PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) inhibitors have changed the landscape of cardiology forever.

This is a Tweetorial🧵on why.

And it starts in 1999, with a French family named HC2. At the time Varret and colleagues were evaluating familial hypercholesterolemia (FH) in a French pedigree.

Most known FH at the time exhibited mutations in APOB or LDLR genes. In the HC2 pedigree, neither of these genes were affected. But a third area was…

So you've heard a lot of stuff, you've read a lot, maybe you listened to our podcast @cardionerds on it, and yet something is still missing.

TRIGLYCERIDES NEED A TWEETORIAL!

Let’s get right into it with 2 big points to start #1: Lipids are insoluble in water. You’ve likely seen in this in science class or making salad dressing

What this means is that cholesterol and TG need to be transported with proteins in the body. So we add proteins + lipids and boom, we’ve got lipoproteins (LDL, ILD, VLDL, etc)

🔥QUICK TEACHING/MEMORY TRICK on FeNa! 🔥

Question: How can we remember FeNa and FeUrea calculations?
☑️Keep things on the UP and UP...
☑️...and HIGHER letters go first.

We'll get into that soon. First...what is FeNa and why it is classically used? ☑️FeNa is the fractional excretion (Fe) of Sodium (Na). That how we get Fe-Na. The FeNa is just the amount of Na our kidney lets leave the body

☑️It's value has been of some debate, but in theory it can help differentiate PRE-renal and INTRA-renal kidney injury

Why?