Thread by @realDaveFeldman

1/ I'd love to take an opportunity to expand on this important topic, and if I may, suggest something important to watch for with some newly emerging data.

To @MichaelMindrum point, I too believe the #ApoB will demonstrate higher association with #ASCVD than #LDL #Cholesterol..

https://twitter.com/MichaelMindrum/status/1533424900207157250

2/ But to be sure, ApoB can be best represented as:

(1) Non-LDL ApoB lipoproteins
- and -
(2) LDL ApoB lipoproteins

The first category is predominantly chylomicrons, VLDL, and IDL -- which associate very highly with ASCVD.

3/ You can think of category (1) as "Triglyceride Rich Lipoproteins" (TRL, aka "remnants") and category (2) as "Triglyceride Poor Lipoproteins" (TPL)

The population of #LMHRs have extremely high levels of ApoB. But this pattern is a mix of very *low* TRL and very high TPL.

4/ If overall high ApoB alone is atherogenic (whether low in TRL or not), then it stands to reason this should be very concerning for #LMHRs, hence the importance of our #LMHRstudy (currently underway).

Certainly we need these data at a population level to consider further...

5/ But I will say again – I think it's worth understanding the relevance of distinguishing these two categories of remnant, triglyceride-rich ApoB lipoproteins from their triglyceride poor counterparts given what it says about the success and failure of lipid metabolism overall.

6/ Of course, I've touched on this area many times before (#LEM), but this article I wrote a while ago from CC goes into this very specific area in depth:

cholesterolcode.com/thoughts-regar…