đ ASB Partners Nuggets 2.21.25
This is a short weekly email that covers a few things Iâve found interesting during the week.
Interesting Links/Reads
Many links are sourced from Marginal Revolution
But how do you know when the corporations are winning and when you are? Mr. Kelly uses a simple formula to calculate the value of any points offering: He divides the listed cash price of the productâthe airline ticket, hotel stay or car rentalâby the number of points required to redeem it. For example, a $100 plane ticket redeemable for 10,000 points makes each point worth one cent. Only points rookies cash in at one cent or less; for Mr. Kelly, the dream is to get five cents or more for each point.
Podcast/Videos
đTLDR - You can get your ApoB checked with a regular blood draw at your annual physical (your doctor and/or cardiologist might not know what it is so just ask for it) and it might help you make moves to prevent/delay heart disease, which is still the leading cause of death in the US and globally, of both men and women
đFrom the Show Notes of the Drive Podcast
Define what is meant by atherosclerotic cardiovascular disease (ASCVD)
â Thatâs a very specific type of a vascular disease, and that means arteries throughout your body acquire a pathology: deposition of cholesterol in the artery wall
If you donât have cholesterol in your artery wall, you donât have atherosclerotic heart disease
We have many arteries in our body and some are much more afflicted than others
The arteries of most concern are the smaller ones supplying our heart and brain
Because those are essential organs that need a profuse blood flow with all the nutrients and oxygen in the blood
The lumen of the cerebral arteries is so small: itâs like the dot of a pencil, so it doesnât take much to affect the blood flow thatâs going through it
The bigger arteries that are bringing in blood to the brain are pretty asymptomatic until they are 75, 80% occluded
At which point those organs are deprived of the nutrients they need
This can build up for a long time without you knowing it
At least if you report chest pain, you will get diagnosed in time to do something about it
â This is different from a plaque rupture where youâve got 4 minutes for somebody to dial 911 and hopefully somebody can give you CPR until you can get and take a clot buster
âIt takes decades for this plaque to finally get to a point where itâs noticeable on some diagnostic image. Certainly, it would take even longer for symptoms to occur, and everything. So, itâs a slow-slow process.ââ Tom Dayspring
In the 1st year of medical school, the pathology professor asked, âWhatâs the most common presenting sign of myocardial infarction?â
Of course, every medical student put up their hand and went through the litany of symptoms that you might have; chest pain, shortness of breath, left shoulder pain, nausea, etc.
He said, âNo, itâs actually sudden death.â
That was true at the time
Itâs not still true today, but itâs close
Risk factors versus risk markers for ASCVD, and how insulin resistance and chronic kidney disease contribute to atherosclerosis [17:30]
There is a difference between risk factors and risk markers
Risk factors have been shown to be causal of the disease through the ways you do that Mendelian trials, a ton of randomized trials, and even observational trials
Risk markers are not causal per se (theyâre associative)
Thatâs not to say theyâre not important
How ApoB-containing lipoproteins contribute to atherosclerosis, and why measuring ApoB is a superior indicator of cardiovascular risk compared to LDL cholesterol [29:45]
Tom explains, âApoB is the ballgame nowadays. Itâs not widely tested like it should be, but anyway, cholesterol has got to get in your artery wall to cause this disease, atherosclerosis.â
I hope you enjoyed it.
Adam