Podcasts about pcsk9

The newest AHA and ACC guidelines for treating dyslipidemia are here — and according to Dr. Kim Williams, they mark a powerful shift toward prevention, earlier testing, and whole-food, plant-based nutrition as the foundation of cardiovascular care.Rip welcomes back Dr. Kim Williams, past president of the American College of Cardiology, for a practical and deeply encouraging breakdown of what these updated cholesterol guidelines mean for everyday people.Dr. Williams explains why cardiovascular risk is no longer just about one cholesterol number. Instead, clinicians are being encouraged to look at the whole picture: LDL cholesterol, ApoB, Lp(a), inflammation, blood pressure, blood sugar, kidney function, family history, lifestyle, and coronary artery calcium when appropriate.The most exciting part for the PlantStrong community? Lifestyle optimization is now treated as the clinical foundation — and Dr. Williams is clear about what that means: a whole-food, plant-based diet built around beans, grains, nuts, seeds, fruits, vegetables, and mushrooms, along with exercise, sleep, mindfulness, strong social connections, and avoidance of tobacco, alcohol, and other harmful substances.This conversation also tackles statins, PCSK9 inhibitors, Lp(a), coronary calcium scoring, and the new philosophy of treating risk lower, earlier, and longer — always with food first, and medication when needed.Key TakeawaysThe new cholesterol guidelines emphasize lifestyle first, not lifestyle as an afterthought.Dr. Williams says a whole-food, plant-based diet should be built around beans, grains, nuts, seeds, fruits, vegetables, and mushrooms.LDL cholesterol is still important, but it is no longer the only number that matters.ApoB may give a clearer picture of risk in some people, especially those with diabetes, high triglycerides, or central obesity.Lp(a) is largely genetic and should be measured at least once in adulthood; the 2026 guideline includes updated recommendations for elevated Lp(a).Coronary artery calcium scoring can help personalize risk and guide LDL targets.Dr. Williams emphasizes that the goal is not “plants versus statins.” It is whole plant foods first, medications when needed.The overall prevention philosophy is: lower, earlier, longer.Watch the Episode on YouTube: https://youtu.be/6cD8tGpsAggLearn More About our 2026 Live PLANTSTRONG Events: https://plantstrongevents.com/ Let Us Help Your PLANTSTRONG JourneyLearn More About Our Corporate Wellness Program: https://liveplantstrong.com/corporate-wellness/ COMPLEMENT: Use code PLANTSTRONG for 30% off at https://lovecomplement.com/pages/plantstrong-special-offer Follow PLANTSTRONG and Rip Esselstynhttps://plantstrong.com/ https://www.facebook.com/GoPlantstrong https://www.instagram.com/goplantstrong/https://www.instagram.com/ripesselstyn/ Follow the PLANTSTRONG Podcast and Give the Show a 5-star RatingApple PodcastsSpotify

He carried two copies of ApoE4, the highest genetic risk factor for Alzheimer's disease, went through medical school knowing exactly what his LDL of 700 meant, decided the experts were wrong, and then published the case report to prove it. In this episode, Louisa sits down with Dr. Nick Norwitz, PhD researcher and metabolic scientist, for one of the most scientifically dense conversations on brain health, cholesterol biology, and Alzheimer's prevention ever recorded on this show. They cover why the phospholipid form of DHA reaches the brain more effectively than standard fish oil, how ApoE4 carriers burn through omega-3s differently and what to do about it, the lithium orotate data that sold out supplement shelves worldwide, and why GSK-3 beta, the enzyme that phosphorylates tau, may be the most under appreciated target in Alzheimer's research today. Then Dr. Nick Norwitz lays out the case that challenges the "LDL is always the enemy" consensus: why metabolically healthy individuals may not benefit from aggressive lipid-lowering therapy, what his viral coronary CT angiogram showed after seven years of 700+ cholesterol, why the EZPAVE trial headlines don't hold up under scrutiny, and what GLP-1s are doing inside the brain completely independent of weight loss. You'll also hear about the sardine diet experiment, the omega-3 thermogenesis connection, ketones as misfolded protein clearance agents, creatine for depression, retatrutide and PCSK9, BPC-157 risks, and what Dr. Nick Norwitz believes is coming in Alzheimer's gene therapy within the next decade. *Reduce your risk of Alzheimer's with my science-backed protocol for women 30+:*https://go.neuroathletics.com.au/youtube-sales-page Subscribe to The Neuro Experience for evidence-based conversations at the intersection of brain science, longevity, and performance. _____ *TOPICS DISCUSSED*(00:00:00) Intro: The ApoE4 Paradox and the Case Report That Broke the Internet (00:00:57) Why Standard Omega-3 Supplements Fail and What to Take Instead (00:05:13) DHA and the Phospholipid Carrier: How It Crosses the Blood-Brain Barrier (00:10:19) ApoE4 Explained: Risk, Genetics, and Why Nick Is Optimistic (00:17:38) Why ApoE4 Carriers Burn Through DHA Faster and Need More (00:20:31) Women, Omega-3s, Menopause, and Brain Insulin Resistance (00:21:41) Statins, Sex Differences, and the DHA-Blood Sugar Connection (00:26:01) Statins and Dementia: What the Data Actually Say (00:32:24) Tau, GSK-3 Beta, Lithium Orotate, and Targeting Alzheimer's Pathology (00:42:19) The Glymphatic System, 40Hz Devices, and Sleep as Brain Clearance (00:45:21) Gene Editing, Prime Editing, and the Future of ApoE4 Therapy (00:49:33) Nick's Case Report: 700 LDL, Zero Plaque, and Seven Years of Data (00:55:10) The EZPAVE Trial: Why the Headlines Don't Hold Up (01:00:33) KetoneIQ: Ketones for Brain Energy and Focus (01:01:29) Cheers Health: Supporting Liver Function and Cognitive Recovery (01:03:54) If Not LDL, What Causes Heart Disease in Metabolically Healthy People? (01:12:05) The Oreo Experiment and the Sardine Diet: Self-Experiments in Metabolism (01:19:10) Ketones, Women's Brains, and Clearing Misfolded Proteins (01:21:08) The Full Brain Health Protocol: Omega-3s, Creatine, NAD, Lithium, and More (01:24:01) GLP-1s for the Brain: Independent of Weight, Targeting Amyloid and Tau (01:25:28) Peptides: BPC-157 Risks, Retatrutide, MOTS-c, and What's Worth Watching (01:29:02) Why Nick Is Controversial And Why He Doesn't Mind _______ *Thank you to our sponsors*Fenix Health Science: fenixhealthscience.com Use code NEUROEXPPulsetto: https://pulsetto.tech/pages/NEURO or use Code NEURO for some off your orderFunction Health: https://www.functionhealth.com/louisanicolaBASED Bodyworks: https://basedbodyworks.com/ and use code NEURO for 20% offKetoneIQ: https://ketone.com/NEURO for 30% OFFCheers Health: https://CheersHealth.com/NEURO or use code NEURO for 20% off _______ I'm Louisa Nicola - clinical neurophysiologist - Alzheimer's prevention specialist - founder of Neuro Athletics. My mission is to translate cutting-edge neuroscience into actionable strategies for cognitive longevity, peak performance, and brain disease prevention.If you're committed to optimizing your brain- reducing Alzheimer's risk - and staying mentally sharp for life, you're in the right place. Stay sharp. Stay informed. Join thousands who subscribe to the Neuro Athletics Newsletter → https://bit.ly/3ewI5P0Instagram: https://www.instagram.com/louisanicola_/Twitter : https://twitter.com/louisanicola_ Learn more about your ad choices. Visit megaphone.fm/adchoices

He carried two copies of ApoE4, the highest genetic risk factor for Alzheimer's disease, went through medical school knowing exactly what his LDL of 700 meant, decided the experts were wrong, and then published the case report to prove it. In this episode, Louisa sits down with Dr. Nick Norwitz, PhD researcher and metabolic scientist, for one of the most scientifically dense conversations on brain health, cholesterol biology, and Alzheimer's prevention ever recorded on this show. They cover why the phospholipid form of DHA reaches the brain more effectively than standard fish oil, how ApoE4 carriers burn through omega-3s differently and what to do about it, the lithium orotate data that sold out supplement shelves worldwide, and why GSK-3 beta, the enzyme that phosphorylates tau, may be the most under appreciated target in Alzheimer's research today. Then Nick lays out the case that challenges the "LDL is always the enemy" consensus: why metabolically healthy individuals may not benefit from aggressive lipid-lowering therapy, what his viral coronary CT angiogram showed after seven years of 700+ cholesterol, why the EZPAVE trial headlines don't hold up under scrutiny, and what GLP-1s are doing inside the brain completely independent of weight loss. You'll also hear about the sardine diet experiment, the omega-3 thermogenesis connection, ketones as misfolded protein clearance agents, creatine for depression, retatrutide and PCSK9, BPC-157 risks, and what Nick believes is coming in Alzheimer's gene therapy within the next decade. Reduce your risk of Alzheimer's with my science-backed protocol for women 30+:https://go.neuroathletics.com.au/youtube-sales-page Subscribe to The Neuro Experience for evidence-based conversations at the intersection of brain science, longevity, and performance. _____ TOPICS DISCUSSED 00:00 Intro: The ApoE4 Paradox and the Case Report That Broke the Internet 00:57 Why Standard Omega-3 Supplements Fail and What to Take Instead 05:13 DHA and the Phospholipid Carrier: How It Crosses the Blood-Brain Barrier 10:19 ApoE4 Explained: Risk, Genetics, and Why Nick Is Optimistic 17:38 Why ApoE4 Carriers Burn Through DHA Faster and Need More 20:31 Women, Omega-3s, Menopause, and Brain Insulin Resistance 21:41 Statins, Sex Differences, and the DHA-Blood Sugar Connection 26:01 Statins and Dementia: What the Data Actually Say 32:24 Tau, GSK-3 Beta, Lithium Orotate, and Targeting Alzheimer's Pathology 42:19 The Glymphatic System, 40Hz Devices, and Sleep as Brain Clearance 45:21 Gene Editing, Prime Editing, and the Future of ApoE4 Therapy 49:33 Nick's Case Report: 700 LDL, Zero Plaque, and Seven Years of Data 55:10 The EZPAVE Trial: Why the Headlines Don't Hold Up 01:00:33 KetoneIQ: Ketones for Brain Energy and Focus 01:01:29 Cheers Health: Supporting Liver Function and Cognitive Recovery 01:03:54 If Not LDL, What Causes Heart Disease in Metabolically Healthy People? 01:12:05 The Oreo Experiment and the Sardine Diet: Self-Experiments in Metabolism 01:19:10 Ketones, Women's Brains, and Clearing Misfolded Proteins 01:21:08 The Full Brain Health Protocol: Omega-3s, Creatine, NAD, Lithium, and More 01:24:01 GLP-1s for the Brain: Independent of Weight, Targeting Amyloid and Tau 01:25:28 Peptides: BPC-157 Risks, Retatrutide, MOTS-c, and What's Worth Watching 01:29:02 Why Nick Is Controversial And Why He Doesn't Mind _______ Thank you to our sponsors Fenix Health Science: fenixhealthscience.com Use code NEUROEXP Pulsetto: https://pulsetto.tech/pages/NEURO or use Code NEURO for some off your order Function Health: https://www.functionhealth.com/louisanicola BASED Bodyworks: https://basedbodyworks.com/ and use code NEURO for 20% off KetoneIQ: https://ketone.com/NEURO for 30% OFF Cheers Health: https://CheersHealth.com/NEURO or use code NEURO for 20% off _______ I'm Louisa Nicola - clinical neurophysiologist - Alzheimer's prevention specialist - founder of Neuro Athletics. My mission is to translate cutting-edge neuroscience into actionable strategies for cognitive longevity, peak performance, and brain disease prevention. If you're committed to optimizing your brain- reducing Alzheimer's risk - and staying mentally sharp for life, you're in the right place. Stay sharp. Stay informed. Join thousands who subscribe to the Neuro Athletics Newsletter → https://bit.ly/3ewI5P0 Instagram: https://www.instagram.com/louisanicola_/ Twitter : https://twitter.com/louisanicola_ Learn more about your ad choices. Visit megaphone.fm/adchoices

