Dr. Michael Richman MD
Region: US
Tuesday 08 September 2026 00:46:59 GMT
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Markus 🇪🇺 :
It’s a failure of Mendelian Randomisation to understand pleiotropy. The LPA gene does much more than increase lp(a) production - high Lp(a) is only a signal that you have a hetero- or homozygous mutation for the risk allele on a single SNP of the gene. LPA also controls thrombosis for instance, which is probably why there’s an increased CVD risk. It’s the same with LDL, which is why reanalysis of PCKS9 inhibitors shows zero benefit from extreme lowering of LDL. It would seem that ApoB, lp(a) included has very little to do with atherosclerosis and the primary causes are endothelial insult and metabolic dysfunction, with lipoproteins representing only a tiny residual risk
2026-09-08 01:12:33
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Eric Farber :
I’m confused, what should you be testing for on the lipid panel to understand your risks?
2026-09-22 03:15:37
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Susan :
I have had 20 years of heart disease. This year a Heart attack in April. Statins and many other drugs for years. Started Repatha after they checked my lipoprotein an and is 272.
2026-09-08 18:55:58
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Cmcwolf :
I had an ischemic stroke at 47. The ONLY thing they could find of all possible causations was lipo a-unlikely, but i hang onto it for dear life. I was so hoping this would be a better outcome. On repatha so will just continue to cross my fingers. Thanks for being real.
2026-09-08 04:34:17
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Kpeel :
Repatha doesn’t lower cardiovascular events?
2026-09-08 04:03:15
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rafaellugomd :
I think lowering ApoB is king. Lpa is driving the inflammatory response. Well my take is that it failed to decrease events in very sick people. But I think the role of lpa is more preventive. More important in people before plaque develop. It has a role more in the inflammatory phase that ignites the injury. They need to do a test in high lpa before plaque. Reduce and see what happens. I think the people studied, already are too far.
2026-09-08 02:47:44
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user6036464071445 :
But GLP1s do reduce events? Does not make sense.
2026-09-08 12:21:57
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colleen :
I usually hate your vids cuz you are opposite of my view, today we ride together. You explained this so very well.
2026-09-08 03:13:06
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MomH :
I also recall the many years that cardiologists advised use of margarine instead of butter. It's hard to trust "science."
2026-09-10 16:30:22
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Ali :
Forty years ago, my high school science teacher taught me that failing to prove your hypothesis is never actually a failure, you’ve learned your hypothesis is wrong which is equally useful. I still think about that all the time.
2026-09-08 19:36:39
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Ryan Graham :
Got mine finally but just showed Lipap A-1 of 164 and Apo B of 99. Still that unsure of the meaning of the A-! and ratio
2026-09-08 16:54:12
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IamGina5.0 :
But Dr. Ali and Dr. Peter Attia support the use of a PKS9 inhibitor.
2026-09-08 03:33:17
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alexanderle826 :
Goat video, don’t see takes like this online often
2026-09-09 03:49:42
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NTK2404 :
I’m one of your biggest fans, not because you’re a “great doctor,” but because you share the data as it is and let people think for themselves. What concerns me is how some physicians on social media helped turn Lp(a) into the next big obsession, sending everyone to get tested while a multibillion-dollar industry is being built around it. Whether intentional or not, the hype can distract from the basics that have decades of evidence behind them. It’s time to get back to fundamentals and tell people what actually matters for cardiovascular risk, while being clear about what is proven, what is promising, and what is still just a biomarker. Keep doing the amazing job of putting the data first. I’m already wondering what the next lipid “bubble” will be.
2026-09-08 04:32:49
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Robin :
Terrible trial! They shouldn’t have tested this on people with literally end stage disease and very high plaque burden. It’s not supposed to take the plaque away. It’s supposed to help prevent the plaque from laying down in the first place so you should test people who have high Lpa but little disease that goes along with it! And then track them and see if it prevents them from getting worse over the years.
2026-09-10 02:28:20
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Chris_H :
Lower apob … there is no floor.
2026-09-10 10:49:20
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Serenity :
* ApoB = the number of atherogenic particles in your blood. * Lp(a) is one type of ApoB-containing particle. * So, if Lp(a) is high, it contributes to the ApoB number. * But if your Lp(a) were low, a high ApoB would have to be coming from other ApoB-containing particles, such as LDL particles, VLDL/remnants, etc.
2026-09-09 00:03:27
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Mr. Meaner :
COC is 1924 APOB is 24
2026-09-08 00:57:18
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Virgu :
Love your informative videos. Tx!
2026-09-09 21:16:04
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Mitch728 :
So we should not let plaque develop in the first place. Does that imply beginning ldl lowering therapies at a very young age, before tests would indicate they're needed? In the real world, many people won't give up their poor diet, etc.
2026-09-08 10:54:13
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The Armenian :
:So should we, instead of acting after the horse has left the barn, start in childhood identifying people with a susceptibility to having high cholesterol?
2026-09-08 13:15:04
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Candace hope :
So don’t take repatha? I thought repatha was to lower your ldl
2026-09-08 10:31:05
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roman.kaput :
Thank you for that. I was really disappointed because I hoped we'd have another tool we could use.
2026-09-08 07:47:44
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Bill0912 :
I had a heart attack at 45 and my ldl was low. (I think around 50, 15 years ago) My LPa is 195. My Apo B is now under 20. (On repatha and was 40 mg Crestor but now 10mg after ldl under 10.). I was hoping these new treatments would be the fix. Thanks for explanation. Is there any info how many heart attacks were in this test?
2026-09-08 02:13:30
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RachyDR :
Thank you!
2026-09-08 14:25:24
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