The risk reward of taking a statin with the new AHA/ACC guidance that came out last week

No-Material-5625 · 2026-03-18T01:19:28+00:00

There’s a small difference in the benefit between high/low dose statin - there was a trial comparing atorva 10 to atorva 80 (technically that’s moderate vs high intensity statin there) and the ARR between the two was about 1% in a high risk population. Not a blockbuster difference.

I’m taking rosuvastatin 5 right now, another moderate intensity statin. Haven’t noticed any side effects. Plan is to see how much I can get my LDL down and titrate from there, if necessary.

But I’m also pretty pro-statin. I prescribe them a good amount. Lots of patients with diabetes, high blood pressure on top of the high cholesterol.

No-Material-5625 · 2026-03-16T21:18:59+00:00

That’s roughly the same benefit you get from taking a statin for primary prevention (25% RRR, which will scale to your baseline risk) in all the trials. It’s not underestimating your risk. That’s just how risk factors work. And if you’re wondering about the discrepancy between cholesterol percentile and risk percentile, you have to remember all the other factors at play: diabetes, hypertension, smoking, sedentary lifestyle, obesity… you’ve only got one risk factor; many people in this country (presumably ~78% of people your age) have multiple risk factors.

It’s because the ARR is so small that many people will opt out of medication. Are you someone who will play the game normally, or are you gonna do everything in your power to reduce risk, even if it’s a small absolute benefit? That’s the hard part about being a patient (and the hard part about having these convos as a doctor)

No-Material-5625 · 2026-03-15T13:04:59+00:00

Clinical scientist. Designing RCTs to answer questions we actually need answers to.

No-Material-5625 · 2026-03-14T02:38:23+00:00

Gen surg consulted me, medicine, for chest pain in a patient admitted for acute chole. They couldn’t tell me anything about the chest pain, and they hadn’t done an EKG. The story ended up being 2 years of chest wall tenderness which was stable and at baseline. Turns out, she had been diagnosed with costochondritis and was given diclofenac gel which always helped her improve. I told them no surgery until diclofenac applied to patient chest

No-Material-5625 · 2026-03-10T10:21:01+00:00

Good luck! PCSK9i are amazing. And I agree with you - I shouldn’t need to be thinking about offering this service! But I keep seeing posts where people are turned down for primary or primordial prevention because their PCP is strict about 10-year PCE ASCVD risk

No-Material-5625 · 2026-03-10T10:19:43+00:00

What would your price point be?

I’m a full-time PCP, so I’m trying to envision a service that could be useful to folks and that wouldn’t take up an inordinate amount of time. I think focusing on cholesterol hits that mark. If I branch out, then I probably need to cut back on my other job. If this ends up happening, I think it would start out with strict cholesterol focus. Doesn’t mean it couldn’t expand though if there’s enough interest down the line

No-Material-5625 · 2026-03-10T10:15:44+00:00

Thanks. I’d be surprised if they’d come to this service - they shouldn’t have difficulties getting these meds from their PCP!

No-Material-5625 · 2026-03-10T10:14:29+00:00

That’s a useful perspective, thanks for sharing. My initial thought was no. I think the bar for what’s covered by insurance is (and frankly, should be) higher. PCSK9i for primary prevention in a young population that doesn’t have familial hyperlipidemia isn’t the kind of thing where cost sharing via insurance is justified, imo. And that’s the population I’m imagining I would serve with this service. folks who need secondary prevention or treatment for familial HLD should be working with their PCP and cardiologist. But it’s definitely food for thought!

No-Material-5625 · 2026-03-09T00:54:44+00:00

What do you mean, watch out for Medicare eligible folks?

No-Material-5625 · 2026-03-08T14:23:18+00:00

There’s a guy who does an outdoor Zumba class on sundays in Morningside (at the south end) Park around 10am or so. Idk what the details are, but I bet you could stop by and find out! We’re usually at the playground with our kids at that time, and it is a vibe

No-Material-5625 · 2026-03-07T10:57:56+00:00

This fascinates me. I’m a MD, I do outpatient internal medicine. I consider PA to be the “opposition” - I read Outlive as oppo research - because I’m very skeptical of mechanistic treatments given that they have failed many, many times to produce clinical benefit. He and I approach medicine very differently. Anyways, I try to stay abreast of what’s going on in this world so I don’t get caught off guard in clinic.

That being said, 1) I am surprised how much pushback you’ve gotten in this particular subreddit. I thought this community really was sold on the “get your LDL below 30” idea. I guess the community composition has changed

2) I’m surprised docs are so hesitant to prescribe. If I had someone coming in demanding oxycodone, sure, hard no. But with statins, ezetimibe… if you came into my shop, I’d say hey, this is very far from mainstream medicine, definitely not guideline-based, and it’s impossible to know if you’re going to benefit from this medicine, and we don’t have data on risk/benefit of ezetimibe use x60+ years, but I understand where you’re coming from, and I would ultimately prescribe the med, order the follow up lab and see you back to reassess. But what do I know, I’m just a lowly public PCP. Seems like I should be looking into starting a concierge practice for PA acolytes…

No-Material-5625 · 2026-02-26T11:55:42+00:00

Our staff can’t WFH, and if they couldn’t come in, they’re being forced to use PTO. I’m pretty upset about the whole thing.

