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Gurleen Kaur, MD Profile picture
@Gurleen_Kaur96
May 16, 2021 • 10 tweets • 8 min read • Read on X
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💥The Ultimate Guide to Lipids💥
🟢Lipid biology
🟢Physical exam clues for lipid disorders
🟢Lipid tests & interpretation
🟢CV risk assessment
🟢Fundamentals of lipid management
🟢Review of guidelines

🧵on this great @ACCinTouch session from today #ACC21 #ACCMedStudent #ACCPrev
1/ Lipid Biology #ACC21 #ACCMedStudent
Lipoprotein-central core of cholesterol ester/TG surrounded by apolipoprotein

Dietary fat➡️chylomicrons➡️TG metabolized in muscle & adipose by lipoprotein lipase➡️chylomicron remnants liver uptake➡️VLDL➡️FFA & IDL ➡️LDL➡️LDL receptor uptake
2/ Lipid Biology continued...#ACC21 #ACCMedStudent

HDL formed by liver/intestines - acquire cholesterol through reverse cholesterol transport

Lp(a) - modified LDL particle w/ additional apolipoprotein (a). Oxidation pro-inflammatory,⬆️atherosclerosis.
3/ Physical Exam Clues #ACC21

Xanthomas, corneal arcus➡️FH
⚡️Sitosterolemia (📈intestinal absorption & decreased biliary excretion of sterols) can appear similar to xanthomas

Palmar Xanthomas➡️Type III hyperlipidemia (recessive, defective removal of VLDL & chylomicron remnants)
4/ Physical Exam Clues continued... #ACC21

🍊orange tonsils➡️Tangier disease (mutation in ABCA1, HDL deficiency), associated w/ hepatosplenomegaly, atherosclerosis, polyneuropathy, elevated TG

👀cloudy cornea➡️Fish-eye disease (mutation in LCAT gene, low HDL, inc VLDL/TG).
5/ Lipid Tests & Interpretation #ACC21 #ACCMedStudent

When to measure Lp(a)?
🔶Family hx of premature ASCVD
🔶Premature ASCVD
🔶LDL >190, suspected FH
🔶Very high ASCVD risk to better define benefit from PCSK9i
6/ CV Risk Assessment

Guidelines recommend use of pooled cohort equations (PCE) for 10-year ASCVD risk

🛑Can under- and over-estimate risk in some populations➡️consider risk-enhancing factors
🛑May use CAC score in risk assessment & treatment decision
7/ Fundamentals of Lipid Management #ACC21

Diet & Exercise are always🔑
➕soluble fibers, nuts, vegetable protein, DASH diet
🚫refined carbs, processed foods

LDL >70 despite statins:
Ezetimibe (IMPROVE-IT)
PCSK9i (FOURIER & ODYSSEY)
Bempodeic acid (pending outcome trials)
8/ Review of guidelines #ACC21

♦️Emphasize heart-healthy lifestyle
♦️Clinical ASCVD➡️max tolerated statin to📉LDL by >50%
♦️Very high-risk ASCVD➡️threshold of 70mg/dL for non-statin
♦️LDL-C>190➡️high-intensity statin
♦️40-75 yo w/ diabetes & LDL-C>70➡️moderate-intensity statin
9/ Review of guidelines continued... #ACC21 #ACCMedStudent

♦️40-75 yo primary ASCVD prevention➡️risk discussion
♦️40-75 yo w/o diabetes, LDL>70 + 10-yr risk >7.5%➡️moderate-intensity discussion if risk discussion favor Rx
♦️Assess response w/ repeat lipids 4-12 weeks after Rx

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More from @Gurleen_Kaur96

Gurleen Kaur, MD Profile picture
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 ⤵️ Image
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 Image
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 Image
Read 6 tweets
Gurleen Kaur, MD Profile picture
Jan 19, 2023
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 Profile picture
Nov 16, 2022
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 Image
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 Profile picture
Aug 30, 2021
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 Profile picture
Jul 25, 2021
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 Profile picture
Jul 24, 2021
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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