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Ticker: Don't die of heart disease

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Re: Ticker: Don't die of heart disease

#461

Post by kelseyfrog »

btilly wrote: post #394
Filligree wrote: post #382

Earlier quoted context omitted.

> This strongly suggests that genetics definitely slips a thumb on the scale, but ultimately we are able to also impact our personal behavior. If it's 30-60% heritable, that leaves 70-40% to split between personal decisions and environment. It does not guarantee that personal decisions matter much at all...

That is why I said "strongly suggests" instead of "guarantees". And then further followed up with a link to research showing that it is, in fact, possible to change. With advice on how to change it.

What would be the upper bound of the effect of heritability where responsibility is no longer assumed?

Re: Ticker: Don't die of heart disease

#462

Post by mac-mc »

nradov wrote: post #289
mac-mc wrote: 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…

There is virtually zero chance that a doctor will lose their medical license for diverging from the from the usual clinical practice guidelines around statins. Check the state medical board disciplinary records. But if they're employed by a health system and fail to follow company policy then yes, they could be fired.

Different countries are different, some are far more trigger happy about it like Canada. What you suggest as an alternative other than 'git gud' diet & exercise also changes it.

Re: Ticker: Don't die of heart disease

#463

Post by mac-mc »

sn9 wrote: post #308
mac-mc wrote: post #74

Earlier quoted context omitted.

IMO, I think that is more of a saturated fat issue, and only a subset of the population is like that. Others solve their health issues through eating a lot of red meat.

Yeah it's definitely more about saturated fat from animal sources. A leaner cut like tenderloin is fine. Ultimately you just want to keep the calories you get from saturated fats from animal sources to less than 10% of your daily calories. You can still enjoy a nice steak or burger every once in a while, but they shouldn't be a daily staple if health is a priority.

No, I mean for some, a high saturated fat diet can do amazing wonders. And for others, it causes horrible issues. The studies are not well segmented genetically and by body state since that is signficantly more expensive and genetics only got cheap in the past 10 years or so, so they wash out these large sub-population dynamics.

Re: Ticker: Don't die of heart disease

#465

Post by 31carmichael »

mac-mc wrote: post #82
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…

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…

You can only do things to reduce your risk. And whatever intervention would be based on overall population statistics, since it's difficult to know your own personal risk. Heart disease kills marathon runners. You can't just "fix it". Someone who has naturally high cholesterol won't magically be okay by changing their lifestyle and diet.

Re: Ticker: Don't die of heart disease

#466

Post by 31carmichael »

pstuart wrote: post #135
Buttons840 wrote: post #33

Earlier quoted context omitted.

What price have you paid?

I now have a cardiologist and just had an MRI to check on the state of my aorta, as a recent calcium scan brought up concerns. I've now been on rosuvastatin and ezetimibe for several years with zero noticeable negative effects. I'm hoping that this with other behavior modification can help stave off further damage for a while.

I recommend the same. There are other interventions, but these two medications are straightforward to obtain with low or no side effects.

Re: Ticker: Don't die of heart disease

#467

Post by 31carmichael »

loeg wrote: post #361
yinser wrote: post #39

Earlier quoted context omitted.

Promoting good habits is good but this is health advice from an unlicensed commenter to say rice and beans is better than taking a statin. Consult your doctor if you’re curious what to do.

Most people aren't on and don't need statins. Everyone would be well served to eat well and exercise regularly. It's not a replacement.

You right. You don't need statins. Nobody does. But look at the statistics. You might also drop dead tomorrow. It's hard to know. If you think eating and exercising would solve heart disease, you are mis-informed. It's the number one killer. If we all died at 30, the drugs would not need to exist. I'm sure you would like to live as long as you can. Taking statins is cheap and simple for most people.

Re: Ticker: Don't die of heart disease

#468

Post by safety1st »

cthalupa wrote: post #406
safety1st wrote: post #83

Earlier 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…

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…

Thanks for the astute and informed comment. So re-reading that portion of the article, it seems to me the answer to my question is not that any general or consensus guidelines are wrong, but that a company called Forward Health is doing lipid panels and providing an incorrect interpretation of the results.

OP's LDL-C was 116 and this is on the very top end of what Forward Health's report says is OK, their report is wrong, this number is bad.

All the stuff about needing to measure ApoB, needing a high end concierge doctor, and the very long article about measuring 10-20 different numbers and doing more exercise than the guidelines and being at risk of heart attack if you don't do amounts of exercise that the author consider unreasonable etc., some of this may have value, but this all seems to be a lot of very lengthy personal opinion by the techbro author of the post. The key insight is simply that your LDL-C becomes a cause for concern over 100, perhaps even over 70, and he was not as healthy as some tech company told him he was. No surprise there, I will talk to actual doctors instead of using services from "tech forward" startups any day of the week.

Re: Ticker: Don't die of heart disease

#469

Post by bean469 »

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…

> Why is it unreasonable to tell people not to drink alcohol, but reasonable to tell people to stop smoking?

Ironic, since alcohol is classified as a Group 1 level carcinogen by IARC, just like tobacco.

1. https://www.who.int/europe/news/item/04-01-2023-no-level-of-...

Re: Ticker: Don't die of heart disease

#470

Post by cthalupa »

lateforwork wrote: post #445
cthalupa wrote: post #402

Earlier quoted context omitted.

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 severa…

> Memory loss and confusion have been reported with statin use.

People reporting things doesn't mean much, because as your own original link mentions, people tend to overreport stuff when they are going to the doctor already for other things. What do actual studies that have controls show? We have human RCTs here that have looked at this very thing - and found no evidence of it.

A random article on webmd also says very little when it contradicts the data we have from human RCTs and provides no sources. The trials I linked specifically looked at the common concerns that people have raised as being possibly related to low cholesterol - and didn't find them.

No one is saying that cholesterol isn't essential - your brain literally won't work without it, among many other things. But there is a difference between serum cholesterol levels and its use in in your body. You do not need high serum LDL-C levels for your body to create cholesterol where it needs it.

Those studies I linked quite specifically check for these concerns on people with way lower LDL-C from PKCS9 inhibitors than even combo therapy of statins and ezetimibe will get most people.

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