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Ticker: Don't die of heart disease

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Re: Ticker: Don't die of heart disease

#351

Post by matthewdgreen »

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…

The general advice is that the scans are only useful sometimes. That is, they can show a problem. But a clear scan doesn’t mean you’re fine. So don’t base anything on a clean scan, be proactive with all the rest of it. My two cents, by the way: Repatha is pretty amazing.

Re: Ticker: Don't die of heart disease

#352

Post by matthewdgreen »

nerdponx wrote: post #143
collingreen wrote: post #96

Earlier quoted context omitted.

I ALSO want to not be a statin-skeptic but, like you, these things look very weird to me. The most prescribed drugs in the country and we don't even try to check if they are addressing the actual problem?

There is a financial incentive not to look.

Whose incentive? All the major drugs are generic now and (at least my) insurance pays for them without even asking for a co-pay.

Re: Ticker: Don't die of heart disease

#353

Post by matthewdgreen »

zamadatix wrote: post #186
m_a_g wrote: post #161

Earlier quoted context omitted.

> 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?

I have intense anxiety attacks on atorvastatin. Rosuvastatin at the low dose (5mg) doesn’t do much, but at 10mg and 20mg it caused the same effects. It took years and multiple cycles of going on and off the drugs to become confident this was the problem. I switched to Repatha which doesn’t have this problem (it does make me a bit hungry though) but it’s expensive and it took a while for my insurance to approve it.

Re: Ticker: Don't die of heart disease

#354

Post by nradov »

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…

Statins can be effective for many patients (and there are multiple different statins with varying effects) but there are also alternative or additional drugs such as Leqvio (inclisiran) and Repatha (evolocumab). Patients should do their research and talk to their doctors. It might take some trial and error to figure out what works best.

Re: Ticker: Don't die of heart disease

#355

Post by ETH_start »

All of this advice seems really good. The only one I am reluctant to follow is getting a CT or CTA scan.

For reference, radiation levels:

Chest X-ray: ~0.1 mSv (millisieverts)

Head CT: ~2 mSv

Chest CT: ~7 mSv

Abdomen–pelvis CT: ~10 mSv

CTA (angiography): often 10–20 mSv

Are there non X-ray diagnostic imaging scans that can detect arterial plaque?

Re: Ticker: Don't die of heart disease

#356

Post by jmpman »

My good friend just died from a heart attack at 60. 90% blockage in 2 arteries, even though he exercised regularly and appeared perfectly healthy. This triggered my exploration of my own risk and I came to the realization that although my lipid panels were ok, I could also have a 90% blockage and be completely unaware. I ended up getting a Calcium CT scan which showed no blockages, but I realized that without my friends death, I’d have no idea of my score. In the US, insurance doesn’t cover the screening. I’m now a believer of all people having a scan at 50, and likely every 5 or 10 years afterwards.

Re: Ticker: Don't die of heart disease

#357

Post by Tempest1981 »

Buttons840 wrote: post #212
jimmydddd wrote: post #196

Earlier quoted context omitted.

My wife had high cholesterol numbers, so her doctor wanted to give her statins. She asked about a scan, he begrudgingly said well, I guess you could do that. Her scan showed 0 plaque.

Plaque won't show as calcium until it has been in your arteries for decades and has calcified. It is a delayed indicator. For anyone under 40, it's expected to have zero calcium. Even a measure of 1 or 2 when you're below 40 would be a bad sign.

Is there any way to get rid of the calcification? Experimental techniques?

Re: Ticker: Don't die of heart disease

#358

Post by nradov »

btilly wrote: post #330
nradov wrote: post #312

Earlier quoted context omitted.

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…

Yes, I'm sure you were arguing against a strawman. The majority of doctors will tell patients about the available options which are generally safe, and allow them to pick. And they don't usually blame patients. Your personal experience might have been different but it was atypical and just an anecdote.

Re: Ticker: Don't die of heart disease

#359

Post by grvdrm »

My first thought after reading: where does a guy like Peter Attia fit into the mix? Is he motivated and communicating in legitimate ways? Just a promotion machine at this point? Somewhere in between?

I love the idea of knowing biomarkers but have trouble with what I might do with them. Yes there are specific actions, but then what? A lifetime of SaaS to monitor?

Planning to ask my doctor for expanded tests in upcoming physical - definitely exploring everything I can.

But, doing basics too. Lot of exercise. Weights. Good diet. Get min 7 hours of sleep if possible. Try not to be a maniac filled with stress.

Re: Ticker: Don't die of heart disease

#360

Post by DennisP »

recursive wrote: post #332
getnormality wrote: post #300

Earlier quoted context omitted.

What you're communicating here, perhaps unintentionally, is that what matters is not results, but blame. If the doctor said what to do but the patient didn't do it, all that matters is the patient is to blame. You've communicated that by ignoring or dismissing the question of whether better outcomes are possible through other means than demanding that everyone follow doctors' orders and blaming them if they don't. "W…

It's hard to help someone that doesn't want to be helped.

Not that hard in this case. Just give them a pill.
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