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Ethan Weiss
UCSF scientist (metabolism)/cardiologist (prevention); 2 girls, 1 wife , 1 dog; , , & latest distraction:
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Ethan Weiss 14h
Replying to @skathire
Doesn’t this weigh towards using PCSK9I in people with high risk and high Lp(a) at least until direct acting therapies are available?
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Ethan Weiss Jan 16
Replying to @gcbioinv
Wow
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Ethan Weiss Jan 16
Replying to @tony_breu
Ps - physiology is the greatest
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Ethan Weiss Jan 16
Replying to @smac121
Yes!! Next week?
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Ethan Weiss Jan 16
Replying to @tony_breu
If you decrease SVR but can’t augment stroke volume you will decrease blood pressure and with the LVH and high filling pressures, I’d bet that impacts the coronary perfusion pressure and then... but I’m sure all these experiments have been done in people and dogs
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Ethan Weiss Jan 16
Replying to @tony_breu
Not sure. I actually think there is probably a role for decreasing coronary perfusion but I’m late to a dinner and wish I had time to really dig in on this. It’s so interesting!
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Ethan Weiss Jan 16
Hint: what happens when you give a patient with severe AS a vasodilator?
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Ethan Weiss Jan 16
Good question
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Ethan Weiss Jan 16
You should call poison control ASAP
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Ethan Weiss Jan 16
Yes it reminds me how I felt when I moved here in 1998 from East Baltimore - In terms of violent crime, SF is safer than Miami, Phoenix, Buffalo, Minneapolis, Nashville, Anchorage and Albequerque (among others)
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Ethan Weiss Jan 16
Replying to @DBelardoMD
I think I am having a STEMI now
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Ethan Weiss Jan 16
Replying to @Eva3034385615
Only people with mutations in this receptor. I imagine that is very rare...
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Ethan Weiss Jan 16
Breaking: attendees love complaining about San Francisco 'I feel unsafe': JPMorgan conference attendees weigh in on SF via
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Ethan Weiss Jan 16
But we could have hung out...
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Ethan Weiss Jan 16
Replying to @ethanjweiss
Of course, as the authors say here, ketogenic diets are strictly contraindicated in patients with loss of function mutations in MCT-1
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Ethan Weiss Jan 16
Replying to @ethanjweiss
Finally, it is so interesting to speculate that lower ketone levels in the brain might well lower the seizure threshold (in addition to what is known about higher levels of ketones apparently raising the seizure threshold)
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Ethan Weiss Jan 16
Replying to @ethanjweiss
This also highlights that lower levels of BOHB in plasma do not necessarily mean lower levels ketogenesis
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Ethan Weiss Jan 16
Replying to @ethanjweiss
This highlights why it is important to remember that steady state levels of BOHB reflect the rate of appearance (production) of BOHB minus the rate of disappearance (use). In this case, the rate of disappearance was zero because of the mutation in MCT-1
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Ethan Weiss Jan 16
Replying to @ethanjweiss
The patient could tolerate normal levels of BOHB but when on a ketogenic diet, the levels of BOHB increased so that there were severe metabolic derangements including acidosis
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Ethan Weiss Jan 16
Replying to @ethanjweiss
This is a fascinating story where loss of the main transporter (MCT-1) for beta hydroxybutyrate (BOHB) appears to predispose to seizures and therapeutic ketogenic diet causes severe metabolic abnormalities
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