More on ASCVD.....wish it was OT

Interesting review article emphasizing lack of precision and opportunity for missing primary prevention strategies using risk based calculators alone.

Personalized Intervention Based on Early Detection of Atherosclerosis: JACC State-of-the-Art Review - ScienceDirect Personalized Intervention Based on Early Detection of Atherosclerosis: JACC State-of-the-Art Review - ScienceDirect

I found this link in a quick search for better access to this article that drifted across my radar screen this am. Serendipitous as a reminder since it’s my appointment with my PCP tomorrow and intervention cardiologist on Monday. A reminder (or awareness raiser for the unaware) of the dangers that “soft”, uncalcified plaque brings ….and the difficulty of detection even with CAC scanning.

https://academic.oup.com/eurheartj/article-abstract/46/46/5073/8248351?redirectedFrom=fulltext&login=false&fbclid=IwdGRzaAOmPKVjbGNrA6Y5sWV4dG4DYWVtAjExAHNydGMGYXBwX2lkDDM1MDY4NTUzMTcyOAABHv4qkiHDLMcL7D2LAxHaraHq7_DpQuVkHwjmSe0g5xXQnmiwEBZgSID1Uk3D_aem_ZRRKIFbDOIugxQpkeocBoA

I don’t know how the 2 links show up on others’ screen but for me, the second has a big set of letters but very few words when opened. Very descriptive graphic, though with an eye opener of what a zero CAC score might actually indicate in the earlier stages of ASCVD.

Here’s 2 more (hoping they show up tidy)

There’s a “heavy lifter” on the forum where the European article was posted who’s doing a lit search service (with knowledgeable oversight) for a couple of cholesterol denialists showcasing their majestic stoopid.

Making use of a sleepless night

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Friendly reminder that your lipid.org abstract states that sleep loss negatively impacts ldl-c.

I saw that. Bloody lawyers and ex son-in-law to blame for that state of affairs, though! Doesn’t seem to be a remedy that’s legal, unfortunately :roll_eyes:

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The glymphatic system wasn’t discovered until 2013, and I was totally unaware of it, and the role of sleep in clearing junk out of the brain and warding off dementia, until sometime after I retired 12/31/18. Sleep did not become an essential component of my health and fitness regime until recent years. For forty years I thought I could work fifty plus hours per week, meet family obligations, eat well, go for early morning runs, and thrive on 4-5 hours sleep per night.

No.

I cannot fully regain my cognition without adequate sleep which optimally would be 7 hours per night. Until recently that was an unattainable Holy Grail. But with a combination of daily exercise, daily meditation both guided and informal practice, and low sugar/alcohol diet, I am getting 7 hours sleep nearly half the time.

It never occurred to me to look for a possible sleep/lipid connection till I read this article.

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Fitful sleep is a new phenomenon for me….a feature of the last two years of mayhem, really. Prior to that I could sleep anywhere, any time of the day or night. My husband’s regular joke was that I could hold workshops teaching folk with narcolepsy how to get more sleep.

Fortunately for me, cronies back in England and other parts of Europe are up and provide a bit of company and commiseration.

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@iampops5 @VeeEnn

I have been fascinated by the glymphatic system ever since it was first published a few years ago.

The glymphatic system functions during deep sleep.

The piping of the glymphatic system is a “tube in tube” arrangement. During the day, the outer tube is constricted and lies tightly against the inner tube which is the capillary. At night, the white matter of the brain (glial cells) constrict by about 40%. This provides the space for the outer tube, which carries cerebral spinal fluid containing waste products (including misformed proteins) to be carried away.

Here’s the part that pertains to ASCVD.

The outer tube wall is made up of the “feet” of glial cells. It’s rigid.

The inner tube wall pulses as the blood flows through the capillaries. This pulsation pushes the CSF through the outer tube of the glymphatic system against the rigid outer tube wall. The glymphatic system doesn’t have its own pump. It’s pushed by the pulsing of the blood in the capillaries.

The brain’s glymphatic system drains cerebrospinal fluid (CSF) and waste products from the brain tissue into the body’s regular lymphatic system which ultimately drains into blood circulation.

The heart provides the pressure pulse through the aorta and carotid arteries and into the brain. Healthy arteries have smooth muscle which can help push the blood along and regulate blood pressure. But athersclerosis stiffens arteries all over the body, not only in the heart.

Think about the implications if the tiny capillaries in the brain are too stiff to pulse enough to propel the glymphatic fluid through the tiny vessels to remove waste from the brain. Those waste products will build up because there’s nowhere else for them to go.

This is why sleep is so precious, especially as we get older. Especially the deep phase of sleep when the glymphatic system operates.

And this is why we have to prevent lipid buildup in our blood vessels. Not only the heart but the brain as well.

Wendy

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Amazingly “clever” system.

Another review article linked to by one of the heavy lifters I mentioned upstream.

