Homocysteine and B Vitamins: What the Trials Showed
Quick Summary Homocysteine is an intermediate in methionine metabolism, cleared by remethylation requiring folate and B12, or by transsulfuration requiring B6. Observational data linked elevated homocysteine to cardiovascular disease and dementia, which drove large randomised trials of B vitamin supplementation. Those trials, including HOPE-2, lowered homocysteine substantially and did not reduce myocardial infarction or cardiovascular […]
Sleep Apnea Screening: The Missed Diagnosis in Lifters
Quick Summary Obstructive sleep apnoea is common, under-diagnosed, and disproportionately affects exactly the phenotype this site is written for: large, thick-necked, heavily muscled men. Peppard and colleagues documented substantially higher prevalence than earlier estimates, tracking the rise in body mass across the population. Untreated apnoea drives hypertension, raises hematocrit through nocturnal hypoxia, worsens insulin resistance, […]
Blood Pressure: The Most Underrated Risk in Lifting
Quick Summary Hypertension is the largest single contributor to global cardiovascular death, and it is silent until it is not. Androgens raise blood pressure through sodium and water retention, effects on the renin-angiotensin system, and adverse changes in vascular stiffness and endothelial function. SPRINT demonstrated that intensive systolic control reduced cardiovascular events and death compared […]
Bempedoic Acid: Evidence Review for Statin Intolerance
Quick Summary Bempedoic acid inhibits ATP citrate lyase, a step upstream of HMG-CoA reductase in the same cholesterol synthesis pathway that statins target. It is a prodrug activated by an enzyme found in liver but not skeletal muscle, which is the mechanistic basis for its low rate of muscle-related side effects. CLEAR Outcomes randomised over […]
Liver Enzymes for Lifters: Why ALT and AST Mislead
Quick Summary ALT and AST are both present in skeletal muscle. Heavy resistance training, especially eccentric work, raises them substantially in people with entirely normal livers. Pettersson and colleagues showed that a single bout of heavy weight training can push these enzymes into ranges that look like hepatitis, and keep them there for a week […]
Hematocrit on Testosterone: Erythrocytosis Explained
Quick Summary Testosterone reliably raises red cell mass, primarily by suppressing hepcidin and increasing iron availability for erythropoiesis, with a secondary rise in erythropoietin sensitivity. Erythrocytosis is the most common dose-limiting effect of testosterone therapy, and it is far more frequent with injectable preparations than with transdermal ones. The link between treatment-induced erythrocytosis and thrombotic […]
Coronary Artery Calcium Score: Imaging Beats Guessing
Quick Summary A CAC scan is a short, non-contrast CT that quantifies calcified plaque in the coronary arteries and returns a single Agatston score. It measures disease that already exists rather than estimating the probability that disease might develop, which is why it reclassifies risk so effectively. A score of zero in an asymptomatic person […]
Lipoprotein(a): The Inherited Risk You Test Once
Quick Summary Lipoprotein(a) is an LDL-like particle with an extra apolipoprotein(a) tail. Its concentration is roughly 80 to 90 percent genetically determined and stays broadly stable across adult life. It is causally associated with atherosclerotic cardiovascular disease and with calcific aortic valve stenosis in Mendelian randomisation and large cohort data. Roughly one in five people […]
ApoB vs LDL Cholesterol: The Number That Predicts Risk
Quick Summary Every atherogenic lipoprotein particle carries exactly one apolipoprotein B molecule, so ApoB is a direct count of the particles capable of entering and damaging the artery wall. LDL cholesterol measures the cholesterol cargo inside those particles, not how many particles there are. The two usually agree, and when they disagree the particle count […]
Cystatin C vs Creatinine: Kidney Tests and Muscle Mass
Quick Summary Serum creatinine is a breakdown product of muscle. The more muscle you carry, the higher your creatinine runs at any given true filtration rate. That means creatinine-based eGFR systematically underestimates kidney function in heavily muscled people, and can produce a chronic kidney disease label in someone with normal kidneys. Cystatin C is produced […]