Let me know in the comments any feedback Thank you

I will be discussing my take on the recently announced failure of Pelacarsen to lower cardiac events in patients with elevated Lp(a) If you are unable to attend LIVE and want to ask a question, then please leave the question in the comments of this posts and I will answer it We will see how a hybrid of asynchronous questions with Live questions work to increase the volume of questions and educational opportunities for this group's members

Looks like Monday mornings are not a good option for Live "Ask Me Anything" No recording for meeting today Please let me know in the comments if Live "Ask Me Anything" are valuable The attendance has been low the last couple meetings If there is a better date and time for the majority of people we will work on using that going forward If you would prefer another format other than Live meetings then please make suggestions Thanks Michael Twyman

I made this research report in Gemini This is a topic I get asked about a lot and there is a much debate about this topic on social media It summarizes the pros and the "red team" against argument Many roads lead to Rome Many tools can work Risk vs Benefit The higher the baseline risk, the more risk reduction with aggressive therapies Atherosclerosis is more than "cholesterol" but the lipoproteins should be addressed and lowered if the person is high risk or wants to minimize cardiac events as much as possible even if the treatment effect may be small These are the frameworks I use to assess vascular risk and best treatment options The lipid hypothesis—the postulate that cholesterol, specifically low-density lipoprotein cholesterol (LDL-C), is a causal agent in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD) and that its reduction lowers the risk of cardiovascular events—remains the central tenet of preventive cardiology in 2026. Over the last four decades, this hypothesis has evolved into a rigid, evidence-based law of cardiovascular medicine, supported by a convergence of epidemiology, Mendelian randomization studies, and randomized controlled trials (RCTs). The cumulative evidence demonstrates a log-linear relationship between the absolute magnitude of LDL-C reduction and the proportional reduction in ASCVD risk, independent of the mechanism by which LDL-C is lowered. However, despite this consensus, the hypothesis faces persistent scrutiny. A "Red Team" perspective highlights the divergence between Relative Risk Reduction (RRR) and Absolute Risk Reduction (ARR), the significant Number Needed to Treat (NNT) in primary prevention, and the U-shaped association between LDL-C and all-cause mortality in elderly populations. Furthermore, the failure of earlier agents that raised HDL-C (niacin, CETP inhibitors) has forced a refinement of the hypothesis: it is not the lipid profile per se that matters, but the concentration and duration of exposure to apolipoprotein B (ApoB)-containing lipoproteins.

It was quite the adventure Once I bounce back from the over 50 hours of travel to get back from Africa, I will post some pictures from the hike and the safari Looking forward to jumping back into this group and dropping some educational nuggets Hope you all had a nice "Winter Break" Let me know if there are any new topics you want to learn about