Matthew "Oki" O'Connor is the CEO of Scientific Affairs at Cyclarity Therapeutics, a clinical-stage biotech building a new class of medicines designed not to slow the accumulation of vascular damage but to reverse it. Oki and Chris first crossed paths as postdocs at Lawrence Berkeley National Lab in the mid-2000s — Oki was in Irina Conboy's lab, not far from the late Judy Campisi's group, where Chris was then working on cellular senescence. After Berkeley, Oki spent nearly a decade running the research program at the SENS Research Foundation, the organization most identified with the "damage repair" framing of aging biology, before co-founding Cyclarity (then known as Underdog Pharmaceuticals) in 2019 to translate one of SENS's most drug-tractable ideas into an actual molecule.When Oki was last on the show in March of 2023 (Episode 36), Cyclarity was deep in IND-enabling work and its lead asset, UDP-003, had only ever seen the inside of a mouse artery. At the end of that conversation, Chris asked what Oki hoped to be discussing the next time he visited. He answered, bluntly, that he wanted to be presenting human data. Last month, at the AHA Vascular Discovery Sessions, Cyclarity reported the results of their first-in-human Phase 1 trial of UDP-003 — a designed cyclodextrin that selectively binds 7-ketocholesterol, the oxidized cholesterol species that drives foam cell formation and arterial plaque. He's back to discuss what the drug actually did when it went hunting for 7KC inside a living human being.In this episode, Chris and Oki cover the unmet need that lipid-lowering drugs — statins, PCSK9 inhibitors, the coming Lp(a) agents — still don't address: none of them remove the damage already sitting in an artery wall. Oki explains the basic chemistry of 7-ketocholesterol and why macrophages, lacking the machinery to recycle it, collapse into foam cells and seed the necrotic core of advanced plaque. They walk through the engineering of UDP-003 as a dimeric beta-cyclodextrin "double cone" tuned for a single oxidized cholesterol species, the design of the 72-volunteer Australian Phase 1, and the exploratory pharmacodynamic readout that has the field's attention: dose-dependent urinary excretion of 7KC, stoichiometric with drug, cleared within a day. The conversation then turns to the 150-patient Phase 2 plan in coronary artery disease patients with plaque imaging as the primary biological readout, the funding math that stands between Cyclarity and that trial, the platform's reach into NASH, vascular dementia, AMD, and aging itself, and how all of this descends from the SENS damage-repair philosophy that Oki has been carrying since LBL.The Finer Details:- Why current standard of care is not enough — statins, PCSK9 inhibitors, GLP-1s, and the soon-to-arrive Lp(a) lowering agents all act by slowing the accumulation of arterial damage, not by reversing what's already there; despite 30 years on the market, statins have never demonstrated an all-cause mortality benefit in a clinical trial, and even the best statin imaging data shows only 1–2% plaque volume regression at very high doses in a subset of patients- The scale of the problem — atherosclerosis is estimated to contribute to roughly 40% of all human deaths once heart attack, stroke, and a surprisingly large COPD contribution are risk-adjusted in, on top of an enormous morbidity tail that includes angina, peripheral artery disease (up to and including amputation), and a growing case for vascular dementia as an undercounted driver of cognitive decline- The biology of 7-ketocholesterol — when an oxygen free radical reacts with cholesterol, it preferentially attacks the 7 position, and a second oxidation step locks the molecule into 7KC, a stable toxic species cells were essentially never equipped to recycle; it builds up in long-lived cells like macrophages, eventually shutting down their ability to traffic lipids back to the liver via HDL and converting them into foam cells that seed soft plaque and, over years, the necrotic core of advanced lesions- The molecular design of UDP-003 — cyclodextrins are naturally occurring carbohydrate rings; the beta size fits half a cholesterol molecule, and Cyclarity's in silico work showed that two beta-cyclodextrins facing wide-side to wide-side form a "double cone" that can fully encapsulate a single cholesterol; engineered correctly, that wrapper can be made selective for 7KC over native membrane cholesterol, which is what gives the drug its therapeutic window- The Phase 1 trial design and result — a traditional 72-volunteer safety study in Australia, split between single ascending dose and multiple ascending dose arms, escalating up to six doses at what Cyclarity believes will be the efficacious level; no serious adverse events, no bioaccumulation, drug excreted essentially completely in the urine (as predicted preclinically), and — the headline exploratory endpoint — dose-dependent urinary 7-ketocholesterol appearing on the same timescale as the drug, consistent with one molecule of UDP-003 binding one molecule of 7KC and leaving the body together- What the urinary 7KC readout can and cannot tell you — the easiest 7KC to mobilize is the free pool in circulation, but there is not nearly enough of it floating in the bloodstream to account for what came out in urine, which means the drug is reaching deeper compartments; how much is coming from vessel wall plaque versus liver versus other peripheral tissues will require the imaging endpoints of Phase 2 to answer- The Phase 2 plan — 150 coronary artery disease patients (the coronary being, as Oki puts it, the artery most likely to kill you), with baseline plaque imaging, a year of dosing, and a repeat scan; safety and PK continue, inflammatory biomarkers come on, and plaque volume change is the prize — for context, a 1% change in plaque volume is associated with roughly a 20% change in next-year risk of heart attack or stroke- The funding math and the platform — Cyclarity has raised $33M to date and needs roughly $45M more to run the Phase 2, with Phase 3 cardiovascular outcomes trials running into the hundreds of millions and likely requiring a pharma partner; beyond atherosclerosis, 7KC is elevated in NASH livers, in Alzheimer's brains, and in the retinal cells that die in age-related macular degeneration, and the underlying chemistry — designed binders that drag a specific toxic molecule out of the body — is meant to generalize into a pipeline against other accumulated damage species, the direct intellectual descendant of the SENS damage-repair programQuotes:"Atherosclerosis, or the plaque that builds up in your blood vessels in your arteries, is estimated to cause approximately 40% of all human death.""When [the macrophage] eats up too much oxidized cholesterol, it just accumulates it… And that's when you get this transition to these kind of monster blob cells called foam cells.""One molecule of our drug is supposed to bind one molecule of 7-ketocholesterol and then go away and never be seen again. You excrete both of them together.""A 1% change in plaque volume is associated with a 20% risk in the next year of your probability of having a heart attack or a stroke.""You pick one target at a time, you do it well, and you take it all the way to the clinic and hopefully prove that you can actually cure patients, help them get better, help their plaque shrink away, and prove that this approach can work."Links:Cyclarity Therapeutics: https://cyclarity.com

