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Ticker: Don't die of heart disease

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Re: Ticker: Don't die of heart disease

#181

Post by Maxion »

flenserboy wrote: post #134
Aurornis wrote: post #120

Earlier quoted context omitted.

> 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. ApoB is shaping up to be an incremental improvement in measurements, but health and fitness influencers have taken the marginal improvement and turned it into a hot topic to talk about. This happens with everything in fitness: To remain topi…

numbers often quoted in favor of statins use relative instead of absolute risk. when seen in absolute terms there is little case for statins except in some possible particular cases. they also do little, if anything, when it comes to life extension — the expected lifespan of a statin user is often estimated to be four days longer than that of those who do not use them. not only is this essentially statistical noise,…

AFAIK statins show better numbers for secondary prevention. For primary prevention its a toss up.

Re: Ticker: Don't die of heart disease

#182

Post by AaronAPU »

rogerrogerr wrote: post #48
AaronAPU wrote: post #32

I was planning to start getting scans ordered for specific risks like aneurysm or heart attack but what holds me back is the idea the scans will harm me worse than those things. It is very difficult to have any level of confidence with the medical industry so my current approach has been to eat as healthy as possible while staying as fit as I can without undue extreme stress.

As someone who would like to do this but has generally been choosing the easy paths - curious what your diet and exercise regime looks like.

Well “fortunately” I’m forced to have a strict diet due to some sort of IBS issues. For that, I use the MacroFactor app and talk through my daily recipes with ChatGPT, making sure to hit the macros and calories targets while also optimizing for heart health and IBS. Fat, protein, carbs, fiber. Taking AG1 to fill gaps.

For fitness I’m obsessed with biking so I do like 90 minutes of endurance/tempo pace 5 days a week and usually a race once a week. Zwift is great with a Tacx when weather is bad (often).

That isn’t a time option for everyone but it is also likely well beyond what is necessary for most people.

I also don’t drink or smoke or vape which I think is important.

Not going to say I’m an expert or an exemplar of health but I am really trying everything I know to do at this stage.

Re: Ticker: Don't die of heart disease

#183

Post by logifail »

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…

> When I see that the purpose of statins is to reduce plaque buildup in the arteries, and that we have the ability to measure these plaque buildups with scans, but the scans are rarely done, I wonder why.

I'd love to know where to get the right advice on this topic.

I have high LDL-C, had a heart CT in hospital last week, yet the hospital's cardiologist phoned me yesterday to cancel a scheduled appointment to discuss the results(!), because she said I have zero arterial plaques and there's simply no need for us to meet.

I feel really quite lost with this stuff :/

Re: Ticker: Don't die of heart disease

#184

Post by autop0ietic »

toast0 wrote: post #167
Flere-Imsaho wrote: post #139

Earlier quoted context omitted.

I learnt a great trick about exercise: find a podcast or audio book that you really enjoy listening to. Here's the trick: you're only allowed to listen when you're exercising. Also with food and drink: place friction between the treat and yourself. The easiest example is to not have biscuits / alcohol in the house. Bonus tip: alcohol free beer is really good these days.

If you're exercising for cardio, and you're able to follow your book or podcast, you're probably not doing good cardio. OTOH, it's not a bad way to do interval training while watching sports, go hard when they're yammering, slow down when the sports are happening (or, if you're watching soccer, you can go hard most of the time and then slow down for the replay if anything happens, which is unlikely)

You are completely wrong and don't know what you are talking about.

You are confusing two different things.

Re: Ticker: Don't die of heart disease

#185

Post by guerby »

captainkrtek wrote: post #60
AaronAPU wrote: post #32

I was planning to start getting scans ordered for specific risks like aneurysm or heart attack but what holds me back is the idea the scans will harm me worse than those things. It is very difficult to have any level of confidence with the medical industry so my current approach has been to eat as healthy as possible while staying as fit as I can without undue extreme stress.

A relevant anecdote. I’m very athletic and skinny, eat well, have a resting heart rate in the 40s, but was recently prescribed a statin at 30, due to my very high LDL cholesterol and lipoprotein A. My family has a history of cardiovascular disease despite us doing what we can w.r.t eating and exercise. I’d encourage you to get some tests at least. My mother similarly was put on statins and is getting a cardiovascular…

You're probably a "lean mass hyper-responders", a phenotype which is actively investigated, initial paper:

Elevated LDL-cholesterol levels among lean mass hyper-responders on low-carbohydrate ketogenic diets deserve urgent clinical attention and further research

https://pubmed.ncbi.nlm.nih.gov/36351849/

A few other more recent papers:

https://pubmed.ncbi.nlm.nih.gov/35498420/

https://www.jacc.org/doi/10.1016/j.jacadv.2024.101109

Note: I'm not a doctor.

