Andreas Tridimas: Atherosclerosis Is Greyer Than We Admit
Andreas Tridimas, Consultant in Chemical Pathology and Metabolic Medicine at Wirral University Teaching Hospital NHS Foundation Trust, shared a post on LinkedIn:
“Maybe the honest thing to say is that atherosclerosis is greyer than we like to admit. We all have patients with dreadful disease and nothing obvious against them, and patients with terrible lipids and clean arteries into their eighties. Whatever the alchemy is, we clearly haven’t got it yet.
ZEUS was the same story a few weeks ago. Ziltivekimab lowered IL 6 and hsCRP exactly as designed, and the hazard ratio came out at 0.99. Hit the target, miss the disease. Twice now this year.
Part of it may be that Mendelian randomisation and a trial like this aren’t studying the same people. MR captures a variant acting from conception on a healthy artery across six decades, while HORIZON took patients at 59 who’d already had their event and treated them for five years. That tells you the biology matters. It doesn’t tell you the analyte is still modifiable once the damage is done.
What it doesn’t change is what I do on Monday morning. Get the LDL down and keep it down, treat the blood pressure, sort the diabetes, talk properly about diet, weight, exercise and smoking. If anything I’ll push harder on all of that in someone with a high Lp(a), because right now that’s the risk I can actually do something about.
So I’m not going to pretend I know what Horizon means yet. We’ve had a conclusion without any numbers. Let’s wait an see the full data set at AHA in November.”
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