This week we talk about LDL, HDL, and cardiovascular issues.We also discuss one-time therapies, statins, and pharmaceutical economics.Recommended Book: Blood by Dr. Jen GunterTranscriptCholesterol is the most common type of what's called a sterol, which is a type of steroid, but also structurally technically an alcohol. But functionally, and classified by scientists, cholesterol is a lipid, which in this case is similar to a fat in all but how the body uses it. Cholesterol is the type of sterol most commonly found in animals—other types are found in plants and fungi—and its function, and this is where it varies from fats, which are used to store energy, is to basically help hold the cell membrane together, and it also serves as an intracellular messenger.Cholesterol is especially prevalent in the brain and spinal cord of animals, but it's found throughout their bodily tissues, as well, and again, it's vital for holding everything together and helping things communicate, in addition to being a precursor for vitamin D, steroid hormones, and bile.You want to have cholesterol, then, as without it you would be dead.Too much cholesterol in the blood, however, can also make you dead, especially when it's bound to what's called low-density lipoprotein, or LDL, as that contributes to cardiovascular disease like heart attacks and aneurysms, which can massively impact one's overall wellness and quality of life, and at extremes lead to the whole system shutting down as a consequence of heart attack, stroke, and the like.A lot of things can contribute to the development of cardiovascular disease, including habits like smoking, genetic predisposition, and the enthusiastic consumption of alcohol and unhealthy foods. But high blood cholesterol, of the LDL variety, is one of the top contributors, as these low-density clusters of lipoprotein can clog the pathways that blood takes throughout our bodies. Other, denser types of lipoproteins, HDLs, can clear it, like a heavier, denser substance pushing through clogs of less-dense materials that are gumming up a pipe, but LDL is at times accumulated as a result of consuming delicious but unhealthy foods, which are hard to avoid, and for some people the only consistently available and affordable foods; and for other people LDL accumulates as a result of their genetic predispositions—two things that are devilishly difficult to change.What I'd like to talk about today is a new type of therapy that may be very good news for people who struggle with the accumulation of LDL, and why this is being seen as very good news more broadly, at the scale of entire nations, as well.—Pharmaceutical company Eli Lilly is testing a new, experimental drug called VERVE-102 which is a one-time infusion that is currently administered over the course of about four hours, and once completed, it turns off a gene called PCSK9, which is responsible for making a protein that regulates cholesterol levels in humans.As I said, this drug is still being tested, so these are early results. But in a study of 35 people with high cholesterol levels, high levels of LDL or LDL-C, which is short for lipoprotein cholesterol, they found that this infusion, which again, is a one-time treatment, so get it once and then theoretically at least you never have to get anything done ever again, it reduced those LDL and LDL-C levels by as much as 62%, and that reduction was maintained a year and a half after the infusion; that's how far out they're retested so far, and the hope is that each retest will continue to show the same.On the strength of those very promising results, a Phase 2 study has been planned by the end of 2026, and the US Food and Drug Administration, the FDA, previously fast-tracked this existing study, because of the promise and potential this drug already demonstrated in early studies; all of which is considered to be very significant progress and possibility.To understand that significance, though, it's useful to know some health stats. And I'm going to focus on the US here, as that's where this drug is being developed, but many wealthy countries have similar stats, at least in terms of cardiovascular disease struggles.As of 2024, which is the last year we had good, cohesive data on this in the US, it was estimated that about 11-12% of the US adult population has high cholesterol levels. This typically doesn't come with any symptoms, but it can contribute a higher risk for all those cardiovascular diseases, including heart attack and stroke. A further 86 million US adults have borderline or elevated cholesterol levels, which can easily tip higher, but also, even in that existing, elevated state, contribute to negative cardiovascular outcomes.There are treatments for high cholesterol, the most common of category of which are called statins, which reduce the production of LDL by inhibiting an enzyme that produces cholesterol in the body.Unfortunately, these drugs do come with some usually minor side effects, which can cause patients to stop using them, and they have to be taken daily, ideally at the same time each day. That necessity for consistency leads to a lot of incorrect or incomplete usage, which reduces the effectiveness of these drugs. But it's also estimated that only about 54.5% of US adults who would benefit from statins are currently taking one—so that's people who could benefit and who have it prescribed, and then within that number are all the people who are taking this drug incorrectly or incompletely, reducing the effectiveness. So a relatively small number of people who should probably be on these things are getting the full benefit they offer because of the nature of the drug.And that's not great, because in the US alone, heart disease is the leading cause of death for pretty much every adult demographic; men, women, people of most racial and ethnic and economic groups, you name it, heart disease is the biggest threat to their lives.One US citizen dies every 34 seconds of some kind of cardiovascular condition, and as of 2023, 1 in every 3 deaths in the US was caused by the same, adding up to just over 919,000 people that year.Between 2021 and 2022, alone, the cost of services and medications related to heart disease added up to more than $168 billion; again, that's just in that period, and just in the US.And once more, these are ailments that are caused or heavily influenced by high levels of cholesterol, which are themselves amplified by common lifestyle choices, environmental factors that are hard for many people to avoid, and just by raw, dumb luck because of genetics.This treatment category, then, is being seen as a pretty big deal because a one-time infusion means those who receive it don't have to remember to take a pill every day at the same time, and won't experience those statin-based side-effects.It also means that people who are currently costing the medical system a bunch of money each year, because they need treatments for all the issues they suffer as a result of high cholesterol, will suddenly cost the system a lot less money, for treatments and medications. Not for nothing, their health and quality of life will likely improve as well. So in addition to having better, healthier outcomes personally, their cost to healthcare systems will drop.Eli Lilly's drug isn't the only one currently working its way through clinical trials, either.Amgen is working on a similar treatment, and Novartis and Ionis Pharmaceuticals have drugs that are even further along in the process, their medicines that cut heart attacks, strokes, and cardiovascular deaths could be approved by the FDA as soon as next year.There are a lot of caveats worth noting here, including that the science is still out as to whether this approach, silencing proteins that lead to the creation of more LDL and a similar substance called Lp(a)—which is more dangerous because it's stickier and thus more likely to get stuck in important blood pathways, and it's also more likely to be caused by genetics than lifestyle—the word is still out on whether reducing these things in the body actually reduces hearth attacks and stroke.Some people have had this particular risk variable dramatically reduced, but have still suffered from cardiovascular events, which raises the question of whether this path is the right one to take in trying to reduce this category of health issues; the correlation between LDL and heart attacks and strokes might not be a clear-cut as long assumed.There's also the issue of price. Drug-makers are economically incentivized to sell treatments over cures, because that means they can continue selling their product over time, potentially for the life of the patient, and a cure, in contrast, is a one-time hit that in theory should alleviate the need for future treatment.There's a chance, then, that the drug-makers will decide they need to make these one-hit treatments really, really expensive in order to make their R&D dollars back and to make the kinds of profits their investors expect from them. That could then reduce the potential audience for these treatments, even if they are effective, and could further slow their deployment and future research in this space.If these trials continue to go well, though, there's a good chance that this combination of similar but distinct treatment types will provide a more sustainable alternative to current options, and that, like the recent bogglingly rapid and widespread deployment of GLP-1 treatments for all sorts of issues, could lead to a new paradigm in this facet of the medical world.Show Noteshttps://en.wikipedia.org/wiki/Cholesterolhttps://en.wikipedia.org/wiki/Cardiovascular_diseasehttps://en.wikipedia.org/wiki/High_cholesterolhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10982736/https://www.cdc.gov/heart-disease/data-research/facts-stats/index.htmlhttps://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1https://www.ama-assn.org/public-health/chronic-diseases/what-doctors-want-patients-know-about-high-cholesterolhttps://en.wikipedia.org/wiki/Statinhttps://pubmed.ncbi.nlm.nih.gov/42187087/https://abcnews.com/GMA/Wellness/new-drug-game-changer-people-high-cholesterol/story This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit letsknowthings.substack.com/subscribe

Heart Disease Prevention: The Complete Cardiologist's Guide to Statins & Early Detection 700,000 Americans die from heart disease every year but most of these deaths are PREVENTABLE. In this groundbreaking episode, Dr. McConnell from Stanford reveals how to treat your heart like cancer: with early detection, proper treatment, and personalized prevention strategies that actually save lives.

In this episode, we review key updates from the 2026 ACC-AHA Guidelines on the Management of Dyslipidemia. Key Concepts The PREVENT ASCVD equation is now recommended to calculate ASCVD risk, with thresholds at 3%, 5%, and 10%. The previous 7.5% threshold for statin treatment is now 5%. In addition to the 10-year ASCVD estimate, clinicians should consider the use of Lp(a), "risk enhancers", and coronary artery calcium (CAC) scans as a "tie breaker" with shared decision-making when the decision to treat is not clear. In addition to LDL goals of < 100, < 70, or < 55 (depending on risk), the new guidelines also suggest non-HDL-C and apoB goals once LDL cholesterol is at goal. Many patients will require non-statin therapies to achieve lipid goals. The recommended non-statin therapies include ezetimibe, PCSK9 mAb, PCSK9-interfering RNA, and bempedoic acid. References Writing Committee Members, Blumenthal RS, Morris PB, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(17):e1154-e1276. doi:10.1161/CIR.0000000000001423 Wiggins BS, Barac A, Benziger CP, et al. 2026 Dyslipidemia Guideline-at-a-Glance. J Am Coll Cardiol. 2026;87(19):2617-2623. doi:10.1016/j.jacc.2026.02.4872 Superko H, Garrett B. Small Dense LDL: Scientific Background, Clinical Relevance, and Recent Evidence Still a Risk Even with 'Normal' LDL-C Levels. Biomedicines. 2022;10(4):829. Published 2022 Apr 1. doi:10.3390/biomedicines10040829

Dr. Joel Kahn dives into a groundbreaking Phase 1 trial of Verve 102, a one-time intravenous gene-editing treatment that silences the PCSK9 gene to produce lasting LDL cholesterol reduction. Among 35 participants, the high-dose group saw LDL drop by 62% with mostly mild side effects — promising results, though Phase 2 and 3 trials and 15 years of follow-up still lie ahead. Also covered: updated colorectal cancer screening guidelines now starting at age 45, healthy lifestyle habits cutting mortality risk in cancer survivors by one-third, real-world weight regain data after stopping GLP-1 medications, why your B12 "normal" range may be too low, a blood test that may predict Alzheimer's years in advance, and a longevity preparedness tool from MIT AgeLab. Sponsored by Igennus — visit igennus.com/drkahn for 20% off.

The conversation delves into the rediscovery of ApoB as a significant cardiovascular marker and its suspiciously aligned timing with pharmaceutical profit motives. It explores the comparison between ApoB and LDLC, the rise of statins, the emergence of PCSK9 inhibitors, the controversy around ApoB, the context of metabolic dysfunction, and the pharmaceutical vs. metabolic approach to ApoB. It concludes with the distinction between treating a number and treating a disease.TakeawaysApoB has become a significant cardiovascular markerThe timing of ApoB's rediscovery is suspiciously aligned with pharmaceutical profit motivesChapters00:00 Treating a Number vs. Treating a Disease

The NACE Journal Club with Dr. Neil Skolnik, provides review and analysis of recently published journal articles important to the practice of primary care medicine. In this episode Dr. Skolnik and guests review the following publications:1. Orforglipron for maintenance of body weight reduction  - Nature Medicine2026. Discussion by:Guest:Joe Gonella, MD Resident - Abington Family Medicine Residency Program Jefferson Health2. Tirzepatide for maintenance of bodyweight reduction in people with obesity in the USA (SURMOUNT-MAINTAIN) Lancet 2026.  Discussion by: Guest:Neil Skolnik, MDProfessor of Family and Community MedicineSidney  Kimmel  Medical College Thomas Jefferson UniversityAssociate Director - Family Medicine Residency ProgramJefferson Health – Abington3. Survival and Recurrence with GLP-1 Receptor Agonists in Breast Cancer" – JAMA Network Open Discussion by:Guest:Neil Skolnik, MDProfessor of Family and Community MedicineSidney  Kimmel  Medical College Thomas Jefferson UniversityAssociate Director - Family Medicine Residency ProgramJefferson Health – Abington4. In Vivo Base Editing of PCSK9 with VERVE-102 for Hypercholesterolemia.   NEJM 2026 Discussion by:Guest:Alex Sauer, MD Resident - Abington Family Medicine Residency ProgramJefferson HealthMedical Director and Host, Neil Skolnik, MD, is an academic family physician who sees patients and teaches residents and medical students as professor of Family and Community Medicine at the Sidney Kimmel Medical College, Thomas Jefferson University and Associate Director, Family Medicine Residency Program at Abington Jefferson Health in Pennsylvania. Dr. Skolnik graduated from Emory University School of Medicine in Atlanta, Georgia, and did his residency training at Thomas Jefferson University Hospital in Philadelphia, PA. This Podcast Episode does not offer CME/CE Credit. Please visit  http://naceonline.com to engage in more live and on demand CME/CE content.

