Impressive results - it's amazing when you just ask!!

Trivia. How many legends can you name in this video? May you watch the video and have a BETTER DAY. And if you can do the splits like the _______ at the end? You're younger than I am. Feel free to share it. It was fun to make. #songwriter youtube.com/watch?v=M2-rIK…

You a never go wrong with a song called Better Day. Another great tune from my brother. Check it out.

This is a really good response to a not so good NYT article. Placebo Effect Revisited | Science-Based Medicine sciencebasedmedicine.org/placebo-effect… via @sciencebasedmed If you ever want to "harness the placebo effect" without deception just start with a VERY low dose of a proven medication.

Was proud to be a part of putting this together. It's simplified but also very evidence-based and all about shared decision making. Check it out along with the new decision aid/calculator decisionaid.ca/cvd/ and also peerevidence.ca.

Gil: This is a beautiful and clever piece of research. However, context is always important. IMHO the differences seen between the groups in LDL and HDL are not big enough to change CVD risk estimates and interestingly they make no mention of blood pressure effects. Thoughts?

The article states a + jump test = a 70% chance you have appendicitis. That is only correct if the pretest probability is ~45%. A post test probability depends very much on the prevalence. I may be wrong but I believe it is more a rule out than rule in test. Thoughts?

Clinical guidelines give risk thresholds for starting #statins based on population benefit. Guidelines should focus more on shared decision making based on individualised risk and patient preferences, argue Sam Finnikin Dr Rani Khatib FESC James McCormack bmj.com/content/384/bm…

It still blows my mind how the foundation of type 2 diabetes pharmacotherapy can be so shaky, with us still not really knowing if metformin prolongs life, or reduces CV events or "microvascular" outcomes onlinelibrary.wiley.com/doi/epdf/10.11… Blair MacDonald James McCormack

We just updated our popular antibiotic sensitivity chart (May 2024). I think you'll find it useful. I believe it is the best one out there but of course I'm biased. Thanks. therapeuticseducation.org/wp-content/upl…

I keep reading/hearing that Apo B is a better CVD risk predictor than LDL. However, we use total chol and HDL in CVD risk calculators. Can anyone point me to evidence that shows Apo B adds important value to CVD risk estimations and if so, how do I use it to make risk% estimates?

That's what I think but would love to hear from the people who think we need to measure Apo B in addition to total cholesterol and HDL to make a reasonable CVD risk prediction. Happy to change my mind if there is evidence - it's an inexpensive test.

Thanks Steve. Can you define nuance with numbers? How about - in patients without established CVD, does the addition of apo B meaningfully change cardiovascular disease risk estimation compared to standard risk estimates (e.g., age, smoking, SBP, TC, HDL) alone?

Agree - 50% of people having a coronary event have SBP< 125mmHg and LDLs < 100 mg/dL (2.6). And so how do we practically use Apo B to improve our risk estimates to enhance shared decision-making. If we can't, it isn't ready/useful for prime time.

Haven't done an exhaustive look at this but here is one reference. Happy to see other info.

I think it is best to hope for medications that reduce CVD risk rather than lower cholesterol. In addition, I would also hope they aren't $7000 a year for an ~1%/year absolute benefit and only in people with a history of CVD.

James McCormack Can take a look here:

Apo B is being promoted as a “better” measurement of risk in the lipid arena. A paper just published shows what knowing Apo B does to 10-yr CVD risk estimates. Apo B likely is a “bit better” BUT you need to look at the actual #s - see my synopsis -happy for constructive comments.

Thanks. Lp(a) would be likely very similar - the big difference is most of our conventional lipid treatments have no effect on Lp(a).

What part are you disagreeing with? Do you have evidence that Apo B importantly improves numeric estimates of risk for individuals over and above using age, sex, total cholesterol, HDL, SBP etc. I can’t find any. Thanks.