r-doc...
Thanks for posting....
The famous 2013 AdComm came down pretty hard on the fact that trig lowering had never really been shown to reduce CVD event risk...Whether that fact was because the trial had never been run or because trig lowering really doesn't lower CVD event risk was left in the realm of conjecture...
These articles that seem to argue that trigs themselves in higher concentrations sort of "gum up the works" and a good idea would be to get a trig vacuum cleaner and clean up the mess...
I don't think this is actually how it works...
My conceptualization is that all lipids and sugars, high energy fuels for the body, are treated in a similar metabolic fashion. The confusion results from the fact that different enzymes are used for different lipids..So blood sugar, triglycerides, and LDL-C are processed in a similar fashion..
The process works like this...the sugar or lipid enters the blood stream and the body decides whether or it needs the fuel immediately or whether it has sufficient amounts of energy presently and then like a prudent house wife, decides to store the excess...The storage bin in this situation is the adipose tissue...So if the fuel supply is sugar...Then insulin is used to lower the blood sugar by converting it into free fatty acids and expediting its storage into body fat..Where it can later be retrieved and used when food is scarce...Trigs are processed in the same manner it's just instead of insulin they use an enzyme Fatty Acid synthase (FAS) which converts trigs into free fatty acids which are then stored in the adipose tissue...That's why I like the term "Trigabetes".
So far so good...OK here's the rub...Both insulin and FAS activity (ability to convert their substrate into adipose tissue) is lowered if systemic inflammation is elevated...So if systemic inflammation is high then insulin is no longer as effective in lowering blood sugar and the blood sugar rises...This is what T2DM is all about..The exact same mechanism occurs in trigs because elevated systemic inflammation lowers FAS's ability to lower trigs and the trig levels increase...The same mechanism must also be seen in elevated LDL...
So the root problem is elevated systemic inflammation (SI)...The elevated blood sugars and trigs are a result of SIs effects on the enzymes that clear these fuel sources from the blood stream..So in the case of trigs it is easy to see why a drug which lowers trigs might not effect CVD event risk if it does not lower the trigs by lowering SI. That is because the CVD event risk is a function of SI and not trig levels....
And that brings us back to Vascepa (EPA)..EPA lpowers SI and that increases the activity of both insulin and FAS...lowering sugar and trigs the proper way...And that is why we are going to see wonderful results on Nov 10th....
":>) JL
AI