The Tim Conway Jr. Show Hour 1 (5.29) Friday is here, and Conway is ready to take the edge off! The crew kicks things off with weekend buzz talk, student love for Fridays, and the universal mission of getting through the week and into relaxation mode. But nothing kills a good buzz faster than the wrong snack — especially when Trader Joe’s candy starts giving people the runs. That’s right, the crew gets into the ultimate Friday night disaster: trying to feel loose and happy, only to have candy turn your weekend into a bathroom sprint. The show also dives into the wild fact that 60 Minutes has been on the air for 57 years, Conway hosting the massive OC Business Awards, and a possible medical breakthrough involving a new gene-editing cholesterol drug that could change how high cholesterol is treated. Then things get weird with the internet’s latest obsession: “hot rodent men.” From Timothée Chalamet-style features to Hollywood’s strangest beauty trend, the crew breaks down why rat-like is somehow now attractive. Conway also admits he likes gambling on new medicine, comparing it to carnival rides, Vegas casinos, Whiskey Pete’s, and his love for Primm Casino. Plus, he pitches a genius idea for reviving Primm with “The Oasis.” Later, the show turns serious with a Riverside apartment complex fire that displaced around 150 people, including UC Riverside students forced out during finals. And somehow, it all circles back to viral fire interviews, Michelle Dobney’s unforgettable “Not today!” moment, Elvis Presley’s legendary bathroom demise, and a Friday night reminder: protect your buzz, choose your candy wisely. Trader Joe’s candy, Friday vibes, weekend buzz, buzzkill, funny podcast, hot rodent men, Timothée Chalamet, gene editing, cholesterol drug, PCSK9, Eli Lilly, Primm Casino, Vegas stories, Riverside fire, UC Riverside, viral moments, Conway Show See omnystudio.com/listener for privacy information.

Good morning from Pharma Daily: the podcast that brings you the most important developments in the pharmaceutical and biotech world. The landscape of these industries continues to evolve with significant scientific advancements, regulatory breakthroughs, and strategic maneuvers that are reshaping drug development and patient care. One of the noteworthy developments is the U.S. FDA's recent approval of Gilead Sciences' Hepcludex (bulevirtide) for hepatitis D. This approval marks a comeback for Gilead after previous setbacks due to manufacturing and delivery issues, highlighting the critical importance of addressing regulatory feedback. It's a testament to persistence in overcoming manufacturing challenges to ensure vital therapies reach those in need. This approval signifies a milestone as it's the first FDA-approved therapy targeting chronic hepatitis D virus infection—a niche condition with limited treatment options. Similarly, Pfizer's Braftovi (encorafenib) is expanding its global reach beyond U.S. borders with regulatory approvals in the EU and Canada for colorectal cancer treatment. This broadening geographic footprint reflects a broader industry trend where companies aim to maximize the therapeutic impact of oncology drugs across diverse patient populations. Meanwhile, Astellas Pharma is navigating the looming patent cliff for its prostate cancer drug Xtandi by actively pursuing new licensing deals and implementing cost-cutting measures. This dual approach underscores a widespread industry strategy where companies balance acquisitions with operational efficiency to sustain growth. In the radiopharmaceutical sector, there's notable activity with Lantheus Holdings possibly being acquired by Curium for $7 billion. This potential deal underscores growing interest in radiopharmaceuticals due to their precision in targeting specific cancer types. Complementing this is Niowave's $75 million investment in a radiopharmaceutical isotope plant in Michigan, set to produce actinium-225 by 2028—an isotope crucial for targeted cancer therapies. Regulatory landscapes are also in flux with continued reforms at the FDA despite leadership changes. Initiatives like the Commissioner's National Priority Voucher program illustrate regulatory bodies' commitment to streamlining drug approvals and fostering innovation. On an international note, SK Bioscience is partnering with Colombia to locally produce the chickenpox vaccine Skyvaricella, enhancing vaccine accessibility through technology transfer. Similarly, Eli Lilly's acquisition spree in infectious disease research signals a robust push toward expanding its R&D pipeline for viral and bacterial pathogens. Eli Lilly has announced plans to acquire Curevo, Limmatech Biologics, and another vaccine company for up to $3.8 billion. This strategic acquisition underscores a commitment to enhancing capabilities in infectious diseases—a field that has gained focus post-COVID-19 pandemic. By integrating these companies, Eli Lilly aims to leverage their platforms and expertise for advanced therapeutic solutions against infectious diseases. In gene editing, Eli Lilly is preparing for a Phase 2 trial of a lipid-lowering gene editor from Verve Therapeutics, showing promising cholesterol reductions akin to PCSK9 inhibitors. This highlights gene editing's potential in addressing cardiovascular diseases. A significant development from Lilly's pipeline includes promising results from their base editor technology acquired through Verve Therapeutics—an exciting breakthrough suggesting substantial potential for gene-editing technologies addressing genetic disorders like high cholesterol. In oncology, AstraZeneca and Daiichi Sankyo's Datroway gained FDA approval for triple-negative breast cancer as a first-line treatment. This antibody-drug conjugate targets Trop2, demonstrating the potential of targeted therapy in difficult-to-treat cancers. Kura Oncology's combination therapy featuring darlifarnib and Krazati showed up to a 69% response rate in KRAS G12C-mutated solid tumors during Phase 1 trials, emphasizing precision medicine's potential in targeting specific genetic mutations driving cancer progression. In obesity management, Eli Lilly's retatrutide achieved Phase 3 success with bariatric surgery-like outcomes. The drug acts as a triple hormone receptor agonist, showcasing advancements in metabolic therapies targeting obesity—a condition linked with numerous comorbidities. Moderna's mFlusiva is poised for an FDA advisory committee review as an influenza preventative for older adults—an extension of Moderna's mRNA technology initially used against COVID-19. Collectively, these developments highlight an industry leveraging cutting-edge science and technology to tackle complex medical challenges. As pharmaceutical giants like Eli Lilly consolidate their positions through acquisitions and research collaborations, transformative advancements promise to reshape patient care across various therapeutic areas. These initiatives not only reflect the industry's dynamic nature but also its pivotal role in addressing unmet medical needs worldwide. Eli Lilly's recent strategic acquisitions underscore its commitment to advancing pharmaceutical innovations, particularly in vaccines and cholesterol management sectors. Acquiring three vaccine-focused biotech firms signifies substantial investment in expanding its vaccine portfolio—a move aligned with global immunization strategies. This follows hiring Peter Marks from the FDA, indicating a strategic focus on bolstering expertise within the vaccine domain. The company has been recognized by IDEA Pharma as a leader in pharmaceutical innovation—a testament to its robust pipeline and successful integration of scientific advancements into marketable therapies. Across oncology landscapes highlighted at ASCO conferences are exciting potentials like Summit Therapeutics and Akeso's potential Keytruda rivals that could reshape cancer treatment paradigms if proven effective. As pharmaceutical landscapes continue evolving rapidly through scientific strides tempered by regulatory hurdles—the current environment promises significant advancements offering new hope while demanding strategic agility within healthcare sectors globally.Support the show

Text Dr. Lenz any feedback or questions The 2026 Cholesterol Revolution: PREVENT Scores, Hidden Risk Markers, and CAC ScansThe script explains how 2026 ACC/AHA guideline changes aim to make heart attacks more preventable by shifting from short-term “10-year risk” thinking to “lower for longer,” precision prevention, and primordial prevention starting earlier in life. It critiques the older Pooled Cohort Equations for underestimating risk in younger people and introduces the PREVENT equation, which adds 30-year risk plus kidney, metabolic, and social factors. It highlights lipoprotein(a) as a largely genetic once-in-a-lifetime test and hs-CRP as an inflammation marker, and emphasizes coronary artery calcium (CAC) scoring as a tiebreaker for statin decisions (0, 1–99, ≥100). Cases illustrate these tools, including tighter LDL goals (

Statin use in the elderly, push for PCSK9 drugs, and pressures on clinicians show how economic interests shape patient care. #StatinsAndSeniors #PCSK9 #DrugMarketing #HealthTalks

Another incredible discovery inside the human body—our built-in recycling system and its surprising role in cholesterol control. What happens when that recycle bin works… or doesn't? Welcome to the fascinating world of the enzyme PCSK9.

