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Michael Albert, MD

@MichaelAlbertMD

Apr 8

Every morning I take five things.
A statin. Ezetimibe. Psyllium. Creatine. A multivitamin.

Once a week, I add a sixth: tirzepatide.

No rapamycin. No NMN. No Bryan Johnson protocol.

Here's what the evidence actually says—and why I left everything else out. 🧵

1/ Every morning I take five things.
A statin. Ezetimibe. Psyllium. Creatine. A multivitamin.

Once a week, I add a sixth: tirzepatide.
I used to raise an eyebrow at longevity stacks. Then I realized I'd quietly built one—each addition requiring enough evidence to clear the same bar I hold my prescriptions to.

2/ The plaque that ruptures at 62 was building in the third decade or earlier.

Ference et al. (JACC 2015): Mendelian randomization shows lifetime LDL exposure reduction yields ~3× greater CV risk reduction than RCTs achieving equivalent LDL lowering.

My LDL in 2018: 127. Today: 41.
The compounding logic means earlier is disproportionately better.

Read 9 tweets

Michael Albert, MD

@MichaelAlbertMD

Apr 4

I'm 36. I'm a physician. I take a statin—and ezetimibe—every day.

No symptoms. No cardiac history. Just an honest read of the evidence.

Here's what I found—and why I stopped waiting for a reason to act.

1/ I take a statin and ezetimibe every day.
My LDL in 2018: 127 mg/dL.
My LDL today: 41 mg/dL.

Here's exactly what changed — and why the evidence earned my confidence.🧵

2/ The CTT Collaboration pooled 27 RCTs and 170,000+ patients.
Each 1 mmol/L drop in LDL → ~21% relative reduction in major vascular events.

Even in low-risk people. Even in people who "seem fine."

That's not a secondary prevention story. That's a primary prevention story.

Read 9 tweets

Michael Albert, MD

@MichaelAlbertMD

Apr 1

The cholesterol wars are over.

LDL won.

New guidelines. Four landmark trials. An oral PCSK9 inhibitor that matches injectables. And data proving we should be treating patients we currently aren't.

Here's everything clinicians need to know. 🧵

1/ The 2026 ACC/AHA Guideline just retired 10-year-old guidance and brought back something crucial: explicit LDL-C numeric targets.

Not "treat to benefit." Treat to a number.

<55 mg/dL for most established ASCVD. <70 for high-risk primary prevention.

Eleven societies signed off.

2/ Ez-PAVE just answered a question cardiology has avoided for years:

Is <55 mg/dL actually BETTER than <70 mg/dL in secondary prevention?

3,048 patients. Head-to-head RCT. The answer:

10 mg/dL difference in achieved LDL → 33% reduction in MACE. NNT ~32 over 3 years.

For a target adjustment.

Read 9 tweets

Michael Albert, MD

@MichaelAlbertMD

Sep 1, 2025

🌍 The world is preparing to be transformed by nutrient-stimulated hormone-based therapies (NuSHs) like GLP-1 medications.

However, here’s the problem: more than 99% of clinics aren’t ready to deliver them at scale.

Here’s why ⬇️ 🧵benefitspro.com/2025/08/05/glp…

1⃣ Insurance navigation
Most clinics lack the workflows and staff necessary to obtain prior authorizations efficiently.

Even though >50% of their patients (modest estimate) could qualify for these medications, they can only push through a handful of approvals because:
🔹Prior auth processes are slow and fragmented
🔹There’s little reimbursement to justify hiring dedicated support
pmc.ncbi.nlm.nih.gov/articles/PMC11…

2⃣ Clinical infrastructure
These aren’t “set-and-forget” drugs. Patients often need:
🔹Slower titration schedules
🔹Dose adjustments
🔹Ongoing counseling & support
🔹Side-effect management (remember: >50% of users experience side effects)

Most clinics don’t have systems in place to deliver this kind of continuous, specialized care. diabetesjournals.org/care/article-a…

Read 8 tweets

Michael Albert, MD

@MichaelAlbertMD

Aug 6, 2023

1/ WHAT YOU NEED TO KNOW ABOUT THE QUALITY OF WEIGHT LOSS. 🧵

2/ When you lose weight, you don’t just lose from fat but also from other body compartments, including lean tissues.

3/ Why should you care about where the weight comes from?
Excess loss from specific lean tissues is associated with many adverse health outcomes: reduced QoL, osteoporosis, sarcopenia/frailty, decreased ability to perform ADLs, etc.

Read 19 tweets

Michael Albert, MD

@MichaelAlbertMD

Feb 19, 2023

1/ Are lean mass losses a real concern with GLP1 meds?
peterattiamd.com/the-downside-o…
🧵

2/ Simply, yes. And it is a concern any time you lose significant wt. I would remind people that human outcomes are the most informative, as physical functioning scores and QoL improved in STEP trials & SURMOUNT-1. However, the LT health impacts of LM loss need to be monitored.

https://twitter.com/MichaelAlbertMD/status/1425176302957457408?s=20

3/ Fortunately, we have some high-quality data from Lundgren et al., 2021.

👉Structured Exercise + Liraglutide (GLP-1RA) led to FM loss and LM gain.

https://twitter.com/MichaelAlbertMD/status/1425176302957457408?s=20

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