geoffrey modest medical blogs

  Will review my understanding of the pathogenesis of coronary artery disease. Then a review of a mendelian randomization (MR) study on lipids, finding that measurements of apolipoprotein B was the most useful one to do (see cad risk lipids mendelrandom pLos2020  in dropbox, or  https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1003062&type=printable     Details:  -- 141,016 participants from the UK Biobank who had genome-wide association studies (GWAS) to find genetic variants reliably associated with lipid and apolipoprotein concentrations  -- mean age 57, 54% women  -- mean nonfasting lipid levels: LDL 138  (3.57 mmol/L) , HDL 56 (1.45 mmol/L) , triglycerides 133 (1.50 mmol/L) -- mean apolipoprotein B (apoB) 1.03 g/L, apolipoprotein A-1 (apoA1) 1.54 g/L  -- they performed univariate mendelian randomization (MR), the traditional one, as well as multivariate MR, a recently developed extension...

  HDL overall is mostly a protective cardiovascular risk factor, but it is only a surrogate marker (see below), and extremely high levels are associated with elevated cardiovascular risk (see  lipids extremely high hdl jthoracicdis2018  in dropbox, or  doi: 10.21037/jtd.2017.12.97) Review : -- a large observational Danish study (see  lipids extremely high Danish study EHJ2017  or doi: 10.1093/eurheartj/ehx274) included 52,268 men and 64,240 women from two prospective studies, with 745,452 person-years of follow-up     -- men: mean age 58, BMI 26, 21% current smokers, 11 alcohol unit consumption per week, physical inactivity 45%, systolic blood pressure 142mmHg, diabetes 5%, lipid-lowering therapy 13%, HDL 52/LDL 124/triglycerides 143     -- women: mean age 57, BMI 26, 19% current smokers,   6 alcohol unit consumption per week, physical inactivity 54%, systolic blood pressure 136 mmHg , diabetes 3%, lipid-lowering therapy 9%, HD...