For decades, a tight carotid stenosis felt like a ticking time bomb — a plaque waiting to throw an embolus and cause the next stroke. We were taught that severe narrowing meant surgery, and trials like ACAS and ACST-1 seemed to prove it. But medicine has changed. Statins, antiplatelets, tighter blood pressure control, even PCSK9 and GLP-1 therapies have quietly slashed stroke risk, and now newer data from CREST-2 suggest that for many asymptomatic patients, the knife — or the stent — may not add much at all. So if modern medical therapy works better than ever… who actually benefits from intervention anymore? Today, we unpack the evidence, the controversies, and how to counsel the patient who feels perfectly fine but has high-grade stenosis.Hosts: Carolyn Judge, Andrew Huang, Luciano Delbono, Frank Davis, Robert BeaulieuInstitution: University of Michigan, Department of Surgery, Section of Vascular SurgeryLearning objectives: Describe how modern intensive medical therapy has transformed the natural history of asymptomatic carotid stenosis and explain why contemporary patients experience substantially lower annual stroke risk than those in earlier eras. Interpret and compare the results of landmark trials—including ACAS, ACST-1, and CREST-2—to assess the relative benefits of medical therapy, endarterectomy, and stenting. Apply current evidence and guideline recommendations to patient care by selecting which asymptomatic patients are most likely to benefit from carotid revascularization versus optimized medical therapy alone. References:SVS Guidelines:Brook, R. D., et al. (2022). Society for Vascular Surgery clinical practice guidelines for management of extracranial carotid artery disease. Journal of Vascular Surgery, 75(1), e1–e67. https://doi.org/10.1016/j.jvs.2021.09.031CREST (1)Brott, T. G., Hobson, R. W., Howard, G., et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1), 11–23. https://doi.org/10.1056/NEJMoa0912321CREST-2Brott, T. G., Howard, G., Fong, P., et al. (2024). Randomized trial of carotid artery stenting or carotid endarterectomy vs best medical therapy for asymptomatic carotid stenosis: CREST-2 results. [Manuscript in preparation]. ClinicalTrials.gov Identifier: NCT02089217. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02089217ACST-1Halliday, A., Mansfield, A., Marro, J., et al. (2004). Randomised trial of carotid artery surgery for asymptomatic stenosis. Lancet, 363(9420), 1491–1502. https://doi.org/10.1016/S0140-6736(04)16153-1ACST-2Halliday, A., Bulbulia, R., Bonati, L. H., et al. (2021). Carotid artery stenting versus carotid endarterectomy in patients with asymptomatic carotid stenosis (ACST-2): A randomised trial. Lancet, 398(10291), 1065–1073. https://doi.org/10.1016/S0140-6736(21)01980-1ACASExecutive Committee for the Asymptomatic Carotid Atherosclerosis Study. (1995). Endarterectomy for asymptomatic carotid stenosis. JAMA, 273(18), 1421–1428. https://doi.org/10.1001/jama.1995.03520420033036Sponsor URL: https://www.goremedical.com/Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WEW865. CME/AAPA/IPCE credit will be available until May 19, 2027.Leveraging Recent Evidence on PCSK9 Inhibition: Strategies to Address Clinical Challenges for Meeting LDL-C Targets In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and The Mended Hearts, Inc. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through an independent educational grant from Merck & Co., Inc., Rahway, NJ, USA.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WEW865. CME/AAPA/IPCE credit will be available until May 19, 2027.Leveraging Recent Evidence on PCSK9 Inhibition: Strategies to Address Clinical Challenges for Meeting LDL-C Targets In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and The Mended Hearts, Inc. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through an independent educational grant from Merck & Co., Inc., Rahway, NJ, USA.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WEW865. CME/AAPA/IPCE credit will be available until May 19, 2027.Leveraging Recent Evidence on PCSK9 Inhibition: Strategies to Address Clinical Challenges for Meeting LDL-C Targets In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and The Mended Hearts, Inc. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through an independent educational grant from Merck & Co., Inc., Rahway, NJ, USA.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WEW865. CME/AAPA/IPCE credit will be available until May 19, 2027.Leveraging Recent Evidence on PCSK9 Inhibition: Strategies to Address Clinical Challenges for Meeting LDL-C Targets In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and The Mended Hearts, Inc. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through an independent educational grant from Merck & Co., Inc., Rahway, NJ, USA.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WEW865. CME/AAPA/IPCE credit will be available until May 19, 2027.Leveraging Recent Evidence on PCSK9 Inhibition: Strategies to Address Clinical Challenges for Meeting LDL-C Targets In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and The Mended Hearts, Inc. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through an independent educational grant from Merck & Co., Inc., Rahway, NJ, USA.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/WEW865. CME/AAPA/IPCE credit will be available until May 19, 2027.Leveraging Recent Evidence on PCSK9 Inhibition: Strategies to Address Clinical Challenges for Meeting LDL-C Targets In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and The Mended Hearts, Inc. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through an independent educational grant from Merck & Co., Inc., Rahway, NJ, USA.Disclosure information is available at the beginning of the video presentation.

In this sponsored episode from Novartis Pharmaceuticals Corporation, a leading preventive cardiologist walks through the 2026 cholesterol guideline update and what it means in practice. Seth J. Baum, a Columbia-trained preventive cardiologist, founder of Flourish Research, chairman of the Family Heart Foundation, and past president of the American Society of Preventive Cardiology, breaks down the major changes in the March 2026 ACC and AHA guideline release. You will hear why LDL targets are explicit again after nearly a decade, why universal lipoprotein A screening is now recommended, why a coronary calcium score above 300 places a patient in the highest-risk treatment tier, and why apolipoprotein B measurement can refine risk assessment when LDL is at goal. Baum also covers the alternatives available when a patient cannot tolerate a statin, including ezetimibe, PCSK9 inhibitors, inclisiran, and bempedoic acid, along with practical framing for the statin-hesitant patient. You will also hear his approach to discussing cholesterol with patients, from the science of lipoprotein physiology to the case for earlier and more aggressive lipid-lowering treatment. Dr. Baum was not compensated for his participation in today's episode. The opinions expressed are his alone and do not represent the opinions of Novartis Pharmaceuticals Corporation. At Novartis, our mission is to ensure no heart is lost too soon. We envision a world where preventable CV deaths are no longer part of our lives. We're proud of the positive impact we've made over the past 40 years and remain dedicated to tackling the most challenging problems in CVD. Through cutting-edge science and technology, we are focusing on areas of high unmet need, including scaling our xRNA platform across multiple risk factors and pioneering breakthroughs for genetically driven CVD risk factors and common heart conditions, including atrial fibrillation. We also work with patients, healthcare professionals, and organizations around the world to improve CV care beyond medicine alone. Together, we can help people with CVD enjoy longer, healthier lives and more time with their loved ones. Learn more here: https://Novartis.us/cardiovascular-disease VISIT SPONSOR → https://Novartis.us/cardiovascular-disease SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

This week, Dr. Kahn reviews new data from the Global Burden of Disease study analyzing the relationship between diet and death from heart disease. In 2023, an estimated 5.9 million deaths worldwide were linked to poor dietary choices, led by excessive sodium intake and insufficient consumption of fruit and whole grains. It's a fascinating and important study with clear takeaways. Other topics include stents for angina, causes of sudden cardiac death, daytime napping and health outcomes, plastic-free diets, PCSK9 inhibitors vs. statins, calcium supplements, and the purity of fish oil samples. Thanks to the Fresh Pressed Olive Oil Club. Visit getfreshdrkahn.com for an incredible introductory offer.

PCSK9 inhibitors in high-risk diabetes without ASCVD, the CAAN-AF trial, conduction system pacing vs biventricular pacing, PFA and stroke, and therapeutic fashion infects expert consensus are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I VESALIUS-CV  VESALIUS-CV Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2514428 JAMA Substudy https://jamanetwork.com/journals/jama/fullarticle/2847162 II How Best to Maximize CRT Benefit in Patients with AF CAAN-AF Trial https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag206/8654625?searchresult=1 Role of AV Node Ablation: Meta-analysis of Observational Studies https://www.jacc.org/doi/10.1016/j.jacc.2011.10.891 III Stroke Rates in PFA vs Thermal Ablation Comparative Safety of RF versus PFA for AF in a High-Volume US Medical Center https://esc365.escardio.org/Ehra-congress/sessions/18281 IV Five New CSP Studies Presented and Published HeartSync-LBBP Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2845803 PhysioSync-HF Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2845802 LEFT-BUNDLE-CRT Trial https://doi.org/10.1093/eurheartj/ehag225 Long-Term Follow-up of His-Alternative I Trial https://www.jacc.org/doi/10.1016/j.jacep.2026.02.016 LECART Trial https://esc365.escardio.org/Ehra-congress/sessions/17140 V New EP Training Document Published Advanced Training Statement on Clinical Cardiac Electrophysiology  https://www.jacc.org/doi/10.1016/j.jacc.2026.01.074 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Shingles vaccination in adults with established cardiovascular disease was associated with dramatic reductions in heart attack, stroke, and mortality in a large real-world analysis, supporting its role as a cardiovascular risk-reduction tool beyond infection prevention. The VESALIUS-CV trial found evolocumab significantly reduced major cardiovascular events in high-risk diabetic patients without known ASCVD, challenging the convention of reserving PCSK9 inhibitors for secondary prevention only. AI-analyzed smartwatch data predicted heart failure hospitalizations days to weeks in advance, signaling a shift toward continuous remote monitoring in heart failure management.

Invest Like the Best: Read the notes at at podcastnotes.org. Don't forget to subscribe for free to our newsletter, the top 10 ideas of the week, every Monday --------- My guest today is Alex Karnal. Alex is the co-founder and managing partner of Braidwell, a life sciences investment firm he built after spending 15 years at Deerfield Management. The frame we use throughout the episode is the health stack. Alex talks about how most of the diseases that will claim most of our lives are already addressable with medicines that exist today. We work through the five layers of what a defensive health strategy looks like, why GLP-1 medicines represent the first commercial proof that people are ready to be proactive about their health, and why PCSK9 inhibitors may ultimately be the more important drug class even though they get far less attention. We also get into the science and business of drug discovery itself — why most of the published literature that AI companies are training on cannot be replicated, what it would mean to have a truly agentic scientific lab running 24 hours a day, and why Alex believes we are now on a deterministic curve toward scientific superintelligence in biology. For the full show notes, transcript, and links to mentioned content, check out the episode page ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠.  ----- Become a Colossus member to get our quarterly print magazine and private audio experience, including exclusive profiles and early access to select episodes. Subscribe at ⁠colossus.com/subscribe⁠. ----- ⁠Ramp's⁠ mission is to help companies manage their spend in a way that reduces expenses and frees up time for teams to work on more valuable projects. Go to⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠ramp.com/invest⁠⁠ to sign up for free and get a $250 welcome bonus. ----- Trusted by thousands of businesses, ⁠Vanta⁠ continuously monitors your security posture and streamlines audits so you can win enterprise deals and build customer trust without the traditional overhead. Visit ⁠vanta.com/invest⁠.  ----- ⁠WorkOS⁠ is a developer platform that enables SaaS companies to quickly add enterprise features to their applications. Visit⁠⁠ ⁠WorkOS.com⁠⁠⁠ to transform your application into an enterprise-ready solution in minutes, not months. ----- ⁠Rogo⁠ is the AI platform for finance. They're building agents for Wall Street that are trained to understand how bankers and investors actually do work: from diligence and modeling, to turning analysis into deliverables. To learn more, visit rogo.ai/invest. ----- ⁠Ridgeline⁠ has built a complete, real-time, modern operating system for investment managers. It handles trading, portfolio management, compliance, customer reporting, and much more through an all-in-one real-time cloud platform. Visit⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ridgelineapps.com⁠. ----- Editing and post-production work for this episode was provided by The Podcast Consultant (⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://thepodcastconsultant.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠). Timestamps: (00:00:00) Welcome to Invest Like the Best (00:02:29) Intro: Alex Karnal (00:03:15) State of the Union: GLP1s and Life Sciences (00:07:01) The Health Stack Framework (00:12:49) Breaking Down the 5 Defensive Layers (00:21:18) GLP-1: What's Driving the Inflection (00:28:28) Diet vs. Drugs: Is Food Enough? (00:31:15) Barriers to Access: Complexity, Cost & Compliance (00:35:04) PCSK9: The Closest Thing to a Free Lunch (00:44:10) Alzheimer's & Neurodegenerative Disease (00:46:59) Cancer: Early Detection & New Treatments (00:54:49) Body Imaging & Diagnostic Trade-offs (00:56:31) How Drugs Are Discovered (01:02:39) AI in Drug Discovery (01:10:57) The Automated Lab of the Future (01:13:05) Peptides & Citizen Pharmacology (01:16:45) Alex's Background (01:28:25) Braidwell's Investment Approach (01:30:39) The Kindest Thing

