An interesting article with some good perspectives on CVD, Lp(a) etc.
https://www.jacc.org/doi/10.1016/j.jacc.2021.05.011
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It’s a great article. I met Borja a couple times and Valentina once. The PESA studies are brilliant for giving us insight.
Just to provide a bit more information, Borja told a told a story that, amazingly, a fetus in the womb can have coronary artery lipid accumulation. Four year olds may have coronary artery disease. For kids with familiar hypercholesterolemia, they can even have plaque as an elementary school kid!
What is really shocking is that even a “normal” LDL-C of 100mg/dl builds plaque, as shown in Figure 5. So why on earth are we saying 100mg/dl is “normal”? It’s a population average, but the evidence shows that you can build plenty of plaque at 100mg/dl. Humans are basically the only species where this happens, where a normal level of something is slowly sending you to an early grave.
He is telling everybody that lower ApoB (or LDL-C if that’s all you can measure) is better in terms of reducing cardiovascular disease risk. That Figure 5 in the paper is the one I show everybody now.
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Agreed, there are several studies by the same group on the subject subclinical aterosclerosis and it’s profession over time. It’s just one more data point that convinced me that lower is absolutely better for ldl levels. Very cool stuff.
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