My brilliant med student asked me to explain correlation, causation, confounding &collider bias. I used the following ex… so sharing here in case anyone finds it helpful!

PS -I have learned much from @dnunan79 @Catalogofbias - a great resource for EBM. hopefully he approves😅 A statistical association between 2 variables implies that knowing the value of 1 variable, provides information about the value of the other. It does not necessarily imply that 1 causes the other. Correlation ≠ causation.

Heartbroken after seeing a young patient with no medical history, end up with a BIFFL GRADE II dissection of the vertebral artery and subsequent acute PICA infarct immediately after a neck adjustment from the chiropractor. This has to stop.

Chiropractors - you HAVE to stop. How can we live in a world where it’s legal to perform something with zero evidence for benefit (neck adjustment from a chiro) when there are such incredibly dangerous and life changing risks?

And yet, insurance often covers chiropractic care- but doesn’t cover most dietitians.

1 year ago I met a patient w/ obesity, HLD, HTN & symptomatic paroxysmal afib, considering ablation.

She was nervous&held off on the procedure.

I started her on semaglutide & a plant predominant diet.

1 year later:⬇️42 lbs, HTN remission, afib undetectable, ablation cancelled!

In 12 months on semaglutide and a high fiber, plant predominant, low SFA diet:

⬇️Her weight dropped from 201 to 159.
⬇️Her BMI dropped from 31.5 to 24.9.

@kevinnbass @bluestarpr @ethanjweiss @DrNadolsky @Drlipid @PeterAttiaMD @POhukainen What really drives LDL particles into the artery wall is particle#/apoB. Typically - 90-95% of your apoB lipoproteins are LDL particles. Once you exceed a certain threshold in the plasma, the liver can’t clear them – so they go into the arteries. 1/n @kevinnbass @bluestarpr @ethanjweiss @DrNadolsky @Drlipid @PeterAttiaMD @POhukainen But when particle numbers (apoB, LDL-p) are discordant from cholesterol metrics (LDL-C, non HDL-c)—this is where people get mixed up -- but risk always traffics with the particle number/apoB. The ex I give my med students re small vs large LDL size, risk, and discordance -- 2/n

Thanks Optimizing PCI for inviting me to give a talk about nutrition & ASCVD prevention! I was so thrilled to see so much interest in prevention from all of my wonderful colleagues who put stents in every day!😊 Prevention is the best intervention, but thankful for interventional cardiologists who can intervene when our patients need it ❤️

Most underrated, anti-aging, fountain of youth, “biohack” that bro science won’t tell you:

➡️Sunscreen. All the time. The second you get up. Every day. All year long.

Oh and it prevents skin cancer too.

You’re welcome 🥰 +yes, even if you work inside (just make it part of your routine)
+reapply every 2 hours
+mineral or chemical, it doesn’t matter, just pick one

This weekend at #ACC22 it was such an honor to present on nutrition & share our new paper "Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease: An ASPC Clinical Practice Statement" sciencedirect.com/science/articl… It was an honor to lead a clinical practice statement with world renowned cardiologists @DrMarthaGulati @ErinMichos @rblument1 @kcferdmd @DrOstfeld @RonBlankstein @pnatarajanmd @KoushikReddyMD and world expert nutrition scientists @KevinH_PhD @deirdre_tobias @KCKlatt & Dr Sriram

Another day, another article ignoring guidelines & expert consensus on nutrition and cardiovascular disease. Disappointed to see this article from @washingtonpost post deny the link between saturated fat, cholesterol, diet, heart disease and erectile dysfunction.Thread🧵 This will be a long thread, so I will provide all citations at the end 😊

The wellness space is filled with endless anecdotes, hypothesis & “mechanistic based medicine” driven by pseudoscience gurus who are often physicians, scientists & RDs. After the ep of our podcast w/ @DrJenGunter I’ve received many messages from women abt our debunks⬇️
a thread🧵 During our episode of Wellness: Fact vs. Fiction, @DrJenGunter debunked many common Women’s health myths that are pervasive in the wellness space podcasts.apple.com/us/podcast/wel…

Today is the day🔥Our new podcast Wellness: Fact Vs Fiction has dropped & it was only appropriate to bring on the evidence based QUEEN of debunking Women’s health misinfo - @DrJenGunter

Gwyneth Paltrow will hate it 😜

Avail anywhere you listen to pods

podcasts.apple.com/us/podcast/wel… @DrJenGunter has been called Twitter’s resident gynecologist and the internet’s OB/GYN and knows a thing or two about the misinformation rabbit hole having nearly become victim to medical lies herself after her own child’s diagnosis.

