tag:blogger.com,1999:blog-3532191218279144258.post3166503934991357803..comments2024-02-14T00:48:25.649-08:00Comments on Fifth Year since diagnosis of Alzheimers: @DaveKeto Challenge did not ask me to prove LDLc is the cause of atheromaBrian Scott Edwards MDhttp://www.blogger.com/profile/03902606363910220662noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-3532191218279144258.post-75142775847520464412018-05-08T13:45:22.416-07:002018-05-08T13:45:22.416-07:00That is, fasting TG/HDL as an untreated value.
If ...That is, fasting TG/HDL as an untreated value.<br />If it is a drug treated value, then, as with CAC, all bets are off - Goodhart's law applies.Puddleghttps://www.blogger.com/profile/00953398103675945541noreply@blogger.comtag:blogger.com,1999:blog-3532191218279144258.post-20853373843548220102018-05-08T13:42:53.694-07:002018-05-08T13:42:53.694-07:00Hi Brian,
If the CAC score goes up with statin, fo...Hi Brian,<br />If the CAC score goes up with statin, for no extra risk because plaque is stabilised, then the CAC score under statin is no longer the measure it was in an untreated population.<br />Similarly, if LDL goes down under statin, associated with reduction in event rates, because HMGR has been inhibited, LDL is no longer the same measure it was in untreated population, because LDL can associate with two patterns - an HMGR-stimulated pattern (HMGR is activated by insulin and leptin) for which highest TG/HDL is a proxy - we would expect statin to be protective here as it inhibits HMGR - and an HMGR quiescent pattern (HMGR is inhibited by glucagon and cortisol) for which lowest TG/HDL is a proxy. In this pattern, the statin may be superfluous, which is what we see in the 4S analysis.<br />These people still have some events, albeit a much lower rate, but lowering LDL with statin is not preventing them.<br />So we can say - yes, the statin works. And it lowers LDL across the board. But it doesn't work for everyone, and TG/HDL, not LDL, is predicting whether it will work.Puddleghttps://www.blogger.com/profile/00953398103675945541noreply@blogger.com