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Ticker: Don't die of heart disease

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Re: Ticker: Don't die of heart disease

#321

Post by nradov »

brandonb wrote: post #268
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 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. Part of this is just that insurance coverage lags science. We've known that ApoB is more accurate than LDL since the 1990's or 2000's, but to be covered by insurance, several more steps have to happen. First, the major professional societies…

ApoB blood tests are relatively cheap. You can pay out of pocket about $70 if you really want one and insurance won't cover it.

Most commercial health plans will cover an ApoB test for members with certain cardiac risk factors or medical conditions. But they generally won't cover it as a preventive screening for all members. I don't think we have enough evidence to justify broad screening yet, although that may be coming.

Re: Ticker: Don't die of heart disease

#322

Post by armada651 »

I honestly think we should live more for the now than the far future. Rather than focusing on how to optimally extend my lifespan I'd rather focus on living the life where I'd be satisfied if I dropped dead the next day.

Like the article says this is only one of the many causes you could possibly work to prevent and if you die of something else then all that effort was for naught. Whereas if you put all your effort into living a worthwhile life then it doesn't matter what you die of or when.

I understand this man has kids he wants to live long for and that makes optimizing for living a long life worthwhile to him. But I don't think that a long life should be the goal in and of itself, it should be to live a worthwhile life.

Re: Ticker: Don't die of heart disease

#323

Post by loeg »

Wall of text, jeez. This reads as neurotic.

The big levers anyone can do (but most don't) are:

1. Exercise regularly (anything aerobic)

2. Minimize your saturated fat / cholesterol intake

That's a better tl;dr than the useless one presented in the article.

Re: Ticker: Don't die of heart disease

#324

Post by starchild3001 »

Lowering LDL cholesterol is arguably the most evidence-backed longevity intervention available today. Mendelian randomization studies suggest that each standard deviation of lifelong LDL reduction translates to roughly +1.2 years of additional lifespan, implying ~+2.4 to +3.6 years from sustained, meaningful lowering alone.

Pair this with tight blood-pressure control (aim systolic A few references: https://mylongevityjourney.blogspot.com/2022/08/a-short-summ...

Re: Ticker: Don't die of heart disease

#325

Post by loeg »

adammarples wrote: post #195
Waterluvian wrote: post #155

I’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 the article makes a valid point: stop worrying about 90% of the other stuff and focus on the thing that will almost certainly kill you - heart disease - for which there are easy diagnostic and preventative measures. I think they're arguing for a better allocation of resources, if anything.

Heart disease is a big one, but so is cancer.

Re: Ticker: Don't die of heart disease

#326

Post by loeg »

Fire-Dragon-DoL wrote: post #252
ericmcer wrote: post #246

Earlier quoted context omitted.

Isn't the global population like 50% obese? What is your actual risk of dying from it if you are relatively in shape and in your 40s?

We don't know how to treat obesity 100% though

GLP-1s are remarkably effective.

Re: Ticker: Don't die of heart disease

#328

Post by mrtksn »

floundy wrote: post #303
mrtksn wrote: post #229

Earlier quoted context omitted.

For alcohol, the default is social drinking which is why you don't have widespread alcoholism in most countries where people consume plenty of alcohol. For smoking the default is constant nicotine top up(the nicotine delivery is instant, lasts seconds to minutes and the withdrawal symptoms starts in an hour). Both harmful of course but the alcohol has much less harmful defaults.

“Alcoholism” is outdated and has been widely replaced by AUD (Alcohol Use Disorder). I looked at Germany, according to Wikipedia the average consumption of pure ethanol per person per year in Germany as of 2019 was 12.2 liters. This was the 5th highest in the world, and equivalent to 686 standard 5% beers per year. According to the WHO “moderate drinking” is 1 drink per day for women and 2 drinks per day for men, so…

And yet, the Germans are having long and healthy lives just like other drinkers like France, Spain and Italy. So maybe just relax and have a drink.

Re: Ticker: Don't die of heart disease

#329

Post by loeg »

embedding-shape wrote: post #219

The author says this about smoking: > If you smoke, don’t. It’s going to kill you. And then this about alcohol: > I think it’s unreasonable to tell people not to drink alcohol if they like it. Why is it unreasonable to tell people not to drink alcohol, but reasonable to tell people to stop smoking? Shouldn't the smoking section also get a "at least make sure it’s really good tobacco that you enjoy and don’t smoke too…

The risk factor of conventional cigarette smoking is much higher than drinking. All other forms of smoked tobacco consumption are extremely niche.

Re: Ticker: Don't die of heart disease

#330

Post by btilly »

nradov wrote: post #312
btilly wrote: post #235

Earlier quoted context omitted.

I have an objection to the "better lifestyle and diet" approach. Sure, it is absolutely true that better lifestyle and diet has a huge effect. However it is absolutely certain that the vast majority of people who are told to improve their lifestyle and diet, won't. The result is doctors giving advice that they know won't be followed. And thereby transferring potential fault from the doctor to the patient, with no imp…

You're arguing against a strawman. The reality is that most doctors will tell the patient their options and let them pick. While statins have some significant side effects in many patients, there is no downside to a better diet and frequent hard exercise (assuming proper technique). So it usually makes sense to at least try lifestyle modification as the initial therapy. And if that doesn't work for whatever reason th…

Are you sure that this is a strawman?

Accepted medical guidelines not long ago said to bring blood pressure from the dangerous range, to elevated, then encourage patients to engage in diet and exercise. Research such as https://pubmed.ncbi.nlm.nih.gov/26551272/ demonstrated that it is better to medicate all of the way to the normal range.

I personally had specialist in blood pressure follow the old advice around 2018. I asked for further medication, and he refused to give it. In so doing, he was following accepted practice, per professional guidelines. This left me with elevated blood pressure for several years. This despite the fact that when I was personally physically fit (when my blood pressure problems were discovered, I still had my crossfit bod), that did not help my blood pressure.

Guidelines are continuing to evolve. Even today, guidelines about how far down to take blood pressure are somewhat vague in the USA. Many countries stick to the older, higher, targets in who even gets medicated in the first place.

It wasn't until about 2 years ago that I encountered a doctor who was willing to medicate me all of the way into the normal range. Given the 2015 research, I'm very happy about this. But it is far from a guarantee that a random person on HN with high blood pressure will encounter a doctor who is willing to do the same.

That's why I believe that this is not a strawman position. I'd be curious to hear your case explaining why you wrongly assumed that it was.

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