[image] Dr. Twyman hosts a September AMA featuring an in-depth analysis of the Horizon Pelacarsen Lp(a) trial’s top-line failure to reduce cardiovascular events, followed by a structured Q&A on Alzheimer’s prevention, omega-3 dietary forms, statin management, blood pressure monitoring, inflammation-targeted therapies, and emerging CETP inhibitor research. He emphasizes prevention-first strategies, vascular inflammation assessment, and practical management of ApoB, lipids, and lifestyle factors, with clear follow-ups tied to upcoming data releases. --- ## Informal Discussion on Alzheimer’s Research and Omega-3s Before the formal session, Dr. Twyman and a participant discuss a newly released podcast on Alzheimer’s prevention. Dr. Twyman underscores that treating Alzheimer’s after mild cognitive impairment appears too late, directing attention to primary prevention. He clarifies that tau and amyloid are the central proteins implicated in Alzheimer’s pathology; while trial settings can quantify tau-related tangles, such assays are not yet commercially available. He reiterates that heart-healthy actions are brain-healthy: the American Heart Association’s Essential Eight—nutrition, exercise, stress management, sleep, not smoking, and tight control of blood pressure, blood sugar, and blood lipids—support both cardiovascular and cognitive health. Genetic risk is highlighted, noting APOE 4/4 confers the highest Alzheimer’s risk, while APOE distributions vary across the population. A key nutritional distinction is detailed: DHA from seafood arrives on a triglyceride backbone in the sn-2 position—the configuration the human body expects for efficient brain uptake and receptor engagement across the blood-brain barrier. Algae initially produce DHA in sn-1/sn-3; fish enzymes reconfigure it to sn-2, which humans then absorb as intended. Processing fish or manufacturing supplements may displace DHA from sn-2 to sn-1/sn-3, potentially impairing neuro-uptake. This mechanistic nuance likely explains why many fish oil supplement trials show anti-inflammatory cardiovascular signals but fail to demonstrate neuro-benefits; Dr. Twyman thus favors consuming seafood (when not contraindicated) to deliver DHA in the biologically aligned form.

@Deborah Bevvino You’re welcome. Glad you liked it

https://www.skool.com/drtwyman/recording-ask-me-anything-september-2026?p=4924a591

@Terri Rae Jones I'll do the recording of the podcast with Dhru tomorrow, and I suspect he'll try to get this one out relatively quickly in the next week or two. It will be interesting to see if LDL particle will make a resurgence. My understanding it was a cost issue as well as how often Apo B and LDL-p are discordant as why BHD stopped offering the test. Quest and Labcorp still offer NMR lipoprotein analysis