I like the “too much, too late” philosophy the author holds. I oftentimes find myself wondering if, say, statins at first introduction would have been “enough, early enough “ to have kept my coronary arteries clear…

https://www.ahajournals.org/doi/10.1161/ATVBAHA.123.320065?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed&fbclid=IwVERDUAOmpOpleHRuA2FlbQIxMABzcnRjBmFwcF9pZAwzNTA2ODU1MzE3MjgAAR622ZG8d9wYCupwpaCNw9KflS9c6_GO1-9JmSqTroyjiAtWEGNCc2PSVA8QbQ_aem_C1gK8kFIw2uPRWo37O_64g

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Thank you for adding your excellent summary and talk by Maikin Nedergaard.

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Your article looks interesting and potentially compelling but between watching the video posted by Wendy and building snowmen with my grandson who has been out of school for snow closings since Friday last week, I am a surprisingly busy retiree. Maybe I can give it a fair reading tomorrow.

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Equally time crunched as a rule, but my car’s in the shop so I’m excused from grandma duties. I suppose I could do some cleaning…..but I don’t want to overexcite myself (being a near cardiac cripple and all😉)

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Wendy,

At 8 minutes the speaker makes some claims on the blood brain barrier. She is wrong. Protein does cross the barrier in a highly regulated way.

I have posted a second AI result on the venous artery system that is a better explanation than hers at 12:50.

It is fascinating what she is discussing. I have limited time to research where she is right or wrong. The problem is a lot of her conversation is only theoretical. She is presenting “facts”. It is a mixture.

AI Overview

[image]

Yes, proteins can leave the brain across the blood-brain barrier (BBB), but it’s a tightly regulated, selective process, often involving specific transporters or endocytosis, not free leakage; small molecules and some proteins (like alpha-synuclein, tau, prion proteins) move bidirectionally, while large, water-soluble plasma proteins are generally excluded, though BBB damage (like in injury or disease) allows many more proteins to pass.

How Proteins Cross or Are Restricted

  • Transporters: The BBB has specific carrier systems (like LRP-1 for alpha-synuclein) that actively transport certain proteins in and out.
  • Receptor-Mediated Transcytosis: Some proteins bind to receptors on BBB cells, get engulfed (endocytosis), and then transported across.
  • Adsorptive Endocytosis: Viral proteins or fragments can use this pathway to enter or exit.
  • Size & Solubility: Large, hydrophilic (water-loving) proteins from the blood struggle to cross into the brain, maintaining low brain protein levels.
  • Efflux Pumps: The brain actively pumps many proteins back out into the blood.

Examples of Proteins Crossing Bidirectionally

When the Barrier Breaks

  • In conditions like Traumatic Brain Injury (TBI), tight junctions loosen, allowing large serum proteins like fibrinogen and IgG to leak into the brain, causing damage and inflammation.

In essence, the BBB isn’t a solid wall but a smart gatekeeper; while it blocks most things, specific proteins use designated VIP entrances (transporters) to move in and out, and damage opens the gates wide.

AI Overview

In the brain, arteries and veins generally run in different patterns;

major arteries have parallel counterparts, but the venous drainage is unique, collecting into large, valveless dural sinuses rather than directly parallel veins, though smaller cortical arteries and veins often run side-by-side in the surface layers before deep drainage.

Key Differences

  • Arterial System: The brain has two main arterial systems (carotid and vertebrobasilar) that form the Circle of Willis (a key arterial structure), branching into progressively smaller arteries that dive into the brain tissue to supply specific regions.
  • Venous System: The brain’s veins don’t perfectly mirror the arteries; they primarily drain into large, unique channels called dural venous sinuses, which are channels between layers of the dura mater, not muscular veins.

Where They Run Together

  • Cortical Surface: On the brain’s surface (cortex), you’ll find smaller arteries and veins running somewhat parallel as they supply the outer layers, as shown in diagrams of cortical arteries and veins.
  • Deep Drainage: Deep veins drain the brain’s interior towards the ventricles and then the sinuses, in a different path than the penetrating arteries.

The Key Distinction

  • While arteries plunge deep, the venous system collects blood via superficial veins and deep veins into sinuses, which then drain to the internal jugular veins. This setup is different from other organs where veins typically run right alongside their corresponding arteries.

My comment she does end up saying much of what is in this second AI response. She began by presenting her approach as revolutionary. We humans have that tendency. It is a bit like who gets to copyright or patent someone else’s DNA.

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….and, apropos of “Too much, too late”, my bloodwork from yesterday is right on target.. LDL-C at 32 mg/dL, HDL, 61, triglycerides 56. My total cholesterol is now measurably lower than my LDL-C prior to starting my meds.

My girlfriend in England (whose, LDL-C was actually lower than mine, and whose GP ignored her shoulder pain for weeks…..yes, turned out to have been an MI!) is on a similar regimen. We bellyache together about how we’d have gotten a good few indefensible lawsuits handed to us if we’d have supervised a similar decline into periodontal disease in our patients.

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