My guest today is Alex Karnal. Alex is the co-founder and managing partner of Braidwell, a life sciences investment firm he built after spending 15 years at Deerfield Management. The frame we use throughout the episode is the health stack. Alex talks about how most of the diseases that will claim most of our lives are already addressable with medicines that exist today. We work through the five layers of what a defensive health strategy looks like, why GLP-1 medicines represent the first commercial proof that people are ready to be proactive about their health, and why PCSK9 inhibitors may ultimately be the more important drug class even though they get far less attention. We also get into the science and business of drug discovery itself — why most of the published literature that AI companies are training on cannot be replicated, what it would mean to have a truly agentic scientific lab running 24 hours a day, and why Alex believes we are now on a deterministic curve toward scientific superintelligence in biology. For the full show notes, transcript, and links to mentioned content, check out the episode page ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠.  ----- Become a Colossus member to get our quarterly print magazine and private audio experience, including exclusive profiles and early access to select episodes. Subscribe at ⁠colossus.com/subscribe⁠. ----- ⁠Ramp's⁠ mission is to help companies manage their spend in a way that reduces expenses and frees up time for teams to work on more valuable projects. Go to⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠ramp.com/invest⁠⁠ to sign up for free and get a $250 welcome bonus. ----- Trusted by thousands of businesses, ⁠Vanta⁠ continuously monitors your security posture and streamlines audits so you can win enterprise deals and build customer trust without the traditional overhead. Visit ⁠vanta.com/invest⁠.  ----- ⁠WorkOS⁠ is a developer platform that enables SaaS companies to quickly add enterprise features to their applications. Visit⁠⁠ ⁠WorkOS.com⁠⁠⁠ to transform your application into an enterprise-ready solution in minutes, not months. ----- ⁠Rogo⁠ is the AI platform for finance. They're building agents for Wall Street that are trained to understand how bankers and investors actually do work: from diligence and modeling, to turning analysis into deliverables. To learn more, visit rogo.ai/invest. ----- ⁠Ridgeline⁠ has built a complete, real-time, modern operating system for investment managers. It handles trading, portfolio management, compliance, customer reporting, and much more through an all-in-one real-time cloud platform. Visit⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ridgelineapps.com⁠. ----- Editing and post-production work for this episode was provided by The Podcast Consultant (⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://thepodcastconsultant.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠). Timestamps: (00:00:00) Welcome to Invest Like the Best (00:02:29) Intro: Alex Karnal (00:03:15) State of the Union: GLP1s and Life Sciences (00:07:01) The Health Stack Framework (00:12:49) Breaking Down the 5 Defensive Layers (00:21:18) GLP-1: What's Driving the Inflection (00:28:28) Diet vs. Drugs: Is Food Enough? (00:31:15) Barriers to Access: Complexity, Cost & Compliance (00:35:04) PCSK9: The Closest Thing to a Free Lunch (00:44:10) Alzheimer's & Neurodegenerative Disease (00:46:59) Cancer: Early Detection & New Treatments (00:54:49) Body Imaging & Diagnostic Trade-offs (00:56:31) How Drugs Are Discovered (01:02:39) AI in Drug Discovery (01:10:57) The Automated Lab of the Future (01:13:05) Peptides & Citizen Pharmacology (01:16:45) Alex's Background (01:28:25) Braidwell's Investment Approach (01:30:39) The Kindest Thing

I'm confused by information presented on diets containing meat as being dangerous. Could you shed some light?Assisted living models that would be of benefit to older adults

Three imaging-guided PCI trials (two with surprising results), LDL targets, an oral PCSK9 inhibitor, and another beta-blocker withdrawal trial are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I IVUS-Guided PCI OPTIMAL Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2600440 IVUS-CHIP Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2601521 ILUMIEN IV Trial https://www.nejm.org/doi/10.1056/NEJMoa2305861 DKCRUSH VIII Trial https://doi.org/10.1016/j.jacc.2026.01.081 II Ez-PAVE Trial — Low vs Very Low LDL-targets Does Ez-PAVE Support 'Lower Is Better' for LDL-C? https://www.medscape.com/viewarticle/does-ez-pave-support-lower-better-ldl-c-2026a1000akx Ez-PAVE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2600283 2026 ACC/AHA Lipid Guidelines https://www.ahajournals.org/doi/10.1161/CIR.0000000000001423 III CORALreef AddOn CORALreef AddOn Trial https://www.jacc.org/doi/abs/10.1016/j.jacc.2026.03.036 This Week in Caardiology 2-6-26 https://www.medscape.com/viewarticle/1003240 CORALreef Lipids Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2511002 IV Another Post-MI Beta-blocker Withdrawal Study: SMART-DECISION SMART-DECISION Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2601005 ABYSS Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2404204 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Hear the latest on PCSK9 inhibitors, cardiorenal benefits of GLP-1 drugs, and other clinical research in this interview with Katie Berlacher, MD, MS, chair of this year's annual ACC meeting. Related Content: PCSK9 Inhibitors in Diabetes, Tirzepatide's Cardiorenal Effects, Shingles Vaccine, and More From ACC

Would strontium help in the healing of lumbar fractures?  How about as a preventive?How valuable is the hs-CRP test?  Are there any drawbacks to eating canned fish?What are your thoughts on Arterosil for cardiovascular health?

The benefits of saunaThe Take Back Your Health TourA follow-up on milk thistle interactions with drugsWhat are your thoughts on low-dose saw palmetto for hair growth?Is monk fruit a safe sweetener to use?

Good morning from Pharma Daily: the podcast that brings you the most important developments in the pharmaceutical and biotech world. Today, we're diving into a series of noteworthy advancements and strategic movements shaping the future of drug development and patient care.The pharmaceutical industry is seeing a flurry of mergers and acquisitions, reflecting a strategic push to enhance therapeutic portfolios. Biogen's $5.6 billion acquisition of Apellis Pharmaceuticals emphasizes its ambition to expand its immunology offerings and venture into kidney disease therapeutics. This move aligns with a broader industry trend where major players are investing heavily in acquisitions to bolster their pipelines and market positions. Similarly, Eli Lilly's $6.3 billion investment in Centessa Pharmaceuticals highlights its focus on diversifying its neuroscience portfolio, particularly in sleep disorder treatments. These strategic acquisitions underscore the high stakes and potential rewards associated with advancing treatments for neurological conditions.On the clinical front, United Therapeutics is making strides with its idiopathic pulmonary fibrosis program. A successful Phase 3 trial for Tyvaso positions it as a potential new standard in IPF treatment, paving the way for an FDA filing. This development underscores the company's ambition to secure blockbuster sales and expand its therapeutic footprint. However, AstraZeneca faced a setback when its Strensiq successor missed primary endpoints in a Phase 3 trial for treating rare metabolic diseases. This outcome illustrates the inherent risks in drug development, especially when expanding indications beyond existing pediatric uses.Regulatory scrutiny remains intense, with the FDA's Center for Biologics Evaluation and Research issuing untitled letters to several companies over promotional practices. This action highlights the importance of compliance in marketing biologics and emphasizes ethical promotional strategies that align with regulatory standards. Meanwhile, GSK's Exdensur secured regulatory approval in China for asthma treatment, marking a strategic expansion into a key geographical market.Economic pressures are also influencing the industry, as seen with BASF Pharma Solutions announcing price increases for excipients and some active pharmaceutical ingredients due to rising energy and raw material costs. Such moves reflect broader economic challenges impacting the pharmaceutical supply chain, emphasizing the ongoing need for cost-effective solutions in drug manufacturing.In obesity treatment innovation, Ambrosia Biosciences has raised $100 million to advance its oral small-molecule GLP-1 therapy into clinical trials. This funding round highlights growing investor interest in next-generation obesity treatments that move beyond traditional peptide-based approaches.Moreover, artificial intelligence is increasingly being harnessed to enhance clinical trial design efficiency. Bristol-Myers Squibb's collaboration with Faro exemplifies how AI technologies are streamlining clinical research processes to improve patient outcomes and accelerate drug development timelines.In other developments, Merck has presented compelling phase 3 results for its PCSK9 inhibitor, showcasing superiority over other oral non-statin therapies for cardiovascular diseases. This positions Merck strategically within the cardiovascular market by offering promising alternatives for patients intolerant to statins.Despite these advancements, some companies face challenges. Astellas Pharma discontinued an early-stage trial for Sjogren's syndrome treatment due to developmental hurdles, while Lipella Pharmaceuticals and Io Biotech filed for bankruptcy after struggling to advance their pipelines past regulatory obstacles.On the financial side, Blackstone's closure of a $6.3 billion life sciences fund underscores robust investor confidence in biotecSupport the show

