Neil Nayan Shah

Board-certified internal medicine physician and Wharton MBA. Integrating precision metabolic health, prevention, and wellness. Owner of @TexasWellnessMD.

[Neil Nayan Shah @NeilShahMD]

Wrote this up in full on my Substack — including what I think should have been done differently and why guideline-based medicine isn't always the same as evidence-based medicine.

https://t.co/FsjXqrnkwE

@CardioNerds @ErinMichos @dramitkhera #PreventiveCardiology #Lipids

[Neil Nayan Shah @NeilShahMD]

The cardiovascular risk calculator now endorsed by the 2026 ACC/AHA dyslipidemia guidelines was never designed for the way we're using it. A thread on why this matters for your statin-naive patients. 🧵

[Neil Nayan Shah @NeilShahMD]

What I'm doing in practice: calculating both PCE and PREVENT using the ACC's CVD Risk Estimator Plus, sometimes even multiplying PREVENT × 1.6 for rough risk approximation, and treating divergence between estimates as clinically meaningful uncertainty to discuss with the patient.

[Neil Nayan Shah @NeilShahMD]

@mercury @sxsw The best unwind in town is simply to walk the trail around Ladybird Lake! No need to overcomplicate it.

[Neil Nayan Shah @NeilShahMD]

Check out https://t.co/YHSLIVP6Ce or https://t.co/19kWHJH8HR for validated blood pressure devices. For a simplified list of devices at different price points (the lowest are around $30) visit https://t.co/75zJdRLe5e

[Neil Nayan Shah @NeilShahMD]

Many people only measure their blood pressure at the doctor’s office. Here’s why that’s a mistake.

[Neil Nayan Shah @NeilShahMD]

What to do → Get a validated BP device and trend BP periodically at home.

[Neil Nayan Shah @NeilShahMD]

@schulte_ss @MananShahmd Completely different. It makes sense for a doc to pay rent for their office, but a hospital doc generates far more revenue (and other value) for the hospital than for themselves for work done in the hospital.

[Neil Nayan Shah @NeilShahMD]

@MananShahmd Because docs just complain and then comply! I was surprised when I first learned of this practice. I’ve been on staff at only a handful of hospitals in TX and MA but have never been asked to pay so I guess it’s just regional where hospitals get away with it.

[Neil Nayan Shah @NeilShahMD]

I'm diving into “Lifespan” today. Sinclair is a big name in the longevity space, but I feel like he's too confident in his assertions and doesn't have the scientific humility to accept that so much of longevity requires embracing uncertainty.
What do you think of Sinclair’s book?

[Neil Nayan Shah @NeilShahMD]

@KunalsLab @tjparker I love the DTC health movement, but I haven't seen examples where any DTC service plays nicely with insurance so would love to understand how this works.

[Neil Nayan Shah @NeilShahMD]

@KunalsLab @tjparker I'm confused how General Medicine can predict what insurance prices will be without dx codes. My best guess is they use a generic screening dx code to get the most basic labs covered, but the rest are unlikely to be covered without insurance-approved diagnosis codes.