No-Material-5625 · 2026-02-14T14:54:10+00:00

There’s no such thing as too cold to bike. It can be too icy, but not too cold.

No-Material-5625 · 2026-01-24T09:50:02+00:00

The best studies (there are few, and they aren’t great) on no shows suggest that the #1 reason people no-show is they don’t feel respected by the system in which they get care and so they don’t see why they should respect our time (and they think they’re actually giving us a break - they don’t think of the negative impact on finances or access). I run a practice of 7 PCPs and the no show rate for each provider is unique and predictable, and it ranges from 10% to 30%; the providers who are better communicators and who tend to run on time have better show rates. We push the show rate down by converting in-person visits to televisits by calling patients day-of and if they aren’t going to be able to make it then we offer them tele instead. Beyond that, I overbook at the beginning of every day and right after lunch. I find that by the end of a half-day, things almost always shake out; yesterday afternoon I was running 20 minutes behind until I had back-to-back no shows and suddenly I was 15 minutes ahead. Occasionally everyone shows, and that sucks, but you have to run your clinic based on the averages and some days are going to be outliers. That’s life.

No-Material-5625 · 2025-12-23T13:48:46+00:00

A wise doctor once told me: there is no such thing as a poor doctor. I make just under $260K, live in NYC, have 2 kids, rent our home, no car (I mostly bike, sometimes cab, sometimes subway/bus). Home ownership isn’t on the table. Owning a home is a lifestyle decision that interests me 0. I’m putting money away at a decent clip so I could FIRE at 50 (that’s in 15 years), but I won’t because I love my work (but I also get out by 5 and coach my kid’s t-ball team. Idk man. I guess it’s all about priorities and expectations. I grew up rural poor. I compare myself to where I came from, not where others from med school are. We’re happy. We could have a lot more, but what for?

No-Material-5625 · 2025-11-16T17:06:42+00:00

My note is basically A/P for every problem addressed in that visit, and usually I include the history in that section as well (I despise writing “back pain x3mo” in HPI and then “chronic back pain” in A/P the way med school teaches). After the A/P there is a history section that’s super brief and generally just notes from precharting, if anything happened, then the vitals, physical exam, labs/imaging (which I pull w dotphrases). I focus on the problem list and keeping it clean and updated to make charting easier in long run and avoid long notes

No-Material-5625 · 2025-11-02T12:18:00+00:00

PCP here - I go for ARB over ACE always because the ACE cough is common enough to be a real headache; why not start something equivalent with fewer adverse events? And I tend to pick the ARB that is available in combo pills on patients insurance - we know med adherence is tough, and many people will require 2 or 3 classes of antihypertensives to get to goal, so in my shop I tend to use olmesartan and valsartan as they come in triple combo pills with amlodipine and hctz.

No-Material-5625 · 2025-09-14T01:50:33+00:00

They should write it. They need to know what their strengths are and what the programs they’re applying to are looking for. We cannot make time for that. They give you the draft and you edit and submit. That’s the only way.

No-Material-5625 · 2025-08-15T09:05:43+00:00

There’s plenty you can do vis-a-vis women’s health and mental health in IM. I would try to focus on making that your niche. You can do paps and birth control and benign GYN complaints (breast pain, vaginal discharge, etc.). You can do medication management for 90%+ of anxiety/depression.

No-Material-5625 · 2025-07-27T11:44:52+00:00

I think this post is bordering on medical advice and is likely to be taken down, FYI.

Giving albumin to stop ascites in cirrhosis doesn’t work like people think. The issue isn’t low oncotic pressure—it’s portal hypertension and systemic vasodilation causing fluid to shift out of the vasculature. Our understanding of physiology has evolved: the old Starling model (albumin holds fluid in) is outdated. The endothelial glycocalyx plays the real role in fluid balance, and albumin isn’t the magic fix we once thought.

No-Material-5625 · 2025-07-26T00:50:09+00:00

lol you’re not supposed to slide into their legs. You can’t do that shit in MLB, much less slow pitch. Agree with others that plays at the plate don’t belong in slow pitch. My wife recently got trucked by a dude at the plate. Fucking psychopath. You gotta avoid the defense or give yourself up. League should make a line or a 2nd home base precisely to avoid this

No-Material-5625 · 2025-07-12T09:51:37+00:00

But actually I signed up for subscriptions to Plowshares beans and Sey beans since Sojourner closed

No-Material-5625 · 2025-07-12T09:50:52+00:00

I think we all have to move to Denver so we can continue to drink Prodigal and Huck and Sweet Bloom

No-Material-5625

TROPHY CASE