Thread by @khurramn1

@TheBhupiThakur @jaideeppatelmd @MichaelJBlaha hi @TheBhupiThakur

For LDL>190 mg/dl
In MESA nearly 35% have #PowerOfZero
13 yr FU, event rate 3.5% (well below threshold for statin consideration)

atherosclerosis-journal.com/article/S0021-…

@TheBhupiThakur @jaideeppatelmd @MichaelJBlaha #2
For genetically confirmed #familialhypercholesteremia

See below, clearly not a homogenous disease, many shades of atherosclerotic disease

Events track with CAC score

With CAC zero, can possibly avoid PCSK9i (statins for all)
@rauldsf_santos @miguelcainzos23 @reed_mszar

@TheBhupiThakur @jaideeppatelmd @MichaelJBlaha @rauldsf_santos @miguelcainzos23 @reed_mszar #3 Across spectrum of Lipid disorders

Clear doesn't matter how you slice or dice the pie, the risk is related to atherosclerotic disease burden across the spectrum of lipid disorders

@TheBhupiThakur @jaideeppatelmd @MichaelJBlaha @rauldsf_santos @miguelcainzos23 @reed_mszar #4
Now what so called "risk enhancing factors (REF)"?

Nearly 40% with 10 yr risk of >7.5% & 3 REF have CAC zero

10 yr risk still <5%

Clearly time to #StartWithCAC rather guesstimating with (REF) as shown by @jaideeppatelmd @mahrifai

@TheBhupiThakur @jaideeppatelmd @MichaelJBlaha @rauldsf_santos @miguelcainzos23 @reed_mszar @mahrifai #5 Are all DM the same

No!

#PowerOfZero still applies (much lower risk than anticipated) whether type 1 or type 2

@BudoffMd @DrNathanWong @JamalRanaMD

@TheBhupiThakur @jaideeppatelmd @MichaelJBlaha @rauldsf_santos @miguelcainzos23 @reed_mszar @mahrifai @BudoffMd @DrNathanWong @JamalRanaMD #6
Furthermore in higher risk groups may also identify those who will need much more aggressive therapies

See example below in @bmj_latest review with @miguelcainzos23 @HMethodistCV

@TheBhupiThakur @jaideeppatelmd @MichaelJBlaha @rauldsf_santos @miguelcainzos23 @reed_mszar @mahrifai @BudoffMd @DrNathanWong @JamalRanaMD @bmj_latest @HMethodistCV In the end choice is clear and for us to make

For "Risk Assessment"

Obsess about more & more biomarkers

or

Focus on CAC that point to accumulated, current (accounting for resilience/vulnerability) future risk

Time to move on from Guestimation-->See disease, treat disease