The LDL Cumulative Exposure Hypothesis. The longer your arteries are exposed to high LDL-C, the ⬆️ the risk of atherosclerosis. 📈. 🔬 Early & sustained LDL lowering = lifelong CV benefit. 🔗 #CardioTwitter #MedTwitter #FOAMed #MedED @ACCinTouch

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🕰️ Atherosclerosis isn’t random. It’s driven by:. • Particle Count → ApoB particles 🧪. • Permeability → Endothelial dysfunction (obesity ⚖️, hypertension 💓, diabetes 🩸, genetics 🧬 ). • Passage of Time → Cumulative exposure ⏳. Plaque builds silently for decades. Know

RT @drbennisahmed: Finerenone Reduces New-Onset Atrial Fibrillation Across the Spectrum of Cardio-Kidney-Metabolic Syndrome: The FINE-HEART….

☕️ Coffee O’Clock Could Shape Mortality Risk. EHJ study of >170,000 US adults finds ⏰ timing of coffee matters:. 🕗 Morning-only coffee = ⬇️ all-cause & CVD mortality. ☕️ Afternoon/evening drinkers = ☝️ higher risk. 🔍 Supports chrononutrition in CV prevention. 🔗

RT @drpablocorral: ☝️Effect of Lipid-lowering Therapies on Lp(a) Levels: A Comprehensive Meta-analysis of RCTs. ☝️New evidence just publish….

🔥 Atherosclerosis Starts Young: Time to Treat BP Like LDL. New EHJ editorial: life-course blood pressure matters as much as cholesterol 🧠🫀. 🧒 Even modest BP elevations in youth/adulthood = ↑ plaque later in life. ⚠️ Calls for early, sustained prevention — not just midlife

🧓 LDL-C Still Predicts Risk at 80+: Age ≠ Immunity. 📊 Copenhagen General Study (n=91,131):. 🔺 LDL-C predicts MI & ASCVD across all ages — incl. 80–100 y/o. 💡 NNT to prevent ASCVD over 5 yrs:.• Age 80–100: 42.• Age 50–59: 345. 📉 Lower LDL = lower risk, even in late life

🧠 Statins & Cognition: No Harm, Possible Help?. 📚 ASPREE & 20+ studies show:. ❌ No link between statins & cognitive decline or dementia. 🧓 Statin users had no faster memory loss. 🧠 Some data suggest slower decline or blunted memory loss. 🧪 RCTs ongoing: STAREE & PREVENTABLE

💊 Statins & T2DM: Risk Real, but Worth the Trade-Off?. 📉 JUPITER & meta-analyses confirm:. 🩺 Statins slightly ↑ new-onset T2DM (HR ~1.28) in 👥 at risk of diabetes . ⚖️ But benefits far outweigh risks:. ✅ 39% ↓ in major CV events. 📊 NNT: 134 events prevented / 54 new T2DM

🛣️ HDL’s Road Trip: How Reverse Cholesterol Transport Works. 🫀 RCT starts as HDL extracts cholesterol from arterial foam cells (macrophage & VSMC origins). 🚚 Cholesterol rides HDL → liver via SR-B1 or transfers to VLDL/LDL via CETP. 💩 Ends with fecal excretion (bile or TICE

📊 From kids to carotids: BP history predicts midlife plaque . 📈 BP tracked from childhood → midlife predicts carotid plaque severity at follow-up (n = 2,446). 🧒 Elevated SBP/DBP in any decade (childhood, young adult, midlife) linked to ↑ plaque burden. 💥 Midlife BP

Mechanistic insights on colchicine in human plaques 🔬. 💊 Ex vivo human carotid plaques → multiomic analysis:. ✅ ↓ Neutrophil degranulation.✅ ↓ Platelet activation.✅ ↓ Macrophage proliferation.✅ ↑ ECM stabilization.❌ Minimal effect on NLRP3/IL-1β. Colchicine’s ASCVD

Air pollution: a global driver of atherosclerosis. 🧬 Review of epidemiological & mechanistic evidence:. 🏙️ PM2.5 & traffic exposure → ↑ carotid IMT, coronary calcium & arterial stiffness. ⚙️ Mechanism 👉🏼 Oxidative stress, lipid oxidation, inflammation, endothelial dysfunction

🧬 Genetic testing in severe hypercholesterolemia isn’t just academic 👉🏼 it changes lives ❤️ . In a landmark study of 👥 with LDL-C ≥190 mg/dL, ~1 in 5 had an FH mutation. Carriers had CAD 22 years earlier ‼️.& ~3x risk 👉🏼 despite similar LDL. 💡 Early ID = early action.

🚨 New data: Cardiometabolic drivers of early vascular remodeling in youth. In 522 healthy kids followed from infancy to 19y:. 🩺 BMI & insulin resistance (HOMA-IR) predict aortic IMT.🩺 BMI & systolic BP predict carotid IMT.🩺 Aortic IMT more sensitive than carotid IMT to early

🚨 10-year follow-up of SCOT-HEART confirms 📉↓. 🩺 In stable chest pain:. ✅ CCTA-guided management ↓ non-fatal MI (4.3% vs 6.0%).✅ No difference in mortality.✅ ↑ Preventive therapies in CCTA arm.✅ Revascularization & angiography similar. 👉 Anatomy-driven risk.

🚨 Heart rate lowering (HRL): not always cardio-protective. 🩺 Meta-analysis of 157,764 👥 ↓HR. ✅ Benefit in post-MI & heart failure.❌ ↑Stroke & mortality in hypertension.⚖️ ↑ central BP 👉🏼 potential harm if poorly selected. 🔑 Benefits of HRL = highly context-dependent.

📚 New study of 9,935 👥 with impaired renal function reveals that . ⏫️ remnant cholesterol & low-grade inflammation (hs-CRP) independently & additively ⬆️ the risk of myocardial infarction, ASCVD, mortality, and kidney events. 🔑 Targeting both may reduce residual risk. ❤️

Lp(a) & autoimmune disease = additive ASCVD risk ‼️. 🩺 353K pts (UK Biobank):. ✅ Autoimmune disease ↑ MACE risk (HR 1.30).✅ Elevated Lp(a ≥125 nmol/L) ↑ MACE risk (HR 1.24).✅ Both together: highest risk (HR 1.77).✅ Effect consistent across multiple autoimmune conditions.