Cholesterol advice has been stuck in “it depends” for years, and we wanted something more concrete you can actually use. So we dig into the 2026 American Heart Association cholesterol guidelines and translate them into plain language: the new LDL cholesterol thresholds, what counts as borderline or high, and why having clear targets can make shared decision-making with your doctor, nurse, or PA a lot less vague. We also explain why non-HDL cholesterol can be a helpful “total bad cholesterol” goal, plus the HDL and triglyceride ranges that still shape overall cardiovascular risk. One update we're especially excited about is the class one recommendation to check lipoprotein(a) at least once in adulthood. Lp(a) is largely genetic, doesn't reliably drop with diet, exercise, or standard statins, and can raise heart attack and stroke risk even when the rest of your lipid panel looks normal. We walk through what the numbers mean, how common elevation is, and how this single test can change the intensity of prevention for you and prompt testing for family members. We also cover the new Prevent equation for 10-year risk, including how it accounts for factors like diabetes and kidney function, and why the risk category cutoffs have shifted. From there, we lay out the foundation of dyslipidemia treatment: heart-healthy eating, consistent physical activity, weight goals, smoking cessation, and limiting alcohol. And when lifestyle isn't enough, we get practical about medications, including statins, ezetimibe, PCSK9 inhibitors, inclisiran, and bempedoic acid, along with straight talk about safety and the harm of online statin myths. If you care about prevention, family history, or simply want a clearer plan for your next lab review, this one is for you. Subscribe, share this with a friend who's confused by cholesterol results, and leave a review with the one question you want your clinician to answer about your heart disease risk.Send us a message with this link, we would love to hear from you. Standard message rates may apply.Support the showProduction and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RNArtwork Rebrand and Avatars:Vantage Design Works (Vanessa Jones) Website: https://www.vantagedesignworks.com/Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qrOriginal Artwork Concept: Olivia Pawlowski

Angela and special guest Dr. Darshan Shah, look at the polarising world of cardiovascular health, specifically demystifying the role of LDL cholesterol.  They challenge the traditional one-size-fits-all approach to statins, arguing that heart health must be viewed through the lens of individual biology—where factors like inflammation, genetic risk, and lifestyle can make the same LDL level a non-issue for one person and a crisis for another WHAT YOU WILL LEARN LDL is Not Always the Enemy: A high LDL reading alone doesn't guarantee heart disease; its impact depends on individual context The Power of ApoB and Lp(a): Traditional cholesterol panels are often insufficient; more modern biomarkers like ApoB(a superior risk marker) and Lp(a) (a genetic factor) provide a much clearer picture of cardiovascular risk. AI in Diagnostics: The Clearly scan uses AI to analyse CT angiograms, allowing doctors to see the actual buildup of both calcified and soft plaque in the coronary arteries rather than just guessing based on blood work. Precision Over Dogma: Because cardiovascular health is an "N-of-1" situation, interventions like statins or PCSK9 inhibitors should be based on actual arterial health TIMESTAMPS: 01:21 The LDL Controversy: An explanation of why cholesterol remains a polarizing topic and why it must be treated as an individual biology issue. 02:37 The Tale of Two Patients: A comparison of a healthy gym-goer with high LDL/zero plaque versus a high-stress professional with lower LDL/significant plaque. 04:13 Modern Biomarkers: A breakdown of the specific tests to ask for, including ApoB, HS-CRP, and the Clearly cardiovascular scan. VALUABLE RESOURCES • Take the BioSyncing Quiz to help you understand what's actually happening in your body — and how to fix it.

Send a textWhat if a lower LDL comes with a quiet cost to your strength and resilience? We dig into a massive biobank analysis linking long-term statin use with declines in grip strength and appendicular lean mass, then connect the dots to sarcopenia, mitochondrial function, and the daily choices that shape metabolic health. Strength is more than performance; it predicts independence, glucose control, and longevity, which is why any therapy that erodes muscle demands a closer look.We walk through the study's design, what “appendicular lean mass” really measures, and why the findings held even after adjusting for lifestyle and genetics like SLCO1B1. From there, we peel back the LDL-centric mindset and focus on terrain: insulin, inflammation, triglycerides, HDL, and LDL particle quality. You'll hear why refined carbs, seed oils, and chronic inflammation push lipoproteins in the wrong direction—and how protein-forward meals, resistance training, and lower insulin load tip the balance toward larger, less atherogenic particles with benefits that extend well beyond a single lab value.We also compare statins with hydrophilic options, alternate dosing strategies, and newer PCSK9 inhibitors, clarifying where they may fit for secondary prevention and where big questions remain—especially around muscle preservation and all-cause mortality. CoQ10 gets a fair review: low risk, mixed evidence, and not a proven fix for long-term function. Most importantly, we share practical steps to protect your muscle: track grip strength, prioritize 1.6 to 2.0 g/kg daily protein, lift two to three times per week, walk after meals, and align circadian rhythms with sleep and sunlight. Medications can lower numbers; only your muscles move you through life. Let's make treatment plans that respect both.If this conversation helped you think differently about risk and resilience, follow the show, share it with a friend, and leave a quick review so more listeners can find thoughtful, evidence-informed health guidance.For slides, open source references and video go to: www.thehealthedgepodcast.com

Dr. Kim Brockenbrough: https://www.cardiavision.com/https://www.linkedin.com/in/kimberly-brockenbrough-md-1b321a123/https://www.instagram.com/kimbromd?ighsh=YjVpcDcwdHA3ejVvYour calcium score came back zero. You're in the clear, right? Not so fast.In this episode, Optispan Clinical Director Dr. Nicki Byrne sits down with Dr. Kim Brockenbrough, board-certified cardiovascular radiologist, 25-year veteran of vascular imaging, and CEO of CardiaVision, for a conversation that challenges one of the most common assumptions in preventive cardiology.If you care about cardiovascular longevity, and you should, because heart disease remains the leading killer, this is the imaging conversation you didn't know you needed.Timestamps:00:00 — Cold open: The 48-year-old runner with an 80% blockage and a zero calcium score00:54 — Dr. Nicki Byrne introduces Dr. Kim Brockenbrough & CardiaVision01:45 — Dr. Brockenbrough's background: 25 years of vascular imaging02:35 — Cardiovascular disease through a longevity lens: imaging vs. labs vs. functional testing03:24 — The lifecycle of plaque: from fatty deposits to rupture and heart attack04:21 — Why soft plaque is more dangerous than calcified plaque (SCOT-HEART 2020)05:14 — How calcium scores are used in clinical practice — and where they fall short06:18 — The only way to see soft plaque non-invasively: coronary CT angiography (CCTA)07:08 — Which populations are most at risk of a false sense of security from calcium scoring08:03 — What a CCTA can tell you that a calcium score can't09:43 — How often should patients follow up with repeat scans?10:28 — Higher vs. lower dose radiation protocols — and why Dr. Brockenbrough chooses higher dose11:17 — Risks of CCTA: contrast reactions, kidney considerations12:15 — Stress tests vs. CCTA: why a negative stress test is a very low bar13:21 — Soft plaque that isn't flow-limiting: small emboli, dementia, and congestive heart failure15:36 — Medications that reverse plaque: statins, PCSK9 inhibitors, and the LOCATE trial16:23 — LDL reduction and plaque regression: what the data shows17:08 — High-intensity statins vs. Repatha — tolerability, efficacy, and the price drop18:27 — When OptiSpan reaches for PCSK9 inhibitors: ApoB, LDL, Lp(a), ApoE4, and significant disease19:22 — Why a rising calcium score on a statin is exactly what you want to see20:25 — AI plaque quantification tools: promise, limitations, and validation concerns22:54 — Has AI ever changed Dr. Brockenbrough's read? A real-world case23:40 — FFR-CT, the ISCHEMIA trial, and why stenting asymptomatic patients is no longer standard of care25:25 — The future of cardiac imaging and the case for universal CCTA screening26:52 — The patient experience: what to expect at a CardiaVision CCTA appointment28:18 — Why seeing soft plaque changes patient behavior — the power of treating disease, not numbers29:49 — Bridging the gap between longevity medicine and traditional cardiology33:11 — Testosterone, the TRAVERSE trial, and what you should know about your coronaries first35:41 — What causes coronary artery disease beyond cholesterol: sugar, inflammation, gum disease37:07 — Image walkthrough: soft plaque vs. calcified plaque on a real CCTA41:36 — Where to find Dr. Brockenbrough and CardiaVision

Managing cholesterol is a key part of preventing cardiovascular disease, and nurses are on the front lines of patient care. In this episode, we explore the main cholesterol-lowering medications, including statins, ezetimibe, PCSK9 inhibitors, fibrates, and more. You'll learn how each medication works, important side effects, lab monitoring, and nursing considerations for safe administration. We'll also cover strategies for educating patients and supporting long-term adherence. By the end of this episode, you'll have practical tools to confidently recognize, monitor, and teach about cholesterol medications in everyday nursing practice. Your support helps me provide more free resources like this! Consider supporting and getting more amazing pharmacology content! Head on over to meded101.com/nurse

A phase 3 trial in The New England Journal of Medicine found that the oral PCSK9 inhibitor enlicitide reduced LDL by 57% at 24 weeks in high-risk patients, with similar adverse events to placebo. An oral option may improve uptake and help more patients reach lipid targets. In The Lancet, SMART-CHOICE 3 showed clopidogrel monotherapy after DAPT post-PCI reduced death, MI, or stroke versus aspirin, without more bleeding. Finally, a large meta-analysis confirmed most reported statin side effects are not causally linked, reinforcing their strong benefit–risk profile.

