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Jan 9 • 5 tweets • 2 min read
Great comments today via @Lpa_Doc -- please note his precise language. 👇

I'm going to thread 🧵 this and his other comments and then add some of my own...

/1
2/ "My point is, there is no athero or chronic vascular inflammation without a lipid disorder."

I have a nuanced difference with Sam on this -- but the important point here is that we need to disentangle the disorder/disfunction from the athero to test..

3/ In other words, to confirm/disconfirm the contribution of LDL-P independently to atherosclerosis, we'd want to look to populations without a likely form of disorder or dysfunction (be it genetic or acquired).

Obviously, I think LMHRs provide a unique opportunity on this...
4/ Hence why I love @Lpa_Doc's other point here as well 👇

Yes -- it's possible the same Rx that ultimately results in a lowering of LDLp is lowering ASCVD by other means (such as reducing inflammation or its upstream root cause)

Regardless...

5/ Again, as always, we can discuss these topics without concluding a certainty in either direction.

But obviously, I consider our #LMHRstudy to provide a unique new corridor of data that's been long overdue given it seeks to exclude these dysfunctions, chronic inflam, etc

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More from @realDaveFeldman

Dave Feldman Profile picture
Dec 25, 2022
🎄My Holiday N=1 Overeating Survival 🧵

Here are the observations I give my own family members based on what's I've learned in my N=1 experiments.

1) Nothing beats proximity.

The further I'm away from food, the less likely I am to eat it. Not just across town, but in the room.
2) Like many (but probably most), eating something outside my diet commitments on a holiday almost always results in my continually breaking that commitment from then on.

Some things I can "cheat" on (like "normal" pizza). Some I can't (like "normal" chocolate chip cookies).
3) Social cues are way, way, way more powerful than everyone gives them credit for, IMO.

"Mom made us <X>"
"Would you like some <x>?"
"You've been so good lately, try just a bite."

Multiple influences: not wanting to displease/reject, being included, looking to appear moderate
Read 8 tweets
Dave Feldman Profile picture
Dec 19, 2022
Wow — i’m currently traveling for the holidays and tweeted this out before getting on the road (currently at a stop). I guess this is actually a topic with a lot of interest…

some quick answers to questions…
Yes, this was one of the things that got brought up. It’s actually where a lot of the arguing originated because naturally everyone wants to reassure everyone else not to feel insecure. But some chimed in that it isn’t “how the real world works”…
… (shared with her permission) — “I think some guys who are super cut just generally aren’t in long term relationship mode. Even if they think they are.”
Read 4 tweets
Dave Feldman Profile picture
Dec 15, 2022
Yes -- let's take a moment to talk reverse causality as this is often confused. #thread 🧵

@NutritionMadeS3's point is that some diseases result in *both* mortality and lower total & LDLc.

Thus, the root cause is upstream of each (such as some forms of cancer, potentially). /1
2/ Hence the value of stratifying away a period of early deaths for a given population (aka "censoring")

Thus, if you exclude all deaths in a given population that took place during the follow up period up to year X, then this helps to address reverse causality.
3/ I just recently got a chance to relook at the centenarians of NHANES with updated data myself.

And as it happens, they have a built in censoring of 15-20 years due using only ≤85 year olds as they confirm turning 100. 👇

Read 4 tweets
Dave Feldman Profile picture
Dec 13, 2022
📍Big milestone!📍

The Nov/Dec @LipidJournal just dropped!

🚨Featuring the #LMHReditorial 🚨
via @nicknorwitz et al

It focuses on #LMHRs, both in consideration of their high #LDL and an urgent call for expanded #research.

Why is this important?... /1
doi.org/10.1016/j.jacl…
2/ Certainly the biggest impact is bringing this phenotype well into the spotlight.

If you've been following my work from the beginning, you can appreciate just how much energy I've put toward putting this phenotype in front of Lipidologists.
3/ But this is understandably a challenge given how much progress on this research has been accomplished outside typical channels ("Citizen Science").

-- Until now.
Read 7 tweets
Dave Feldman Profile picture
Dec 9, 2022
🧵 Dec 9th anniversary thread

On this day in 2015 I received a lab result that would alter the course of my life.

Just two weeks earlier I had gotten my very first bloodwork after half a year on #keto that showed my total and #LDL #Cholesterol had nearly doubled (!)… /1
2/ With that first test I was overcome with shock and curiosity — much more former than the latter.

I wanted to get a repeat test to confirm this wasn’t a lab error.

I wasn’t ready to give up #keto, but I was miserable enough that I ate considerably less.
3/ At the same time I learned as much as I could about Lipidology - which focuses on how the body moves lipids (like cholesterol) in the blood.

And to my surprise, this system is already very familiar to me as a software engineer given it is a distributed object network.
Read 15 tweets
Dave Feldman Profile picture
Nov 29, 2022
1/ 🧵 I like a lot of @NutritionMadeS3's videos, but I'll concede this one was a little mixed, so I wanted to share some notes (it gets better by the end)

As always, I hope this will be received by everyone in a productive, respectful manner.
2/ myth: “CAC score of 0 means no plaque”

👆I feel this is another statement that is extremely categorial and unrepresented by the vast majority of knowledgable proponents for CAC.

We were chatting about this before on the debate questions...

3/ As an analogy - if someone were to make a video that outlined:
"Myth: LDL-C < 70 will keep you from ever having a heart attack" -- and then knocked it down, it would rightly be considered a strawman position of proponents more knowledgeable and representative of the whole.
Read 9 tweets

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