Ticker: Don't die of heart disease • Hacker News Board

Re: Ticker: Don't die of heart disease

#101

Post by dumbmrblah » Sat, Nov 08, 2025, 5:52 PM UTC

throwaway89201 wrote: post #55

I'm not sure that non-medically indicated CT scans are a great idea, as you're at least doubling your yearly dose of radiation in the year of the CT scan. Perhaps it's warranted, but the article doesn't seem to balance that at all against doing a CT scan "every 1-5 years".

I agree. As a physician, this is sticking out to me as bad / dangerous advice. By getting unneeded regular CT scans, you’re dramatically increasing your risk of developing cancer. Beyond the radiation exposure itself, there is also the very real possibility of incidental findings that can lead to further testing, invasive biopsies, and unnecessary interventions, all of which compound your overall risk. You might solve one problem, but you’ve just guaranteed a much bigger, more explosive one down the line.

Re: Ticker: Don't die of heart disease

#102

Post by Esophagus4 » Sat, Nov 08, 2025, 5:52 PM UTC

throwaway89201 wrote: post #55

I'm not sure that non-medically indicated CT scans are a great idea, as you're at least doubling your yearly dose of radiation in the year of the CT scan. Perhaps it's warranted, but the article doesn't seem to balance that at all against doing a CT scan "every 1-5 years".

Yes - in addition, medical professionals warn against “overdiagnosis” from unnecessary screenings.

This can happen when we choose to treat otherwise benign issues that would have had few negative consequences for our health or longevities. Those treatments can have negative effects that are worse than the ailment we’re trying to treat.

I know it’s a natural tech-guy impulse to quantify everything and get access to as much data as you can, but that myopic focus can actually lead us to optimize for the wrong thing.

[1]https://pmc.ncbi.nlm.nih.gov/articles/PMC4077659/

[2]https://pmc.ncbi.nlm.nih.gov/articles/PMC6135119/

Re: Ticker: Don't die of heart disease

#103

Post by poszlem » Sat, Nov 08, 2025, 5:52 PM UTC

lateforwork wrote: post #11

loloquwowndueo wrote: post #8

Earlier quoted context omitted.

Why is heart disease a “good” cause of death?

Less suffering. Stroke on the other hand... you become partially disabled, which causes suffering not just for you, but also for your loved ones.

I think you are confusing "getting a stroke" and "dying from stroke". If you get a heart attack and don't die from it you might become a burden on your family too.

Re: Ticker: Don't die of heart disease

#104

Post by dragonwriter » Sat, Nov 08, 2025, 5:53 PM UTC

reidrac wrote: post #94

There are some points on this post that confuse me. > In early 2023 during a routine skin check at my dermatologist [...] Are routine skin checks a thing? > [...] I’ve spoken with several of the world’s leading cardiologists and lipidologists [...] How come?

> Are routine skin checks a thing?

If you have a dermatologist, I would imagine so.

Is having someone you can describe as "my dermatologist" a common thing? Probably not for most people who don't have a chronic skin condition of some kind, I would think.

Re: Ticker: Don't die of heart disease

#105

Post by dehrmann » Sat, Nov 08, 2025, 5:54 PM UTC

everdrive wrote: post #65

What if heart disease saves me from dementia? I'm not just being contrarian. I think about this a lot of the time. I'm already 40. I'm being healthy now, but whatever damage has already been done is baked in. (plus whatever is in my genetics) A quick death at 65-70 might be much more preferable to a slow terrible decade-long decline.

My grandfather always said "there's something to be said for a good coronary." He was in his 70's when he said it, and his point was that he had a good run, and there's an argument for going out while things are still good rather than slowly dying over six months in a nursing home (which is what actually happened).

Re: Ticker: Don't die of heart disease

#106

Post by derbOac » Sat, Nov 08, 2025, 5:54 PM UTC

lateforwork wrote: post #5

The title of the article says "don't die of heart disease", but given that we all have to die at some point, if you could choose what natural cause to die of, wouldn't you pick heart disease? It is the best way to die. The worst is stroke. So once you cross a certain age, say 60, don't worry about heart disease, worry instead about stroke.

Sometimes I think the way this type of thing is framed is misleading. There's a list of putative causes of death and there's an assumption that they're equally systemically impactful, and you can go down the list and just lower the probability of each and lower your overall likelihood of death.

