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Ticker: Don't die of heart disease

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Re: Ticker: Don't die of heart disease

#401

Post by js2 »

Merck has a promising pill (enlicitide) coming that blocks PCSK9, lowering LDL-C:

- up to a 60% reduction in LDL cholesterol, with sustained reductions at 52 weeks;

- a 53% reduction in non-HDL, a combination of all types of cholesterol except for HDL (“good cholesterol”);

- a 50% reduction in ApoB, a protein that helps carry fat and various “bad” types of cholesterol throughout the body;

- a 28% reduction in Lp(a), a different type of lipoprotein that is structurally similar to LDL, determined by genetics and a risk factor for heart disease; and

- a similar rate of serious side effects (10% in enlicitide vs. 12% in placebo), a small proportion of participants left the study early because of side effects (3% vs.4%, respectively).

https://newsroom.heart.org/news/investigational-daily-pill-l...

Blocking PCSK9 isn't new, but thus far only available as an injectable:

https://my.clevelandclinic.org/health/drugs/22550-pcsk9-inhi...

Re: Ticker: Don't die of heart disease

#402

Post by cthalupa »

lateforwork wrote: post #191
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…

> Statins are well-tolerated drugs with little to no noticeable side effects. Sorry, that's nonsense. It is a dangerous drug with plenty of side effects. If it had no side effects it would be sold over the counter. The brain needs cholesterol to function. If you artificially remove cholesterol this is what happens: https://www.health.harvard.edu/cholesterol/new-findings-on-s...

No, your post is nonsense. You link a random article that doesn't even make the argument that you're making - that it's low cholesterol causing the memory loss - or that statins are causing the memory loss at all.

And considering serum cholesterol cannot pass the blood brain barrier and that it is all synthesized de novo in the brain makes it an even sillier claim. Your serum cholesterol level does not have impact on your brain's cholesterol levels.

Quite a few organs have the ability to synthesize cholesterol as needed and can do so just fine. Another area where we make use of cholesterol is for synthesizing hormones... but those organs can all synthesize it de novo just fine too.

The new pkcs9 inhibitors have gotten people down to extremely low levels of LDL (https://pubmed.ncbi.nlm.nih.gov/36779348/

https://www.ahajournals.org/doi/10.1161/ATV.0000000000000164

https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/201...

https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/201...

Re: Ticker: Don't die of heart disease

#403

Post by cthalupa »

liveoneggs wrote: post #215
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 also raise your blood sugar and lower your GLP-1, increasing your risk of diabetes? They also tend to be continued well into old age (off label) despite increasing fall risk, which is way more dangerous to an 80 year old.

A single study showed a single statin reducing GLP-1 levels and ascribed it to gut microbiome changes that could be totally resolved with UDCA supplementation.

If this even ends up being reproduced it at most says there is an easy fix for people taking atorvostatin and that it might be a concern with other statins, but this should be treated with the same health skepticism of any other single study finding.

Not all statins raise blood sugar either - pitavastatin usually shows an improvement in insulin sensitivity.

Re: Ticker: Don't die of heart disease

#404

Post by cthalupa »

jimmydddd wrote: post #196
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…

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.

Was it a CAC or CTA?

It was almost certainly the former, and the former is is basically an indicator that the damage is already done.

Soft plaque takes a long time to calcify. But soft plaque is the stuff that ruptures, and will clog up your arteries just as much.

Statins are best used as a preventative measure - once the plaque is there it's difficult to regress it even while soft, and as far as we know effectively impossible once it is calcified.

Re: Ticker: Don't die of heart disease

#405

Post by Shaanie »

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…

The top 20% consumers consume a large majority of the alcohol, which means there are many Germans who consume reasonable amounts.

Re: Ticker: Don't die of heart disease

#406

Post by cthalupa »

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 National Lipid Association and American Heart Association have both been advocating that lower cholesterol numbers are better, e.g. https://www.lipidjournal.com/article/S1933-2874(25)00317-4/f...

Research science in this area has been in agreement for a long time now that ApoB is a more informative indicator than just LDL-C, because there are a variety of different atherogenic particles, not all LDL particles are created the same, etc.

His ApoB numbers are quite readily and apparently out of range. Hell, even his LDL is out of range for the two largest lab providers in the US - Labcorp and Quest both have His numbers are well within the range of concern based on pretty universal consensus across the research in this area over the past couple of decades. Preventative cardiologists and lipidologists would almost certainly agree with this concierge doctor.

Re: Ticker: Don't die of heart disease

#407

Post by cthalupa »

kelipso wrote: post #132
malfist wrote: post #109

Earlier quoted context omitted.

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"

ApoB is a better indicator of heart problems and his ApoB was bad, unlike his LDL-C. ApoB is not some imaginary thing made up by a quack doctor.

Even his LDL-C is bad. 116/119 are both out of range by most lab testing standards and the top end of range already allows for plaque deposition.

Re: Ticker: Don't die of heart disease

#408

Post by bsder »

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 plural of anecdote is not data.

Maybe he got missed--let's concede that. What about the other 10 or 100 or 1000 or subjected themselves to tests and didn't find anything? Where are their stories?

If you have enough people, the tests, themselves are eventually going to harm somebody.

For example, certain scans require contrasts like gadolinium that bioaccumulates. That's not a big deal if we only pump it into people 2 or 3 times in their lives when something in their body is about to explode. It's a lot bigger deal if we're doing that to them every year.

Re: Ticker: Don't die of heart disease

#409

Post by cthalupa »

hinkley wrote: post #187
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…

Every organ in your body that utilizes LDL can synthesize it de novo. Some of the heaviest users, like your brain, literally can't get it from your serum LDL levels - they do not pass the blood brain barrier. It is all synthesized locally.

PKCS9 inhibitors and mendelian randomization studies show that people function just fine with Googling for statin and aggression links I find a fairly small set of studies with fairly disparate outcomes.

Re: Ticker: Don't die of heart disease

#410

Post by wjnc »

getnormality wrote: post #344
recursive wrote: post #332

Earlier quoted context omitted.

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

Struggling to change is different from not wanting to change. People seem to have trouble with basic distinctions like this when they're heavy into moralizing failure to change.

Profound point. My mother struggled with alcoholism and ultimately succumbed to that disease. In philosophy of mind they use “akrasia” and “akratic thinking” for acting against ones better judgement. It helped me somewhat getting to understand what my mother was going through at that time.

She wanted to change, tried a many multiple of times and it failed. Fault, guilt, blame are useless concepts to use on the Other. And only in moderation should they be applied to the Self. There deep disconnects between what we think, know and do.

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