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Ticker: Don't die of heart disease

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Re: Ticker: Don't die of heart disease

#441
post #235
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…

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…

I think people use it as cudgel to blame people and as a crutch to avoid action. And we ignore the psychological and other factors that make improving lifestyle and eating better difficult.

No doctor wants their patient to have a stroke. But they also only get to meet patients where they are.

Re: Ticker: Don't die of heart disease

#442

Earlier quoted context omitted.

Your health is ultimately your own responsibility - it's your body. You have free will, and your appetite for risk is yours alone. You can choose to ignore expert advice and refuse to wear a seatbelt, skip your rehabilitation exercises, invest all-in on crypto, or smoke cigarettes. None of this responsibility should fall on the expert if they communicated the risks clearly.

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 may not be the case for statins specifically, but my main concern is side effects. If there was a panacea, I would support giving it to everyone, but lifestyle changes are usually more available, if not easier.

Re: Ticker: Don't die of heart disease

#443
post #372
post #359

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 upcomin…

Attia's one of those expensive concierge doctors. But his public youtube recommendations are basically sound.

I enjoyed Outlive. Rather technical (for me) but made sense.

Re: Ticker: Don't die of heart disease

#444
post #167

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)

Giving people cardio advice while being completely unaware of what zone 2 training is.

Peak HN right here. The epitome of confidently incorrect

Re: Ticker: Don't die of heart disease

#445

Earlier quoted context omitted.

> 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…

Memory loss and confusion have been reported with statin use. The FDA makes note of this here:

https://www.fda.gov/drugs/drug-safety-and-availability/fda-d...

FDA requires statins to have warnings about potential memory issues.

There are risks associated with extremely low cholesterol: https://www.webmd.com/cholesterol-management/cholesterol-too...

The human body creates cholesterol because it is essential for several vital biological functions. Cholesterol is a key structural component of cell membranes, providing rigidity and fluidity necessary for cellular function.

Re: Ticker: Don't die of heart disease

#446
post #337
post #290

Earlier quoted context omitted.

> Sure, it is absolutely true that better lifestyle and diet has a huge effect. not for me. My cholesterol was hovering in the high 200's, then finally hit 300 and I completely freaked out, radically changed my diet, and lost 22 pounds (from 180 to 158). What did my high cholesterol do ? It did absolutely nothing. ticked down to like, 280. So I'm on the statins. my total cholesterol went from high 200's to about 150…

Your anecdotal report that diet and exercise did not have a huge effect on your cholesterol does not discount the mountain of evidence that we have showing that diet and exercise has a huge effect on health and lifespan. These effects were first demonstrated in 1953. And has been confirmed over and over again since. So don't discount the value of diet and exercise just because losing weight didn't fix your cholestero…

yeah I read all that and it's why i did "diet" (already exercised) first.

still doesnt explain what my cardiologist was talking about, though. he's not the first dr. to tell me that "diet isn't really going to help you much". one dr. said, "if you went totally vegan, maybe it would have a slight effect". so no I didnt go totally vegan.

i think the idea is diet/exercise can make a 20 point dent in your total cholesterol but in practice, not much more than that, if you have total cholesterol over 250 kind of thing.

Re: Ticker: Don't die of heart disease

#447
post #296

Earlier quoted context omitted.

> My cardiologist tells me that the conventional wisdom of "diet and exercise" is almost entirely disproven to have any meaningful effect on lipids these days (though i havent researched deeply). I would be immensely skeptical of this unless he was talking about something much more narrow, like how there's a fraction of people who have really unfortunate genetics and can only improve their blood lipids with medicatio…

> I would be immensely skeptical of this unless he was talking about something much more narrow, like how there's a fraction of people who have really unfortunate genetics and can only improve their blood lipids with medication. I am one of those unfortunate genetic people, sadly, and have had high cholesterol numbers since my early 20s. Most of my older grandparents passed from heart disease. Now in my 40s, have a d…

both of my parents have low cholesterol, my mom's cholesterol is naturally under 200, my dad is on statins but the highest he ever got was about 230. they are in their 80s. Nobody on any side of my family (for which I have about 25 first cousins) has ever had any heart disease of any kind, no bypass surgeries, no heart attacks, nothing.

I'm familiar with the genetically high cholesterol thing and when you look at that you see parents/grandparents having heart attacks in their 40's. nothing like any of that in my family.

anyway yes im on the statins and probably need to boost my dose a little more to be below 200.

Re: Ticker: Don't die of heart disease

#448
post #438
post #180

Earlier quoted context omitted.

What the BMJ has to say on this very topic of statins: https://www.bmj.com/campaign/statins-open-data So no settled science here. Unless you consider the BMJ a trash journal of course.

note: > individuals at low risk of cardiovascular disease

Yes, you're right.

I pointed to this BMJ reference because in the article there is the following: "To help drive down our ApoB, we have statins which do miracles for lipid management. Some people believe that everyone should be on a statin so long as they don’t have adverse side effects."

Most statins prescribed today are not for secondary prevention.

A lot of doctors prescribe a statin immediately on seeing just one measure of "high" LDL without looking at any other parameter or context.

