Matt Hope

Cardiology Fellow @LankenauCV • Formerly Medicine @TempleIM • MD @GeisingerCwlth • MPH @DrexelPubHealth • BS @UrsinusCollege • Opinions my own

[Matt Hope @Matt_R_Hope]

@DrDiGiorgio Polling also shows a higher % on Medicare/Medicaid have a favorable view of their insurance compared to those with private employer sponsored insurance

And despite net favorable opinion, Americans still fear rising costs / administrative complexity with their private plans

[Matt Hope @Matt_R_Hope]

@stringerbell99 @kderosa @Tellit007 My friend, always remember to check the account

(1) Anon account
(2) almost 70k tweets (Averaging 11 tweets per day since 2008)

[Matt Hope @Matt_R_Hope]

@ScottAppliedSci @cremieuxrecueil It’s pretty simple - he’s smart, credentialed, and decided social media content can pay his bills and build his brand

Why go through the slog of post graduate training/actual patient care and/or post doctoral fellowship research when you can just tweet instead

[Matt Hope @Matt_R_Hope]

@cremieuxrecueil @DrNadolsky The best part is when he cooks himself by asking Grok, only to have it reveal he doesn’t actually understand the concept of cardiac mass and why it’s actually a pro-cardiovascular outcome

[Matt Hope @Matt_R_Hope]

@drjohnm Data consistently find anywhere from 80-90% of people who lose significant weight with diet/exercise experience weight regain

“80% regain ~80% of weight lost” is a general rule of thumb within 5 years

I think you need to revisit your priors on this topic

[Matt Hope @Matt_R_Hope]

@drjohnm Discussion gets more interesting as the CAC score climbs

1-99, probably should “do something” for risk reduction

100-299, definitely should

300+, risk appears to be equal to those with established disease

1000+, risk exceeds those with established disease

[Matt Hope @Matt_R_Hope]

@freefallRN @drjohnm @ThomasSowell Statins “if indicated” therefore are a totally reasonable option if a patient wishes to maximize risk reduction over a 30-50 year period

Net clinical benefit is still present, even in primary prevention and despite the small but real side effect/off target profile

[Matt Hope @Matt_R_Hope]

@freefallRN @drjohnm @ThomasSowell You just aren’t understanding my point - I’m not equating lifestyle and statins in primary prevention

I’m arguing that the logic of risk reduction over decades is always “small chance to prevent something from happening years later”

[Matt Hope @Matt_R_Hope]

@maybeadoc1983 @DrDeepMD @drjohnm @ThomasSowell I don’t think so, absent a very severe inherited hypercholesterolemia

Earliest evidence of fibrous plaque development seems to be age ~15-19, so certainly reasonable to avoid medications before adulthood in the “general population”

[Matt Hope @Matt_R_Hope]

@radiokeller @DrDeepMD @drjohnm @ThomasSowell Yep agreed - literature and pathophys seems fairly straightforward on this

It accelerates T2DM in those who are already pre diabetic, it does not seem to “create diabetes” out of the blue in otherwise metabolically healthy adults

[Matt Hope @Matt_R_Hope]

@DrDeepMD @drjohnm @ThomasSowell So even if it were a blanket “give meds to everyone” which isn’t even what I’m saying, the data as we know it today still mostly reflects net benefit to mass utilization of statins for ApoB reduction

[Matt Hope @Matt_R_Hope]

@DrDeepMD @drjohnm @ThomasSowell NNH for statins as it relates to new onset diabetes is 255 patients on a statin for 4 years to have 1 patient develop new onset diabetes

Similar studies suggest of those 255 patients treated for 4 years, there would be ~5 fewer MACE events (heart attack, stroke, CV death)

[Matt Hope @Matt_R_Hope]

@SBlake2000 @Totoro_derGeist @drjohnm @ThomasSowell Your body continues to produce and use cholesterol in cell membranes, in hormone synthesis, and other essential functions uninterrupted

Reducing circulating Apolipoprotein B molecules is just to reduce atherogenesis: The inappropriate buildup of cholesterol plaque in the series

[Matt Hope @Matt_R_Hope]

@SBlake2000 @Totoro_derGeist @drjohnm @ThomasSowell (2) stop the liver from producing excessive Apolipoprotein B (mostly VLDL) and re-circulating it within the vasculature

[Matt Hope @Matt_R_Hope]

@nicknorwitz @realDaveFeldman Thought experiment:

“Perfect Drug A” - no side effects or off target externalities, it brings ApoB (or other surrogate for circulating atherogenic particle count) to 40 mg/dL

In high ASCVD risk patients, do you think this will (a) reduce MACE and (b) promote longevity?

[Matt Hope @Matt_R_Hope]

@freefallRN @drjohnm @ThomasSowell From your profile it seems statins and vaccines are the boogeyman to you

My suggestion: a little less conspiratorial reasoning, a bit more independent thought on these issues - Try depoliticizing it a bit and start from first scientific principles, then see where you end up

[Matt Hope @Matt_R_Hope]

@DrDeepMD @drjohnm @ThomasSowell Let’s try this - tell me why shouldn’t patients be interested in maximizing their ASCVD risk reduction by reducing circulating atherogenic particle count by all safe and evidence-based means available to them? Which can include lifestyle and/or medications?

[Matt Hope @Matt_R_Hope]

@Totoro_derGeist @drjohnm @ThomasSowell Statins do have benefits (help stabilize soft plaque, reduce circulating atherogenic particle count) and do not have neuro degenerative effects

Healthy lifestyle is always #1 priority, but withholding evidence based, cheap, and safe care from patients is silly and bad medicine