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Posted on Thursday December 12, 2024 in Medication

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Cholesterol, LDL, and what we learnt from PCSK9 mutations in familial hypercholesterolaemia

PCSK9 binds to LDL receptors and directs them to be destroyed within the cell, rather than allowing them to recycle to the surface. When too much PCSK9 is present, fewer LDL receptors remain available to clear LDL from the blood. The result is simple: LDL levels rise. When that happens, the liver compensates by making even more cholesterol internally. This is why around 90% of the cholesterol in your blood is made by your liver, not absorbed from your diet.

Patent Foramen Ovale (PFO): A Hidden Link in Stroke, TIA, Migraine and More — When to Close the Hole in the Heart

Before birth, the foramen ovale is a vital foetal opening between the right and left atria, allowing oxygen-rich placental blood to bypass the inactive lungs. After the first breath, pressure in the left atrium increases, closing the flap naturally. In around 25% of adults, the flap does not seal fully — this persistent communication is called a Patent Foramen Ovale (PFO) which is an important cause of cryptogenic stroke. All standard tests including an echocardiogram can be normal- it can be only be diagnosed using a bubble contrast study and once diagnosed, treatment with clam shell closure is high effective.

When to Operate in Aortic Stenosis: Timing, Symptoms, and Considerations for Intervention

The timing of intervention in aortic stenosis is critical. Delaying surgery or transcatheter procedures until symptoms become severe or complications arise can lead to poorer outcomes. Conversely, intervening too early may expose patients to unnecessary procedural risks. For exceptionally fit individuals aged 75-85, timely intervention can be particularly advantageous, as they may tolerate surgical aortic valve replacement (SAVR) better than expected for their age. In these cases, earlier treatment may prevent irreversible damage to the heart and reduce the risks associated with waiting until the disease progresses further.