Robert Fishberg

[Robert Fishberg @Robdfish]

@hsbhatia @PaulLacaze @Lpa_Doc @JACCJournals @ACCinTouch @UCSDCardiology @UCSDCardFellows Have been treating these patients with aspirin for many years. This variant is available directly from Quest, GB Insight or 23andme.

[Robert Fishberg @Robdfish]

@Lpa_Doc Based on the newest ACC guidelines with a NonHDL chol of 70, he is at goal. However, I would always want the ApoB less than 65 in high risk cases, probably even lower as per Dr Sniderman.

[Robert Fishberg @Robdfish]

@Lpa_Doc 64 y/o with multiple interventions on atorvastatin 40. Chol 114, LDL 55, trigs 75,NHDL 70, Lp(a) 17. ApoB 70!. Will add ezetimide to further decrease risk.

[Robert Fishberg @Robdfish]

@Drlipid I agree. But please add Lp(a) to the initial assessment too.

[Robert Fishberg @Robdfish]

@Lpa_Doc Long term are patients with high Lp(a) with ASCVD better off on dual anti platelet vs aspirin and low dose rivaroxiban?

[Robert Fishberg @Robdfish]

@Lpa_Doc Lowering Lp(a) is the next step after lowering ApoB. Very excited about the new therapies!

[Robert Fishberg @Robdfish]

@Lpa_Doc I respectively disagree. Please look at the new Odyssey Outcomes analysis. ApoB outperforms LDL and NonHDL Chol. Focus on ApoB as goal and we will save more lives!

[Robert Fishberg @Robdfish]

@Lpa_Doc Lowering LDL is only important because it lowers ApoB. The entrapment of ApoB in the arterial wall is the driving force for atherosclerosis.

[Robert Fishberg @Robdfish]

@Lpa_Doc Any thought on whether bempedoic acid would affect Lp(a)?

[Robert Fishberg @Robdfish]

@Lpa_Doc Can’t wait

[Robert Fishberg @Robdfish]

@poptartdaddy @Lpa_Doc @theproof Great case. With lack of family history and probable tuberous Xanthomas. Consider Sitosterolemia. Genetic test would diagnose.
Boston Heart cholesterol balance test would confirm. Ezetimide and diet.

[Robert Fishberg @Robdfish]

@Lpa_Doc Niacin is still useful. I have a few patients who are hyper responders.

[Robert Fishberg @Robdfish]

@Lpa_Doc I haven’t seen the approval. I am only aware of Lp(a) aphoresis when LDL is also elevated.

[Robert Fishberg @Robdfish]

@GrimSpeaker79 @Lpa_Doc I would first change from saturated to a poly or monounsaturated fats. I would also check genetics. There is no indication for PCSK9i for this.

[Robert Fishberg @Robdfish]

@Lpa_Doc Looking forward to their upcoming phase 3 trial.

[Robert Fishberg @Robdfish]

@Lpa_Doc any value for following CIMT in younger patients with elevated Lp(a)?

[Robert Fishberg @Robdfish]

@Drlipid @PeterAttiaMD The ACC/AHA guideline “geniuses” didn’t listen to Dr Sniderman 10 years ago. They won’t listen now.

[Robert Fishberg @Robdfish]

@Lpa_Doc I would study patients in the 99th percentile whose risk is approximately equivalent to heterozygous FH. We shouldn’t wait till we get the Horizon data.
Pelacarsen will take us to “The Promised Land” and will “Prove It All Night”.

[Robert Fishberg @Robdfish]

@Lpa_Doc With a 80% reduction in Lp(a) with Pelacarsen the benefit May outstrip all of the LDL lowering trials. Blockbuster!
Should plan a primary prevention trial in preparation.

[Robert Fishberg @Robdfish]

@Lpa_Doc I would love one!
Rob Fishberg