Metabolic Podcast Questions

Medical Q&A [Moderated]
1

Hello Docs,

Thanks for this platform and the contents u all generate. Whenever there are extreme claims on health topic I always stop here to get a
clarification. Thanks for the evidence based approach. Back to my question

I am 48 Male South Asian decent with a Family History of Cardio Vascular diseases.

For metabolic syndrome

  • I know currently Fasting glucose < 100 is the norm. On the podcast Austin mentioned about having a OGTT for 1 Hr as Criteria (May be a wish list )
    What is the OGTT Normal value for 30 mins and 60 mins .

  • Also TG <100 and BP 120/80 is that also a part of the little more proactive measurement instead of TG <150 and BP 130/80

  • What would be an ideal LDL-C or Apob Target ? . Currenlty my Apob is 72 and LDL-C is 96 with 5 mg Rosuvastatin.

I have a Primary appointment coming up ,based on your current articles for lipids seems like Lower lipids over longer period of time is better
But I am not sure how much low is better and from Medication Increasing statin Or Combining with Statin/ezetimibe works better in reducing the
values better.

Appreciate all of the information’s shared in your platform

Thanks
Easwara

2

  1. I would use a 1-hour cutoff of 155 mg/dL (8.6 mmol/L), as discussed here and here.

  2. Yes, that represents stricter, more “proactive” cutoffs. For example, even when I see triglycerides of 140 mg/dL I do have some concern about a degree of insulin resistance going on, especially if HDL-c is low as well.

  3. Unfortunately this is getting a bit more into the realm of a consultation, as I do not have enough information to provide comprehensive recommendations here. For “primary prevention” (i.e., a person who has never had a cardiovascular event, does not have known cardiovascular disease, and is not otherwise at exceptionally high risk), an ApoB target of less than around 80 mg/dL is reasonable, although if lower levels can be achieved easily, it would confer incrementally lower long-term risk. Statin dose escalation comes with further, albeit diminishing returns (see here), so if further lowering is desired that is one option, versus combining low-dose rosuvastatin with ezetimibe.

3

Thanks Dr Austin for your response. Few follow-up on the LDL part if u can answer

  • Do u have a similar LDL-c reduction chart for Statin/ezetimibe combination ?

  • I have attached a chart

with percentile Vs Apob values . For a primary prevention for low/medium/High risk under what percentile we should target Apob Is there any data like that ?

Thanks for all of your responses .

[ATTACH=JSON]{“data-align”:“none”,“data-size”:“medium”,“data-tempid”:“temp_1353_1680307615380_737”}[/ATTACH]

Thanks
Easwara

4

Also forgot to ask one more thing Once we start statin do u see any relevance of checking CAC test for every 5 years ?​

5

No, I am not aware of this kind of data given that ezetimibe is only dosed at 10 mg (despite the fact that it shows similar dose-response effect from 1 mg to 5 mg to 10 mg). However there are trial data comparing higher-dose statin against lower-dose statin plus ezetimibe ( Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial - PubMed ).

I do not see an attached chart, but generally target less than 90 mg/dL in general, less than 80 mg/dL for high risk patients, and as low as possible for secondary prevention patients (or those continuing to have cardiovascular events despite treatment).

Also forgot to ask one more thing Once we start statin do u see any relevance of checking CAC test for every 5 years ?​​

No, I would not do this.

6

Thanks Dr Austin for taking your valuable time and responding to my questions . Appreciate that .