Program notes:0:38 Removal of fallopian tubes to prevent ovarian ca1:43 129 studies included2:43 Women who no longer desire pregnancy3:40 Technically feasible4:30 New oral PCSK9 inhibitor5:35 Think it's a slam dunk6:08 EHR helping deprescribing in older adults7:08 Two sequential EHR interventions8:08 40% more likely in one group9:08 Something in email less effective9:50 Benefits of knee braces for OA10:50 Brace specific to area of OA12:00 If it results in a placebo effect13:00 End

In this pharmacology podcast episode, we focus on two key non-statin cholesterol-lowering therapies: ezetimibe and PCSK9 inhibitors (Click here to listen to the statin podcast episode). These agents play a role in lipid management, particularly for patients who are unable to reach LDL cholesterol goals with statins alone or who have statin intolerance. Ezetimibe works by inhibiting the absorption of dietary and biliary cholesterol at the brush border of the small intestine. By reducing the amount of cholesterol delivered to the liver, ezetimibe lowers circulating LDL cholesterol by approximately 15 to 25 percent. It is taken orally once daily and is commonly used as add-on therapy to statins in patients with established atherosclerotic cardiovascular disease or high baseline LDL levels. Ezetimibe is generally well tolerated, with a favorable safety profile and minimal systemic exposure, making it an attractive option in older adults and patients with multiple comorbidities. PCSK9 inhibitors, including alirocumab and evolocumab, offer a much more potent LDL-lowering effect. These monoclonal antibodies work by blocking PCSK9, a protein that promotes degradation of LDL receptors in the liver. By preserving LDL receptors, PCSK9 inhibitors enhance clearance of LDL cholesterol from the bloodstream, often reducing LDL levels by 50 to 60 percent. They are administered via subcutaneous injection every two to four weeks and are most commonly used in patients with familial hypercholesterolemia, established cardiovascular disease, or persistently elevated LDL despite maximally tolerated statin and ezetimibe therapy. Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE! Support The Podcast and Check Out These Amazing Resources! NAPLEX Study Materials BCPS Study Materials BCACP Study Materials BCGP Study Materials BCMTMS Study Materials Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated) Guide to Drug Food Interactions (Amazon Best Seller) Pharmacy Technician Study Guide by Meded101

This week, Dr. Kahn breaks down a new paper examining the risks and reported side effects of statins—including the surprising finding that placebo alone is linked to many of the same symptoms. He also covers an oral PCSK9 inhibitor currently under study and what it could mean for cholesterol management. The episode then dives into the latest research on emerging therapies designed to lower lipoprotein(a), including a real-world case study that highlights where this rapidly evolving field is headed.  Shorter discussions include heart disease at a young age, why so many patients fail to reach blood pressure treatment goals, aspirin use one year after AFib ablation, skeletal muscle as an endothelial stabilizer, and why exercise variety may be one of the most powerful risk reducers we have.  Thanks to WellBean for sponsoring the show. Save on their delicious bean-based products at wellbean.life with code DrKahn15.  Dr. Kahn will also be leading a free online seminar on cholesterol on February 17, 2026 at 7 PM EST with Forks Over Knives. Register HERE.

Send us a textDr. H. Jackson Downey sits down with MedEvidence!™ to give the low-down on keeping your lipoprotein(a) numbers down. Lipoprotein little a, also called Lp(a), is a really, really, really, really, really bad cholesterol that is genetically determined, meaning exercise and diet don't help lower the numbers. Instead, Dr. Downey explains, clinical trials are looking into investigational medications for this bad type of cholesterol. Dr. Downey describes the ins and outs of Lp(a) and how clinical research is our best bet for solutions to this dangerous cholesterol.Be a part of advancing science by participating in clinical research.Have a question for Dr. Koren? Email him at askDrKoren@MedEvidence.comListen on SpotifyListen on Apple PodcastsWatch on YouTubeShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramX (Formerly Twitter)LinkedInWant to learn more? Checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.comMusic: Storyblocks - Corporate InspiredThank you for listening!

On this podcast episode, I discuss important practice pearls and important test prep information about statins. Statins are cornerstone agents for ASCVD risk reduction, so test questions often focus on indication, intensity, and monitoring. Health care professionals should quickly identify statin intensity: high-intensity therapy (atorvastatin 40–80 mg, rosuvastatin 20–40 mg) lowers LDL by ~50% and is indicated for patients with clinical ASCVD, LDL ≥190 mg/dL, or high-risk diabetes patients age 40–75. Moderate-intensity statins (e.g., atorvastatin 10–20 mg, simvastatin 20–40 mg) are commonly tested for primary prevention. Statin-associated muscle symptoms range from myalgias (most common, normal CK) to rare but serious rhabdomyolysis (marked CK elevation and AKI). Risk factors include high doses, advanced age, hypothyroidism, drug interactions, and renal impairment. If muscle symptoms occur, stopping the statin, ruling out secondary causes (like hypothyroidism), and rechallenging with a lower dose or different statin is often the correct clinical approach. Drug interactions and statin selection frequently separate good from great test-takers. Lipophilic statins (simvastatin, atorvastatin, lovastatin) are more prone to muscle effects and CYP3A4 interactions, while hydrophilic statins (pravastatin, rosuvastatin) are preferred in patients with prior intolerance or complex drug regimens. Grapefruit juice, strong CYP3A4 inhibitors, and certain calcium channel blockers raise simvastatin levels—often prompting dose limits or avoidance on exams. If LDL goals aren’t met, adding ezetimibe or a PCSK9 inhibitor is the next evidence-based step. Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE! Support The Podcast and Check Out These Amazing Resources! NAPLEX Study Materials BCPS Study Materials BCACP Study Materials BCGP Study Materials BCMTMS Study Materials Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated) Guide to Drug Food Interactions (Amazon Best Seller) Pharmacy Technician Study Guide by Meded101

Peripheral artery disease has been called the ‘silent circulatory crisis'—affecting millions, limiting mobility, and quietly raising the risk of heart attack, stroke, and limb loss. For decades, treatment focused on walking programs, aspirin, and sometimes a stent or bypass. But today, the landscape is changing. From PCSK9 inhibitors that drive cholesterol to record lows, to GLP-1 agonists like semaglutide improving walking distance, to novel antithrombotic strategies that balance bleeding and clotting—PAD care is entering a new era. In this episode, we'll explore the breakthroughs, the evidence behind them, and what they mean for patients who just want to keep moving forward." Hosted by the University of Michigan Department of Vascular Surgery: - Robert Beaulieu, Program Director - Frank Davis, Assistant Professor of Surgery - Luciano Delbono, PGY-5 House Officer - Andrew Huang, PGY-4 House Officer - Carolyn Judge, PGY-2 House Officer Learning objectives:  1.  Describe the current evidence-based recommendations for multifactorial medical management of peripheral artery disease (PAD), including lipid, glycemic, and antithrombotic strategies per 2024 SVS/AHA guidelines.  2. Interpret the clinical implications of the FOURIER trial regarding the role of PCSK9 inhibition in reducing cardiovascular events in patients with atherosclerotic disease, including PAD.  3.  Evaluate the emerging role of GLP-1 receptor agonists, such as semaglutide, in improving walking performance and quality of life among patients with diabetic PAD based on findings from the STRIDE trial. Sponsor URL: https://www.goremedical.com/ References:  H. L. Gornik et al., “2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease,” JACC, vol. 83, no. 24, pp. 2497–2604, June 2024, doi: 10.1016/j.jacc.2024.02.013. L. Mazzolai et al., “2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM),” Eur Heart J, vol. 45, no. 36, pp. 3538–3700, Sept. 2024, doi: 10.1093/eurheartj/ehae179. https://pubmed.ncbi.nlm.nih.gov/40169145/ M. S. Sabatine et al., “Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease,” N Engl J Med, vol. 376, no. 18, pp. 1713–1722, May 2017, doi: 10.1056/NEJMoa1615664. https://pubmed.ncbi.nlm.nih.gov/28304224/ M. P. Bonaca et al., “Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial,” Lancet, vol. 405, no. 10489, pp. 1580–1593, May 2025, doi: 10.1016/S0140-6736(25)00509-4. https://pubmed.ncbi.nlm.nih.gov/40169145/ N. E. Hubbard, D. Lim, and K. L. Erickson, “Beef tallow increases the potency of conjugated linoleic acid in the reduction of mouse mammary tumor metastasis,” J Nutr, vol. 136, no. 1, pp. 88–93, Jan. 2006, doi: 10.1093/jn/136.1.88. https://pubmed.ncbi.nlm.nih.gov/16365064/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

I am honored to have Dr. Tom Dayspring join me again today for another AMA session. He and I have done eight podcasts before, and this is a continuation of our last Ask Me Anything episode.  Dr Dayspring is an esteemed expert on internal medicine and clinical lipidology. He is likely one of the most influential worldwide lipid experts, so I am thrilled to have him back with me to dive into various topics related to listener questions, including the impact of hormone replacement therapy on lipid changes, methods of administration, and why bioidentical hormone replacement therapy is preferable for managing both menopausal symptoms and lipid health. We discuss medications, including PCSK9 inhibitors and GLP-1s, as well as intermittent fasting, lipids, and cardiovascular disease risk. We also examine how heart disease develops gradually, over time, the impact of stress and lifestyle, and Dr. Dayspring shares the labs he recommends beyond traditional lipids, ApoB, and LpA. In our discussion, Dr. Dayspring noted that he was not in a position to speak about GLP-1 therapies or microdosing. Since I received many questions from listeners on those topics, I will host a future solo AMA to address some of their concerns. Today's conversation with Dr. Tom Dayspring is truly invaluable, and I trust you will walk away with valuable insights you can share with your healthcare providers. We created a PDF - cynthiathurlow.com/lipids -  specifically for listeners that outlines key labs to discuss with your providers and questions to ask them to help you advocate for your own health and your family members' health. IN THIS EPISODE, YOU WILL LEARN: Why being physically fit does not always eliminate the risk of heart problems arising How ApoB and cholesterol contribute to heart disease over decades Why the early testing of risk factors is essential How chronic stress increases the risk of heart disease  How high cortisol affects insulin sensitivity and glucose regulation How stress impacts endothelial and nitric oxide function The link between low Omega-3 levels and heart problems How insulin resistance degrades heart health How high homocysteine levels can impair endothelial function and contribute to cardiovascular problems Connect with Cynthia Thurlow   Follow on⁠ X⁠,⁠ Instagram⁠ &⁠ LinkedIn⁠ Check out Cynthia's⁠ website⁠ Submit your questions to support@cynthiathurlow.com Join other like-minded women in a supportive, nurturing community ⁠(The Midlife Pause/Cynthia Thurlow⁠)⁠ ⁠ Cynthia's⁠ Menopause Gut Book⁠ is on presale now! Cynthia's⁠ Intermittent Fasting Transformation⁠ Book ⁠The Midlife Pause supplement line⁠ Connect with Dr. Thomas Dayspring On X (@DrLipid) On LinkedIn