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Michael Albert, MD

May 19

A patient asked me this week if they could stop their obesity medication.

I told them what the data says:
67% of people who stop regain almost everything within a year.

That's not a failure of willpower. That's biology. And we finally have trials that prove it.

1/ ECO 2026 just changed the conversation in obesity medicine. For 3 years, every major meeting asked: how much weight can we lose? Istanbul asked something different: how do we keep it? Here's what we learned. 🧵

2/ SURMOUNT-MAINTAIN published in The Lancet this week. After losing 22% of their weight on tirzepatide, patients were randomized to continue full dose, drop to 5 mg, or switch to placebo. The results were unambiguous.

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Michael Albert, MD

@MichaelAlbertMD

May 11

1/ I'm a physician.
I just left traditional healthcare.

2/ I spent years inside the system.
7-minute visits.
Portal messages answered three days later by someone the patient had never met.

Care fragmented across platforms built around billing codes — not people.

3/ I'm not sure there's any going back.

Last week, I joined Vineyard as Chief Medical Officer and Staff Physician.

It's a direct-care virtual cardiometabolic clinic operating in all 50 states.

No insurance gatekeeping. Built around the patient and physician experience.

Read 7 tweets

Michael Albert, MD

@MichaelAlbertMD

Apr 8

Every morning I take five things.
A statin. Ezetimibe. Psyllium. Creatine. A multivitamin.

Once a week, I add a sixth: tirzepatide.

No rapamycin. No NMN. No Bryan Johnson protocol.

Here's what the evidence actually says—and why I left everything else out. 🧵

1/ Every morning I take five things.
A statin. Ezetimibe. Psyllium. Creatine. A multivitamin.

Once a week, I add a sixth: tirzepatide.
I used to raise an eyebrow at longevity stacks. Then I realized I'd quietly built one—each addition requiring enough evidence to clear the same bar I hold my prescriptions to.

2/ The plaque that ruptures at 62 was building in the third decade or earlier.

Ference et al. (JACC 2015): Mendelian randomization shows lifetime LDL exposure reduction yields ~3× greater CV risk reduction than RCTs achieving equivalent LDL lowering.

My LDL in 2018: 127. Today: 41.
The compounding logic means earlier is disproportionately better.

Read 9 tweets

Michael Albert, MD

@MichaelAlbertMD

Apr 4

I'm 36. I'm a physician. I take a statin—and ezetimibe—every day.

No symptoms. No cardiac history. Just an honest read of the evidence.

Here's what I found—and why I stopped waiting for a reason to act.

1/ I take a statin and ezetimibe every day.
My LDL in 2018: 127 mg/dL.
My LDL today: 41 mg/dL.

Here's exactly what changed — and why the evidence earned my confidence.🧵

2/ The CTT Collaboration pooled 27 RCTs and 170,000+ patients.
Each 1 mmol/L drop in LDL → ~21% relative reduction in major vascular events.

Even in low-risk people. Even in people who "seem fine."

That's not a secondary prevention story. That's a primary prevention story.

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Michael Albert, MD

@MichaelAlbertMD

Apr 1

The cholesterol wars are over.

LDL won.

New guidelines. Four landmark trials. An oral PCSK9 inhibitor that matches injectables. And data proving we should be treating patients we currently aren't.

Here's everything clinicians need to know. 🧵

1/ The 2026 ACC/AHA Guideline just retired 10-year-old guidance and brought back something crucial: explicit LDL-C numeric targets.

Not "treat to benefit." Treat to a number.

<55 mg/dL for most established ASCVD. <70 for high-risk primary prevention.

Eleven societies signed off.

2/ Ez-PAVE just answered a question cardiology has avoided for years:

Is <55 mg/dL actually BETTER than <70 mg/dL in secondary prevention?

3,048 patients. Head-to-head RCT. The answer:

10 mg/dL difference in achieved LDL → 33% reduction in MACE. NNT ~32 over 3 years.

For a target adjustment.

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Michael Albert, MD

@MichaelAlbertMD

Sep 1, 2025

🌍 The world is preparing to be transformed by nutrient-stimulated hormone-based therapies (NuSHs) like GLP-1 medications.

However, here’s the problem: more than 99% of clinics aren’t ready to deliver them at scale.

Here’s why ⬇️ 🧵benefitspro.com/2025/08/05/glp…

1⃣ Insurance navigation
Most clinics lack the workflows and staff necessary to obtain prior authorizations efficiently.

Even though >50% of their patients (modest estimate) could qualify for these medications, they can only push through a handful of approvals because:
🔹Prior auth processes are slow and fragmented
🔹There’s little reimbursement to justify hiring dedicated support
pmc.ncbi.nlm.nih.gov/articles/PMC11…

2⃣ Clinical infrastructure
These aren’t “set-and-forget” drugs. Patients often need:
🔹Slower titration schedules
🔹Dose adjustments
🔹Ongoing counseling & support
🔹Side-effect management (remember: >50% of users experience side effects)

Most clinics don’t have systems in place to deliver this kind of continuous, specialized care. diabetesjournals.org/care/article-a…

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