I thought I'd ask my question now to be answered tomorrow (if you don't mind!): thoughts on the use of low-dose aspirin for primary prevention in people w/high Lp(a)? Seems like intriguing but not conclusive positive evidence growing for it?

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Sam Tsimikas, MD

4 years

This is not scientific data but an opinion piece by known provocateurs. There is no arterial inflammation without cholesterol and fat. Chol and fat come first and inflammation follows, not the other way around.

@douglasritz

Douglas Ritz

4 years

@Lpa_Doc We've come along way since 2016.

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Sam Tsimikas, MD

5 years

The Lp(a) ODYSSEY Outcomes paper is now out: . It concludes "Lipoprotein(a) lowering by alirocumab is an independent contributor to MACE reduction". Every 10 mg/dL reduction in Lp(a) was associated with 6% RRR.

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Sam Tsimikas, MD

1 year

1/20 Good Saturday "morning" to everyone, welcome to class. Todays topic, Saturday Morning Class #26 - Lp(a) and relationship to Coronary Calcium" Courtesy of Dr Harpreet Bhatia, @hsbhatia , Assistant Professor @UCSDCardiology , my colleague and part of our research group:

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Sam Tsimikas, MD

2 years

The discussion on apoB is great. I do agree apoB is a better predictor than some individual variables. But, I am still waiting for someone to send an example where it made a difference in management on top of LDL-C, tg and Lp(a). There must be at least one case.

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Sam Tsimikas, MD

4 years

Random thought of the day: Since there are ~40 isoforms of apo(a) in Lp(a), with some caveats, we could trace all of humanity back to only ~40 common ancestors, human beings, that gave rise to us all. Blows the mind to think of this....We are much more similar than different...

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Sam Tsimikas, MD

3 years

Interest in TGs is growing among cardiologists, this was one of the most popular JACC tweets of 2021 @JACCJournals

@JACCJournals

JACC Journals

3 years

Patients w/ elevated triglycerides at ⬆️ risk for #ASCVD have the greatest risk of recurrent ASCVD events. @ACCinTouch just released clinical guidance on ASCVD risk reduction in patients w/ persistent #hypertriglyceridemia : #CardioTwitter #MedTwitter

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Sam Tsimikas, MD

3 years

1/19 Saturday Morning Class #18 Lp(a) and apoB First some definitions There are 2 kinds of apoB: apoB48 which is made by small intestine and apoB-100 made by the liver. ApoB48 and apoB100 come from the same gene, except one is 48% the size of the other, thus the name.

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Sam Tsimikas, MD

2 months

try one on this list.

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@delightedbeta

delightedbeta

2 months

@Lpa_Doc How to pick a physician in continental Europe that would be open to prescribe an LP(a) and/or ApoB test?

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Sam Tsimikas, MD

4 years

2/3 It shows if you mathematically remove Lp(a)-C from "LDL-C" to derive a corrected LDL-C, corrected LDL-C is NO LONGER predictive of events. It basically says the measure we call LDL-C is predictive only if it contains the Lp(a)-C in it.

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Sam Tsimikas, MD

1 month

Niacin has its many issues, but I still have many legacy pts on it that can tolerate it, although I rarely prescribe it now if I can get a pt on PCSK9i. Although the CVD trials have been negative, it does lower Lp(a) at least as much and likely more on average as PCSK9i in the

@Drlipid

Thomas Dayspring

1 month

Fortunately, no one uses it anymore, but just in case this is from the NIH How excess niacin may promote cardiovascular disease -- @nationallipid @society_eas

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Sam Tsimikas, MD

2 months

I think it may be time for "Ask me anything, about Lp(a)" Episode #5 tomorrow Sat, July 20, 9 AM PST?. Who is up for it?

@Lpa_Doc

Sam Tsimikas, MD

5 months

There have been several new advances in Lp(a), so its time for a new "Ask me anything, about Lp(a)" Episode #4 . Tomorrow Morning, 9-10 AM PST. Get your questions ready...

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Sam Tsimikas, MD

5 years

Ionis held Lp(a) Awareness Day for Ionis employees and UCSD colleagues @UCSDMedSchool @UCSDHealth . Rosanne Crooke shared her story on how Ionis had listed Lp(a) on their target list as far back as 2000, amazing. Its only been 18 years of hard work, but we are almost to Phase 3.