Re: Ticker: Don't die of heart disease

#186

Post by zamadatix »

m_a_g wrote: post #161
lateforwork wrote: post #152

Earlier quoted context omitted.

There are plenty of statin skeptics and for good reasons; see prior discussion here: https://news.ycombinator.com/item?id=45430939

> and for good reasons That prior discussion gives no good reasons. The linked medium posts are, to be frank, trash. Statins are well-tolerated drugs with little to no noticeable side effects. You might have to try a few. You may need to combine ezetimibe to maintain a moderate statin dosage level, and that's it. (Like the author of this article) Source: Leading cardiologists worldwide, and doctors of the rich and fa…

I recently went on a statin (atorvastatin) and found I have the WILDEST dreams of my life if I don't take them in the morning, and my doctor said my liver readings were elevated after use but not enough he wants to switch it yet. Which alternative statins should I be looking at, or do they have even harder side effects to deal with?

Re: Ticker: Don't die of heart disease

#187

Post by hinkley »

kingofmen wrote: post #99

There's something I deeply don't understand about this. > I shared these results with a leading lipidologist who proclaimed: “Not sure if the lab or the primary care doc said an LDL-C of 116 mg/dL was fine but that concentration is the 50th percentile population cut point in the MESA study and should never ever be considered as normal. > It’s also important to note that, according to a lipidologist friend, an ApoB of…

The other thing these number chasers don’t tell you is that extremely low LDL numbers are also associated with anger management issues. The stuff is used in your body to build things. You need some, and probably at least half of the number this doc is trying to say is scary. In fact in a different test he is advised to talk to his doctor about whether a 29 is safe.

Has the guidance changed that you want LDL less than 2.5x (or was it 2x?) your HDLs?

Re: Ticker: Don't die of heart disease

#188

Post by Buttons840 »

logifail wrote: post #183
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…

> When I see that the purpose of statins is to reduce plaque buildup in the arteries, and that we have the ability to measure these plaque buildups with scans, but the scans are rarely done, I wonder why. I'd love to know where to get the right advice on this topic. I have high LDL-C, had a heart CT in hospital last week, yet the hospital's cardiologist phoned me yesterday to cancel a scheduled appointment to discuss…

If it was a calcium scan, it is expected to be zero until mid 40s. It doesn't really start to give a signal until then.

A zero is still a zero though, and is associated with low risk of heart disease in the near future.

Re: Ticker: Don't die of heart disease

#189

Post by mac-mc »

kryogen1c wrote: post #146
mac-mc wrote: post #82

Earlier quoted context omitted.

If you fix it without statins through better lifestyle and diet, that is the preferrable route. As to why medicine is like this, it's because it's conservative, usually about 17 years behind university research[0], and doctors are shackled to guidelines in most health systems or risk losing their licenses. It isn't a coincidence that the article author had his out-of-pocket concierge doctor tell him the more up-to-da…

>doctors are shackled to guidelines To expand, one of the coverage pillars of malpractice insurance (in the US) is the "standard of care". This is basically what most doctors and their associations consider acceptable, which by definition excludes new, better techniques. This is both a bug and a feature. A move fast and break things philosophy would cause more harm than good, but it also prevents rapid adoption of in…

17 years is far from rapid or move fast and break things. ApoB has been known about for quite a long time, since the 90s its effects have been obvious, and showed up in research in the 70s-80s!!! It's still not part of standard testing!!!

Guidelines also leads to standards of care being random and heavily driven by politics & financial reasons disguised as medical best practice. South Korea and India are "parallel testing" places, which saves time, while the USA & others are serial testing places mostly because of their funding models.

Talk to any American doctor and they will give you a bunch of emotionally wrapped cope about why it's bad because the cognitive dissonance sucks and there are liability reasons to avoid admitting your wrong. I would argue that in many cases, parallel testing is cheaper because $300 of tests is cheaper than 4 chained $500 doctor visits. But whatever.

Re: Ticker: Don't die of heart disease

#190

Post by Buttons840 »

flenserboy wrote: post #134
Aurornis wrote: post #120

Earlier quoted context omitted.

> 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. ApoB is shaping up to be an incremental improvement in measurements, but health and fitness influencers have taken the marginal improvement and turned it into a hot topic to talk about. This happens with everything in fitness: To remain topi…

numbers often quoted in favor of statins use relative instead of absolute risk. when seen in absolute terms there is little case for statins except in some possible particular cases. they also do little, if anything, when it comes to life extension — the expected lifespan of a statin user is often estimated to be four days longer than that of those who do not use them. not only is this essentially statistical noise,…

This is all true. If you take a statin and it causes no issues, you're... maybe (30%, yay!) better off for it.

If a statin makes you feel miserable, I think any doctor would sympathize with a calculated decision to stop them. There are many types of statins to try though, so hopefully one would work without side effects.

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