Re: Ticker: Don't die of heart disease

#449
post #107

Earlier quoted context omitted.

https://jamanetwork.com/journals/jamainternalmedicine/fullar... Meta-analysis conclusion: This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up.

A meta-analysis that only includes 11 studies on statins is immediately suspect. There have been a lot of studies on statins. If a meta-analysis comes along and only cherry picks a couple of them, something is up.

Ah, you were so close...

If you actually read the article, you would find the selection criteria and the explanation for the criteria.

First, a preface.

The article was published in 2009. At the time, AstraZeneca, the maker of the controversial statin Rosuvastatin, had been engaged in a yearslong intensive campaign to promote the drug. The editor of The Lancet wrote "AstraZeneca's tactics in marketing its cholesterol-lowering drug, rosuvastatin, raise disturbing questions about how drugs enter clinical practice and what measures exist to protect patients from inadequately investigated medicines"; CEO Tom McKillop [1] angrily fired back. Consumer rights group Public Citizen tried to get the medicine withdrawn for safety reasons; the FDA denied the request [2.]

AstraZeneca prevailed, and Rosuvastatin proceeded to make billions of dollars a year in sales. Today, 42 million Americans take it and in 2015 it was the most prescribed branded drug in America.

Now, back to the article. Most new drugs focus on studying the most diseased patients first and then, if possible, attempt to expand to the (far larger and more lucrative) prevention markets later. Statins are no different. The overwhelming majority of research on statins has been industry-funded, done on patients with CVD. Pharma companies want to expand to a larger market, of course. So there are efforts on many fronts. One was to broaden the definition of CVD or other criteria for starting statins. For example, in 2017 the definition of high blood pressure was successfully changed from 140/90 to 130/80. That bumped up the proportion of US adults with CVD from 36% in 2011-2014 [3] to 48% in 2013-2016 [4], or in other words, added 30 million US adults to the market. Similarly, in 2013 the 2013 ACC/AHA guidelines encouraged starting statins for anyone with LDL-C ≥190 mg/dl "even in the absence of other risk factors" which increased statin use from 31 million to 92 million Americans from 2008-09 to 2018-19 [5.]

Where did these changes come from, what motivated them? Studies, of course. Studies like the AstraZeneca-funded JUPITER trial, which claimed an improvement in the health of participants with even _low_ levels of LDL-C. A lot of this stuff was considered fairly strange, and it didn't seem to replicate. Thus the meta-analysis. Are statins truly useful for prevention?

So, in short: Most studies investigating statins in real depth are funded or influenced by industry. They usually focus on the sickest patients, presumably to get a larger effect size, yet the industry is constantly trying to prescribe to a wider audience - the healthier patients - often on grounds that mainstream health authorities find weak. This meta-analysis was only able to include 11 studies because industry SOP is to study the sickest patients yet prescribe to a wider audience. And as you might then expect: "This literature-based meta-analysis did not find evidence for the benefit of statin therapy on all-cause mortality in a high-risk primary prevention set-up."

[1] If the name sounds familiar, it's because Tom McKillop was the CEO of RBS who "aggressively" pursued leveraged buyouts up until its collapse and bailout in 2008.

[2] Here's the 10-year followup on that: https://www.bmj.com/content/350/bmj.h1388

[3] https://www.ahajournals.org/doi/epub/10.1161/CIR.00000000000... "total CVD prevalence, age >20y, both sexes" from Table 12-1 is 36%/92.1M

[4] https://www.ahajournals.org/doi/epub/10.1161/CIR.00000000000... "total CVD prevalence, age >20y, both sexes" from Table 13-1 is 48%/121.5M

[5] https://pmc.ncbi.nlm.nih.gov/articles/PMC10203693/

Re: Ticker: Don't die of heart disease

#450
post #335

Earlier quoted context omitted.

Your health is ultimately your own responsibility - it's your body. You have free will, and your appetite for risk is yours alone. You can choose to ignore expert advice and refuse to wear a seatbelt, skip your rehabilitation exercises, invest all-in on crypto, or smoke cigarettes. None of this responsibility should fall on the expert if they communicated the risks clearly.

If my health is my responsibility, then shouldn't the treatment that I receive be to the standard that I request? In 2015, https://pubmed.ncbi.nlm.nih.gov/26551272/ showed that medicating all of the way to normal works out better than medicating down to stage 1 hypertension, then insisting on diet and exercise. And yet my request in 2018 to be medicated down to normal blood pressure was refused, because the professio…

> In 2015, https://pubmed.ncbi.nlm.nih.gov/26551272/ showed that medicating all of the way to normal works out better than medicating down to stage 1 hypertension

Thanks for posting this. While I would generally advise a healthy dose of skepticism for any individual study, this one was very large and seems to be both well designed and executed. While there was a (statistically) significant increase in side effects with more intensive treatments, only about 1% more patients had adverse effects versus the standard treatment group, which seems like a very reasonable risk given the improved outcomes.

I've been trying to get my blood pressure under control recently and was thinking getting down to 12x/8x was good enough, but this has me rethinking that.

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