Thread by @han_francis

#JoeRogan @joerogan and @DrAseemMalhotra misled you again, willfully, on vaccine myocarditis and statins, on the Joe Rogan show. Here, I explain how. 🧵
#vaccineswork #myocarditis #HeartDisease

One part of his presentation focuses on statins, and the controversy surrounding his project with Abramson/ Malhotra et al about the risk/ benefit ratio of statins. As a quick recap, statins are intended to lower cholesterol, and Malhotra's position is that...

as many people as possible should stop their statins and focus on exercise. This narrative is as usual based upon distortions of the evidence, and normal cardiologists don't need to distort the evidence to make their point.

The complex process of heart artery damage that leads to an eventual heart attack can be thought of as a mixture of lipid (oil) being deposited in the heart arteries, which then sets up an inflammatory process, which then may add calcium, which then may scar, which...

then may form a plaque, which could break or get thicker, which...

ultimately restricts blood flow to the heart, which leads to a heart attack. First of all, you won't find cardiologists out there who intentionally tell people not to do exercise. This is an integral part of our counseling, especially after something as serious as a heart attack.

As a cardiologist, @DrAseemMalhotra should theoretically be cognizant of the difficulties of optimizing all the social determinants of health that need to be improved in a particular patient, but chooses not to address them here.

If anyone has spent any time in an actual medical clinic, s/he will realize that it is sometimes not as easy as "Hey you need to exercise" - and then the patient is magically able to exercise 8 hours a week.

Exercise is an integral part of what we counsel patients about after something as serious and as life threatening as a heart attack. On statins - they lower cholesterol but also have a secondary effect of lowering heart artery inflammation- something really important after STEMI.

There is actual legitimate concern for the side effects of statins - but cardiologists are well capable of monitoring for those side effects, and coming up with a different solution if the side effects are too much.

There is also actual legitimate debate around the utility of giving out statins to people who don't actually have any evidence of heart disease - but the picture on people who had a heart attack is quite a bit clearer.

Don't stop statin after an actual heart attack - unless you want to gamble with having a future heart attack. nicswell.co.uk/health-news/st…

Aseem also neglects the entire field of pediatric cardiology, where there is quite good evidence for the use of statins in kids, to prevent future heart attacks, who are born with familial homozygous hyperlipidemia (Kids are not small adults!!)

Part 2- onwards to myocarditis.First, he intentionally misrepresents the Tuvali group's study - here is how you actually interpret it. Study design parameters need to be respected - it has never been cool to cherrypick (even @DrAseemMalhotra said not to!)

https://twitter.com/han_francis/status/1590205964413972480?s=20

Next - he claims that there is no study that indicates whether or not COVID vaccines protect against COVID disease myocarditis. While that is technically partially true, this neglects the entire body of literature showing these vaccines still protect against severe disease...

of which COVID viral myocarditis is one of the forms of severe disease. cidrap.umn.edu/covid-19-vacci…

He cites the Fraiman/ Doshi paper to attempt to show his point for vaccine side effects, which has major methodological issues: (basically they re-analyzed the statistics to demonstrate their preferred conclusion) sciencebasedmedicine.org/dont-do-this/

He cites the PULS study, which he still doesn't seem to publicly understand cannot be used for a purpose that it is not validated for. One cannot claim a phillips head screwdriver is good for a hex nut. sciencebasedmedicine.org/the-puls-test-…

Will update this thread as more of the video trickles through. Feel free to reference this more comprehensive debunk of Aseem Malhotra for the time being - sciencebasedmedicine.org/the-aseem-malh…

Moral of the story: Even if you have different political beliefs, you should be empowered to seek out the most effective cardiology care (should you need it). Malhotra falls short of that standard.