The lower the LDL the better? Yep. Endless data, RCTs, Mendelian randomization, have given us the key to prevent atherosclerosis in our patients.

“Cholesterol: the race to the bottom” by the one and only Eugene Braunwald

academic.oup.com/eurheartj/arti… Some dietary tips to ⬇️ apoB/LDL-c

https://twitter.com/dbelardomd/status/1463579306618064897

SO proud of my friend @RealDoctorMike who dropped his cholesterol over 50 mg/dL in just *5 weeks* by following my favorite 3 high yield tips for eating a more plant predominant diet!

You can check out our discussion, and see his amazing results here! ⬇️

My favorite 3 high yield tips for lowering cholesterol via diet:

1. Drop your saturated fat intake. This can be through decreasing red meat, butter, high fat dairy, high saturated fat/sugary processed foods.
Swap with foods higher in polyunsaturated fat instead

Shared this case a few months ago & given the amount of vaccine misinformation out there - I think it’s worth re sharing.

38 y/o patient presented with fatigue, 7 weeks s/p COVID +. *Before vax was available
(Shared with patient permission)
This patient has no pmhx He experienced a mild case of COVID 7 weeks prior, with some sniffles. Over the following 7 weeks he began to feel more fatigued. He experienced some shortness of breath.

12 lead EKG: P waves marked by red arrows. Sinus rhythm, 3:1 AV conduction, RBBB QRS.

Did an exciting interview w/ some incredible people all about COVID vaccines, health misinformation, & we even discussed my passion for veganism (coming on 12 years soon!)❤️

Yes, you can be vegan & pro vaccine.

And… yes I’m not wearing scrubs for the first time in a minute😜 The unfortunate idea that vegans should be anti vaccine is sadly pervasive in the vegan community. Vaccines work, vaccines save lives. And the best activist for animals is one that’s alive and healthy, and cares about humans too.

I woke up today to like 500 notifications that Dave Asprey had commented all over my Instagram posts to defend his multi million dollar empire of butter in coffee, selling supplements/detoxes, & his pseudoscience about how LDL doesn’t matter.

I have bro science PRESSED 😅 What’s so funny, is that all of these online “health gurus” are constantly trying to denigrate physicians and say we are all bought by pharma (false), and that our guidelines are BS. Meanwhile they make millions selling alternative therapies & partnering with snake oil companies

Another day, another “biohacker” telling people to put butter in their coffee & call it healthy. I love when @bulletproofexec shows up in my comment section on IG. I don’t get $$ from pharma, Asprey. I don’t want patients to put butter in their coffee bc I don’t want them to die. And we don’t tell patients to drink soda either. Please, share with #medtwitter the “thousands of years of medical learning” as you call it, that demonstrates drinking butter is healthy? You’ve only made millions promoting this idea and other pseudoscience. I’ll wait.

Being called a cardiology “guideline shill” at least 10X daily by keto Twitter makes me realize I must be doing something right 😂 PS I do really love our cardiology guidelines ❤️

Working with registered dietitians has been INCREDIBLE for my patients care. Especially my patients who are statin hesitant.

...And not just in the way you would expect.

A thread about our telehealth RD @KCKlatt and how he’s impacted our patients care 🧵 Having an RD affiliated with your practice that you can send patients to is incredibly valuable.
As a cardiologist who cares extraordinarily about prevention, whether it’s seeing patients in primary prevention who have hyperlipidemia, diabetes, hypertension, and trying to reduce

I think empathy and compassion are the two most important reasons I am a good cardiologist. Not publications, not leadership positions, not titles, not where I trained. It’s because I look at every patient as if they were MY family member. Because they *are* important to someone. Patients are scared, they are looking to us for help. They need us to listen. All of the brilliance in the world, doesn’t trump the power of listening to your patients

Meat eaters: would you eat lab grown meat? Keep in mind it’s structurally identical to non-lab meat! Vegans: would you eat lab grown meat?

My dad is having some statin intolerance, and we just had an hour conversation about trying a PCSK9i, so I offered to e-mail his cardiologist to give her the rundown & he said NO! He said he didn’t want me to “bother her” and he’s her favorite patient 😂

LMAO I’m a cardiologist Playing backseat doctor with parents is always interesting 😂