This reminded me of the other extreme to health consciousness: the 109 year old that smoked cigars and ate ice cream every night [0].
Ticker: Don't die of heart disease
201–210 of 501 posts
Re: Ticker: Don't die of heart disease
#202I’m sensing a potentially significant misallocation of resources. My mental model is that there’s a hypothetical quantification of not just your time and money, but your anxiety, attention bandwidth, mental energy, etc. I think, in some ways, the trick is being able to short circuit the entire journey represented by this website in favour of some form of, “I’m 40. I should be more mindful of heart disease. I should a…
I think people should be mindful of it since they were 18 - it's something that progresses over decades. You can have a lot bigger impact making changes when you're young rather than at 40
But yeah I agree with your message. Focus on the big impact macro level things. Hyper-optimizing it is a waste of energy
Re: Ticker: Don't die of heart disease
#203Earlier quoted context omitted.
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.
> There are many types of statins to try though
Most with efficacy determined by the proxy variable of LDL-C levels, and with even more questionable results in actual lifetime improvement.
I too really wanted not to be that skeptical about medicinal research. But if I had high cholesterol and a doctor recommended newer statins to me, I don't think I would take them.
Re: Ticker: Don't die of heart disease
#204I 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…
I was found to have high cholesterol in my late 20s. At the time the doctors (my cardiologist, then a second one brought in for advice) determined that the source was hereditary, but the effects would be the same. So they put me on statins. It's been 40 years now. I changed the statins three times since, when the actual one, at a specific time was no longer able to keep the values within acceptable limits. Approximately 8-9 years ago (I think) I ended up on Rosuvastatin 20mg, which I'm still taking every day. I do not maintain any diet (it'd be very hard, as I'm a heavy meat eater) and cholesterol levels are still staying within acceptable limits. Of course YMMV
Re: Ticker: Don't die of heart disease
#205I 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 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…
>If you were given the choice of two different dangerous roads where one road had a 30% lower chance of getting into a life-threatening car crash, you would probably think that the choice was obvious, not that the two roads were basically the same.
You could absolutely think that they were basically the same, depending on the base rate. The differece between a one-in-a-million and 0.7-in-a-million is 30%, but it wouldn't be humanly perceivable. We're all likely faced with situations like that regularly. Differing airlines probably have much greater variances in their crash statistics, but it just doesn't matter in 99.99999% of flights.
Re: Ticker: Don't die of heart disease
#206Earlier quoted context omitted.
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"
You may have missed the stat that 30% of the population that’s the median of will die of heart disease. You don’t want to be at the median.
Re: Ticker: Don't die of heart disease
#207My dad went to doctor who was like his friend as long as I can remember. Always received a clean bill of health. Until he suddenly got heart disease and a stroke on the operating table. His doctor basically said that he had seen this coming. Doctors secretary, probably twenty years his junior was a stunner.
Re: Ticker: Don't die of heart disease
#208> what most primary care physicians will do with patients to help them avoid heart disease is not enough. The status quo simply does not work
The reason the status quo doesn't work is that people don't actually follow the guidelines set
Barely anyone (like 10% last I saw) meets the recommended amounts of fruit and vegetable intake or exercise. We're all addicted to terrible foods, are sedentary, have high blood pressure and are overweight
Before you start micro optimizing everything just fix your diet, avoid saturated fat and sodium and get enough moderate intensity or better exercise every week
The 95/5 of it is just basic stuff everyone knows and yet barely anyone does
Re: Ticker: Don't die of heart disease
#209Earlier quoted context omitted.
I had assumed "the MESA study population" was a particularly unhealthy bunch in terms of this measurement, meaning the 50th percentile puts one in the worst half of an already bad off group.
I don't know the exact details, but I thought the Framingham survey was just a cross-section of the population. So getting upset about a 50th percentile score makes no sense at a population level. A quick Google says that the Mesa study was actually of people without cardiovascular disease at the beginning of the study. So again, these conclusions don't make any sense to me.
Of course it makes sense. 30% of this population will die of heart disease. You don’t want to be at the median of that population if you can avoid it. And as a society we need to move the median, not just accept it. Which means giving people better advice based on better data.
Re: Ticker: Don't die of heart disease
#210Earlier quoted context omitted.
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…
Interesting, thanks for sharing!