@ionispharma

Ionis

5 years

A huge thank you to Dr. Sam Tsimikas @Lpa_Doc for sharing his inspiring journey to develop a potential first in class antisense treatment that specifically targets elevated Lp(a) & deliver it to patients around the world #LpaAwareness

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Sam Tsimikas, MD

21 days

Final results of latest apoB poll. A significant proportion of voters go beyond guidelines. This whole field will change quickly once we have approvals for potent Tg and Lp(a) drugs, especially when they can be dosed 1/yr. The CV prevention field will move rapidly to general

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Sam Tsimikas, MD

28 days

A follow-up apoB poll. When I check apoB, it changes my aggressiveness of lowering LDL-C by:

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Sam Tsimikas, MD

2 months

Lp(a) levels are >90% genetically determined, so there only a few things we know about that can permanently raise it and keep it high. In some instances there is an acute phase response, so it goes up transiently due to a specific illness, like heart attack. People with chronic

@DrEricRodgers

Eric Rodgers

2 months

@Lpa_Doc Top 5-10 reasons Lp(a) can be elevated in someone without a genetic cause.

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Sam Tsimikas, MD

2 years

Many are worried Twitter will implode, but I doubt it. In any case, my Lp(a) twittorials are saved on my hard drive, so we will find another venue to post these in worse case scenario. They are gong to need an update anyway in 2023, so a good opportunity for a fresh start.

@Lpa_Doc

Sam Tsimikas, MD

3 years

For those interested in the Saturday Morning Lp(a) Class, the course is now linked to my bio and is open access. Big thanks to @TheBhupiThakur for organizing the twittorials. It is ~500 tweets in 24 classes. Syllabus enclosed. I wish to all the joy of learning.

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Sam Tsimikas, MD

1 year

Lp(a) has the highest heritability of all CV risk factors, not due to poor metabolic health. In fact, pts with high Tgs/diabetes have slightly lower levels than those that do not. The risk of Lp(a) is mostly independent of CAC, but if both are elevated risk is additive.

@rke21

Robert K

1 year

@Lpa_Doc Doesn’t matter. CAC is the best predictor of cardiovascular events while Lp(a) is not. To me, elevated Lp(a) is associated with poor metabolic health. High Lp(a), high triglycerides, high fasted insulin, low HDL, elevated small density LDL, low buoyancy LDL & A1C higher than 5.2.

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Sam Tsimikas, MD

6 years

We are learning that not all Lp(a) particles have OxPL. The most inflammatory Lp(a) are likely ones with OxPL, which might explain why people with high Lp(a)/OxPL have events early, and some with high Lp(a)/low OxPL don't. Its a hypothesis we can test in future outcomes trials

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Sam Tsimikas, MD

2 years

New Lp(a) paper in JACC (seems like ~1/wk.😀), quantitating equivalent risk of CVD in patients with elevated Lp(a) to familial hypercholesterolemia. Listen to Fuster podcast and read commentary led by Pam Morris @JACCJournals

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Sam Tsimikas, MD

2 years

Hi all, for those not able to attend or access ESC, see link to my talks: 1- All you ever needed to know about Lp(a)- 2- Targeting RNA for treatment of dyslipidaemias-

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Sam Tsimikas, MD

3 years

Observation: when I tweet about diet I note many intellectually curious people who want answers they dont have. I also see a lot of diet polemics. My advice: debate the idea NOT the person. Once things become personal, minds close and nothing can be learned except how to hate

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Sam Tsimikas, MD

3 years

OK folks, this is the latest creation, I will have to figure out what to do with them....colleagues, friends and family...maybe I will have a twitter raffle/quiz for my twitter followers...

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Sam Tsimikas, MD

5 years

I think all will enjoy reading this @TCTMD article on the Lp(a) debate I had with good friend Brian Ference on Lp(a). These are a bit artificial as sides have to be taken, but it forces one to carefully craft your arguments. I think I had the easier task..

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Should Lp(a) Be Measured and Treated? Two Experts Hash Out Its Current Role

Researchers debated the merits of Lp(a)—while one sees the future, another argued in favor of sticking with LDL cholesterol.

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