2/ At about eight minutes in Dayspring discusses how there is new emerging data on various things in the last couple years, particularly triglycerides and how they have taken center stage in relation to atherogenicity of an ApoB particle.
3/ About 10m in @PeterAttiaMD brings up the importance in distinguishing the difference between what ApB and LDL-P — of course, if you followed me for a while, you know this is a distinction of crucial importance for me (see cholesterolcode.com/thoughts-regar… )
4/ So I have some thoughts around the discussion following the 15:45 mark, but it’s not super Twitter friendly and I want to just keep going. I’m a double back with the thread of its own at some point...
5/ Wow — at around 23m in @PeterAttiaMD describes a (what I assume is) a hyper-responder case. (Possibly a LMHR...?)
6/ Full disclosure -- I had to pause the podcast to ruminate on these discussions, and now I need to take care of some business.
I'll restart this #ListeningThread later at my next bloc of convenience...
7/ At 35m in they are discussing the Vasa Vasorum.
@PeterAttiaMD differentiates the environments of the arterial lumen vs the VV with regard to insulin, glucose, sheer stress, etc. and why that should be considered a stronger suspect given potential risk of damage.
8/ At around 37m in they start talking HDL cholesterol, expanding on our drug targeting of this marker has it yielded positive effects, along with a brief mention on Mendelian randomization studies as well.
9/ Talk about timing. At about halfway through – around the 60 minute mark — @drlipid talks about OxLP_ApoB test and its value (particularly in the context of Lp(a))
11/ At about 74m @drlipid points out that if one were only allowed to look at one metric to be cost effective, he would recommend LDL triglycerides (tho they concede that discreet assay isn’t commercially available). But I definitely agree that LDL-TG should be very meaningful.
12/ I'll concede the pharmacological topic isn't as interesting to me so I'll button up here.
Again, this podcast has definitely been very interesting for many reasons I've outlined above. (I don't think I'll re-cover the ground of ApoB vs LDL; see blog post for details on that)
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First, let me say that data on this has been a bit limited. But *IF* we do ultimately confirm there are more ApoB-48 (B48) than ApoB-100 (B100) in ASCVD plaque, it would be a very big deal.
Let's unpack...
2/ First, thanks to @TuckerGoodrich for pinging me on these pubs and pressing the discussion.
But also credit to @CaloriesProper on tweeting this a couple years ago (I missed it then)
To understand why this would be so important if true, some review...
3/ B48 and B100s are the major proteins on chylomicrons (CMs) and VLDLs, respectively.
CMs mostly carry lipids from the small intestine to the bloodstream (lipids consumed), VLDL mostly carry lipids from storage; predominantly from adipose stores.
#Me: Why would triglyceride rich LDL particles be more atherogenic than triglyceride poor LDL particles?
#ChatGPT: Triglyceride-rich LDL (low-density lipoprotein) particles are more atherogenic (i.e., more likely to contribute to the… twitter.com/i/web/status/1…
2/
#Me: Couldn’t it also be possible that triglyceride rich LDL are ultimately the result of metabolic dysfunction and that better explains its association with atherosclerosis?
#Me: Is it possible that almost the entire amount of atherogenesis associated with high triglyceride rich LDL is due to dysfunctional lipid metabolism and the diseases that result in these profiles rather than the LDL particles themselves?
1/🧵 I'm definitely a fan of both @DominicDAgosti2 and @DrRagnar (obviously), so I was excited to see them chatting about #lipids, #LMHRs, and Dom's consideration of increasing carbs to lower his #ApoB
3/ When chatting with Dom in SD last year for dinner, he mentioned focusing less on maintaining such a sizable muscle mass as he typically does, and I predicted he'd likely see his LDL/ApoB as considerably higher with this change if still #keto. This podcast appears to confirm...
But I also know many people in my own family who have struggled their whole lives to lose weight and assume if they don't have this near instant drop to their goal weight like <fill in the blank success story> then they are doing it all wrong...
... I can't tell you how many times I point out truly new, record-setting successes with people I know personally -- but it's their own record, their own health journey.
But they often can't see it because they hear they "won't be hungry anymore on <fill in blank diet>"...