The Forbes article "Epigenetics: The Brain-Booster You've Never Heard Of"

that Cabel shared is a very entry level article on epigenetics. I get the feeling that the author doesn't have a very good grasp on what epigenetics really is and was just wanting to throw that big word around. If the author's goal was to educate people on epigenetics, I think she failed miserably.

 

Over to the LDL-C article.....the DailyMail article that Cabel shared is based on the recent study "LDL-C Does Not Cause Cardiovascular Disease: a comprehensive review of current literature" published in Expert Review of Clinical Pharmacology.

 

I am not swayed by an extreme minority opinion published in a journal most have never heard of. I'll side with the true experts in the field that the LDL-C hypothesis is solid and is not going away anytime soon. In my opinion, the DailyMail article was much better than the actual scientific article it is based on.  At least the DailyMail article acknowledged that LDL-C reduction in high-CVD risk patients with established heart disease has been unequivocally proven over and over again to reduce risk of subsequent MACE and aggressive LDL-C lowering in these patients should be continued. The Expert Review of Clinical Pharmacology article is extremely ugly in its unproven bias that clinicians should entirely abandon the use of statins and PCSK-9 inhibitors. Perhaps there is some merit in the argument that statins and other LDL-C lowering drugs are overly prescribed and over-used use in low-risk patients (LDL only risk factor, no history of cardiovascular disease). However, the authors of this  Expert Review of Clinical Pharmacology article unfairly demonize the clinical benefit of any and all LDL-C lowering approaches. Not a fan of this article at all. 

 

Koo has asked several times a question related to "The 30% RRR is over and above what the statin provides seeing that both groups on BOM are on statins.....Correct?" 

 

Yes Koo, you answered your own question that should have been obvious in the first place. Both placebo and apabetalone groups are on statin standard of care, so any apabetalone-mediated RRR in MACE is going to be on top of a statin background. There is no apabetalone only (w/o statin) group in BETonMACE.

 

That leads to Golfyeti's question:

 

"Bear, do we have solid data on the effects of Apabetalone on patients NOT on statins?  We're some included in the earlier and short-duration trials?   My angle here is "At what point would Apabetlone be widely prescribed like statins have, as either preventative medicine or at least prescribed widely to anyone with low or moderate risk?""

 

The only apabetalone trials in which patients were not required to be on a statin are short term (5 week or less trials).

 

5-week Glucose metabolism in patients with pre-diabetes trial: https://clinicaltrials.gov/ct2/show/NCT01728467

 

4-week Early safety and apoAI/HDL elevation: https://clinicaltrials.gov/ct2/show/NCT00768274

 

They also did the single dose clinical trial in New Zealand in patients with kidney disease, but that was just a single dose. 

 

In order for apabetalone to become widely prescribed to those with even low- to moderate-risk for cardiovascular disease, likely many more clinical trials will be needed. What patient populations? What risk factors? What endpoints? How many patients will be required? How long will they need to be followed? Those are all great questions for the future. First things first. Pass BETonMACE with flying colors.

 

BearDownAZ