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Gurleen Kaur, MD

May 16, 2021 • 6 tweets • 4 min read • Read on X

🌟Future of Dyslipidemia Management🌟
🧵on this great session from #ACC21 #ACCMedStudent

1/ Team-based approach to improve CV outcomes
🔸pharmacist interventions reduce LDL-C
🔸sessions with dietitian improves lipids &📉costs
🔸Multi-D lipid clinic⬆️guideline-directed treatment

2/ Familial Hypercholesterolemia (FH)
♦️ Genetically inherited, autosomal dominant
♦️ LDL-C >190 mg/dL
♦️ Family hx of premature coronary disease

Presence of corneal arcus (ring of cholesterol precipitate) or tendon xanthoma (>8mm Achilles tendon) before age 45 highly suggestive

3/ Genetic Testing for pts at risk due to family history or w/ FH phenotype

🌟Up to 30% of patients with very high LDL-C have high polygenic risk score (PRS) vs. single gene mutation🌟

4/ New Targets for LDL-C Reduction

🫀 Bempedoic Acid - prodrug, inhibits ATP citrate lyase (biosynthesis of cholesterol)
🫀 Evinacumab - antibody for angiopoetin-like protein 3 (ANGPTL3)
🫀 Inclisiran - injectable siRNA, inhibits PCKS9 translation
🫀 CRISPR -pre-clinical studies

5/ Lp(a) measurement

Major issues:
🔸units of measurement (mg/dL vs. nmol/L)
🔸lack of standardization of assays

Apo(a) isoform size heterogeneity can complicate Lp(a) measurement

Recommend➡️particle concentration units (nmol/L) rather than mass concentration (mg/dL)

6/ 🔥2021 Lipid Clinic🔥

From 1995 study showing improvement in LDL goal attainment w/ lipid clinic pubmed.ncbi.nlm.nih.gov/7487258/

To 2021...what is different?
♦️ Telemedicine
♦️ IT and billing support
♦️ COVID-19

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More from @Gurleen_Kaur96

Gurleen Kaur, MD

@Gurleen_Kaur96

Jul 23, 2023

1/ Strategies for medical management of obesity, presentation by @BevTchangMD #ASPC2023

Currently 5 meds FDA-approved for long term management of obesity ⤵️

2/ Who is eligible for anti-obesity medication❓

🫀 BMI >= 30, BMI>=27 with weight related comorbidity
🫀For Asians, BMI>=25-27, BMI>=25 with weight-related comorbidity

#ASPC2023

3/ Efficacy‼️

Expectation of response rate: >5% weight loss over 1 year

Phen/top: 10% weight loss, 70% response rate

Semaglutide: 15% weight loss, 86% response rate

Tirzepatide: 20% weight loss, 90% response rate

#ASPC2023

Read 6 tweets

Gurleen Kaur, MD

@Gurleen_Kaur96

Jan 19, 2023

@CardioNerds

1/ Cardiac Stress Testing @CardioNerds
🔶Indications
🔶Types - Exercise vs. Pharmacological
🔶Compare & Contrast Modalities

Thanks to @SimratKaurMD, @AmitGoyalMD, @jholtzman3 for feedback on this infographic!

Follow🧵for a breakdown of the graphic⤵️

2/ Indications

Evaluate:
🔺Stable chest pain in pts w/ intermediate-high risk of CAD
🔺New onset symptoms in pt w/ known CAD
🔺Valvular heart disease & provocative testing in HCM
🔺Microvascular disease & CAV in transplant pts
🔺Hibernating myocardium in pts w/ known CAD

3/ Types❓Exercise vs. Pharmacological

🏃‍♀️Exercise
What➡️Treadmill
Who➡️ Anyone who can exercise (achieve 4 METs) and get to 85% of max predicted HR (220-age)

When evaluating report, look for:
🌟Duration of exercise
🌟METs achieved
🌟% max HR
🌟HR/BP response

Read 12 tweets

Gurleen Kaur, MD

@Gurleen_Kaur96

Nov 16, 2022

@PaChapterACC

1/ In Episode 234, @PaChapterACC & @CardioNerds featured a Narratives in Cardiology discussion on Structural Heart Disease & LatinX Representation in Cardiology w/ @MayraGuerreroMD, @TDonisan, @AdrianaCMares

Follow this #CardsNarratives 🧵 on Valvular Heart Disease in Women

2/ We’ll cover these 2 questions:

❓What are the disparities in valvular heart disease in women?
❓What changes need to be implemented to improve the care of women with valvular heart disease?

3/ I feel comfortable openly discussing or asking others about factors that make them different from myself like race, religion, ethnicity, gender, sexual orientation, immigration status, etc

Read 12 tweets

Gurleen Kaur, MD

@Gurleen_Kaur96

Aug 30, 2021

@PaChapterACC

1/ In the🥉@PaChapterACC & @CardioNerds Narratives in Cardiology episode @mirmerrill, @scfuentesr, and @NatashaCuk talk w/ @KTamirisaMD

Follow this #CardsNarratives🧵on the discussion about gender equity & women in Cardiology/Electrophysiology (EP)

2/ We'll cover these 3 questions:

🔸Why should we promote gender diversity in Cardiology/EP?
🔸How do we address barriers for women in Cardiology/EP?
🔸What are some opportunities for EP in private practice?

3/ I feel comfortable openly discussing or asking others about factors that make them different from myself like race, religion, ethnicity, gender, sexual orientation, immigration status, etc

Read 20 tweets

Gurleen Kaur, MD

@Gurleen_Kaur96

Jul 25, 2021

@ASPCardio

1/ Day 3 & last session of #ASPC2021 on special populations

Talk on MI & HF among people with HIV by Dr. Markella Zanni

Follow this🧵on:
🔹MI risk in people w/ HIV
🔹HF in PWH
🔹CVD preventive approaches tailored to people w/ HIV

@ASPCardio @CardioNerds

2/ Patients with HIV are now living longer ➡️increased risk of CVD

Global burden of atherosclerotic CVD in people living with HIV has tripled over past 2 decades

Relative risk of MI is 1.5-2 in high-income countries

pubmed.ncbi.nlm.nih.gov/23459863/

#ASPC2021

3/ From US Partners database study – adjusted relative risk for MI was around 3 for women & 1.5 for men – regionally specific

Type 1 vs. type 2 MI: both ~50%
Women – more type 2 MI

pubmed.ncbi.nlm.nih.gov/17456578/

#ASPC2021

Read 18 tweets

Gurleen Kaur, MD

@Gurleen_Kaur96

Jul 24, 2021

@NMHheartdoc

1/ #ASPC2021 talk for Honorary Fellowship Award by @NMHheartdoc on New Kind of Prevention – Reducing CV Health Disparities at Community and Individual Level

🧵from session

@ASPCardio @CardioNerds

2/ #ASPC2021
Covid-19 deaths by race and ethnicity in the US:
1 in 555 Black Americans has died

Populations w/ highest disease burden➡️ lowest vaccination rates

3/ Any discussion of prevention shouldn’t start at hypertension, dyslipidemia, but at the root cause of those inequities.

Need to address policy. All policy is health policy.

Stolen breaths nejm.org/doi/full/10.10…

#ASPC2021

Read 10 tweets

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