Thread by @realDaveFeldman

1/ New video by @NutritionMadeS3 which I'd like to retweet for added discussion.

There's a layperson-friendly section in it that does a great job of illustrating the existing expectation of:

(1) LDL/ApoB Exposure Size
X
(2) Time
=
Rate of Plaque Development

https://twitter.com/NutritionMadeS3/status/1533826262594162688

2/ Using "mg-years" (much like "pack years" with cigs), one can quickly figure out what state of cumulative exposure they'd be at.

Gil's graph in video was similar to the one I tweeted on last week 👇

And indeed, this is the convention of exposure x time

https://twitter.com/realDaveFeldman/status/1529888065493168128?s=20&t=IGGYVynuytzNU7Y0N5CM4g

3/ To be sure, I'd echo @NutritionMadeS3's qualifier in the video that this is expected at a population level. So the exceptions don't prove the rule (in either direction).

Hence the enormous importance of studying those with extremely high LDL/ApoB at a population level...

4/ Naturally, this is where I again emphasize the importance of studying plaque emergence and development in #LMHRs

Using the above equation, we should certainly see a lot of plaque at a population level for even short term LMHRs compared to healthy likewise cohorts of avg LDL..

5/ Here's an example using the equation above:

Someone has a mean LDL-C of 125 up to their 40th birthday, but then goes #keto and becomes a LMHR with an LDL of 500 for the next 3 years.
Their "mg-years" are
125 x 40 -> 5000 (age 0-40)
+
500 x 3 -> 1500 (age 40-43)
=
6500

6/ Per the equation above-> in 3 years at an LDL of 500, they will have added the equivalent of 12 years at LDL-C of 125.

So at 43, given the equation, this person should have comparable likelihood of plaque development for a 52 year old (again, speaking to population averages).

7/ If adding an additional 3 years, that 46 year should have comparable likelihood of plaque development for a 64 year old. (8000 mg-years)

Certainly I'm hoping this isn't the case, but I don't know (nor does anyone else)...

8/ But we're getting this specific data on #LMHRs right now (see LMHRstudy.com)

While I'm sure most will be at lower than levels comparable to 500, I likewise know there are many who are (or even higher). Hence the need to collect this population data soon!