That's not totally off, but the thing about cardiovascular disease is it affects everything because it's how your body distributes oxygen. Stop distributing oxygen and you die.

That's not to say other organs aren't important, it's just that if you replace "cardiovascular" with "oxygen distribution" it becomes apparent that almost by necessity it's going to include a lot of deaths.

Re: Ticker: Don't die of heart disease

#107

Post by sixtyj » Sat, Nov 08, 2025, 5:54 PM UTC

Buttons840 wrote: post #58

I am not a statin skeptic--or rather, I don't want to be a statin skeptic. I've done the research and it makes sense to me, but I still feel some social and psychological pressures to reject statins. When I see that it is widely accepted that ApoB is better to measure than LDL-C, but the industry continues to measure LDL-C, but not ApoB, I wonder why. It makes me skeptical. When I see that the purpose of statins is t…

https://jamanetwork.com/journals/jamainternalmedicine/fullar...

Meta-analysis conclusion: This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.

Re: Ticker: Don't die of heart disease

#108

Post by arjie » Sat, Nov 08, 2025, 5:55 PM UTC

The primary thing I did was ask a cardiovascular surgeon in my network to send the lab requisition form to a lab. This is the gate for much of this stuff, even if you pay out of pocket. If someone knows a simple “pay and play” testing service that would be fantastic.

Most doctors recommend against these and against the full body MRI one can get because they believe you’ll always find things you don’t expect and that will make you indulge in interventions that have weak support, resulting in deleterious iatrogenic effects.

I found that I had no such impulse with the data I had. But a friend of mine, supplied with evidence of a little arrhythmia went through a battery of tests and experimentation. He was in line for getting a cardiac ablation when he finally quit his job and stopped having the problem. So I get why they say that. There’s people like that.

Anyway, if you’re curious what you can get for $800 email me and I’ll post here. I’d do it proactively but I’m traveling so it will take a little work.

Re: Ticker: Don't die of heart disease

#109

Post by malfist » Sat, Nov 08, 2025, 5:55 PM UTC

safety1st wrote: post #83

carbocation wrote: post #56

Key Takeaway: Get a CT or CTA scan, and if you can afford it go for the CTA with Cleerly. There is a reason that we don't recommend getting imaging for everyone, and that reason is uncertainty about the benefit vs the risks (cost, incidentalomas, radiation, etc, all generally minor). Most guidance recommends calcium scoring for people with intermediate risk who prefer to avoid taking statins. This is not a normative…

Right. Hang on a second. This guy is making a big big claim. The central point of his article is that he went to a doctor who followed the guidelines, tested him and found he wasn't at risk for heart disease. But then he went to another, very expensive concierge doctor, who did special extra tests, and discovered that he was likely to develop heart disease and have a heart attack. Therefore he is arguing that THE STA…

His evidence is also kinda weak. And appeal to authority largely about someone who he's paying to tell him he has health problems. The incentives aren't aligned.

I also disagree that the 50the percentile is the breakpoint between healthy and unhealthy. There's a lot more to deciding those ranges beside "well half of the population has better numbers"

Re: Ticker: Don't die of heart disease

#110

Post by carbocation » Sat, Nov 08, 2025, 5:56 PM UTC

safety1st wrote: post #83

carbocation wrote: post #56

Key Takeaway: Get a CT or CTA scan, and if you can afford it go for the CTA with Cleerly. There is a reason that we don't recommend getting imaging for everyone, and that reason is uncertainty about the benefit vs the risks (cost, incidentalomas, radiation, etc, all generally minor). Most guidance recommends calcium scoring for people with intermediate risk who prefer to avoid taking statins. This is not a normative…

Right. Hang on a second. This guy is making a big big claim. The central point of his article is that he went to a doctor who followed the guidelines, tested him and found he wasn't at risk for heart disease. But then he went to another, very expensive concierge doctor, who did special extra tests, and discovered that he was likely to develop heart disease and have a heart attack. Therefore he is arguing that THE STA…

The claim on an individual level is not objectionable to me. The question is that if we extrapolate it out to the population and actually take this action for everyone, do we make people better off? This is what clinical trials (or at least large observational studies) try to achieve. Right now, it is not clear.