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Ticker: Don't die of heart disease

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Re: Ticker: Don't die of heart disease

#471

Post by cthalupa »

safety1st wrote: post #468
cthalupa wrote: post #406

Earlier quoted context omitted.

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 w…

I would agree that this article overstates a lot of things.

ApoB is still a reasonable thing to check though, at least once - Lp(a) is the primary cause of atherogenic particle counts being high when LDL-C isn't the culprit, and it's usually a genetic factor. Having a high Lp(a) will bounce your ApoB up and give you a better understanding of the total atherogenic particle load. You could have fine LDL-C or Lp(a) on their own but the total amount could be enough to be worrisome.

Lp(a) being problematic is definitely less common than it being more or less fine, but it's certainly not incredibly rare, either.

Re: Ticker: Don't die of heart disease

#472

Post by cthalupa »

liveoneggs wrote: post #430
cthalupa wrote: post #403

Earlier quoted context omitted.

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 s…

How many doctors are cycling through all the statin classes to find the least-bad option for each patient? (I'll rant about one guy I know.. was any of this related to statin over perscribing? who can know) Now that we have your LDL under management isn't it easier to just add metformin and gabapentin into the mix? I mean what are the chances you're not also put on a calcium blocker too? Now you've got brain fog and…

If you go and tell your doctor you're having trouble with a statin, they should have you try a new one, yeah. Some might need to get clued in on pitavastatin, as it only recently went generic and insurance companies really didn't want to approve it before this due to the cost and wide field of generic statins, but it tends to have one of the best profiles when it comes to side effects.

The PKCS9 inhibitor monoclonal antibodies are an option for most people if they show intolerance to multiple statins - insurance will usually relent at that point.

If your doctor isn't willing to work with you to find the medication that works best for you, then find a new doctor.

Re: Ticker: Don't die of heart disease

#473

Post by koliber »

ericmcer wrote: post #245
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…

Seriously there is too much shit to worry about to micro manage each facet, unless your like a Bryan Johnson billionaire with a staff. Beyond just heart disease & cancer taking you out entirely its: my eyesight is going, my hearing, every joint in my body could fail, my brain is slowing, etc. There is just way too much shit to do anything other than be like: sleep, exercise, eat better and don't drink too much.

> Beyond just heart disease & cancer taking you out entirely its: my eyesight is going, my hearing, every joint in my body could fail, my brain is slowing, etc.

Absolutely right. You can’t fix everything. But if you can only dedicate time, money, and attention to one thing, cardio health is probably highest impact for most people. This article makes that case. Also it makes the case that there are a few things that will have an outsized positive effect on cardio health and we’d be wise to focus on them.

Re: Ticker: Don't die of heart disease

#474

Post by logifail »

Buttons840 wrote: post #188
logifail wrote: post #183

Earlier quoted context omitted.

> When I see that the purpose of statins is to reduce plaque buildup in the arteries, and that we have the ability to measure these plaque buildups with scans, but the scans are rarely done, I wonder why. I'd love to know where to get the right advice on this topic. I have high LDL-C, had a heart CT in hospital last week, yet the hospital's cardiologist phoned me yesterday to cancel a scheduled appointment to discuss…

If it was a calcium scan, it is expected to be zero until mid 40s. It doesn't really start to give a signal until then. A zero is still a zero though, and is associated with low risk of heart disease in the near future.

> If it was a calcium scan, it is expected to be zero until mid 40s.

I turned 50 fairly recently...

Re: Ticker: Don't die of heart disease

#475

Post by logifail »

MPSimmons wrote: post #194
logifail wrote: post #183

Earlier quoted context omitted.

> When I see that the purpose of statins is to reduce plaque buildup in the arteries, and that we have the ability to measure these plaque buildups with scans, but the scans are rarely done, I wonder why. I'd love to know where to get the right advice on this topic. I have high LDL-C, had a heart CT in hospital last week, yet the hospital's cardiologist phoned me yesterday to cancel a scheduled appointment to discuss…

How old are you? I was told that they're not considered diagnostic until somewhat later in life (>50) because the plaque may not have calcified yet, which could cause a false negative.

I turned 50 recently

Re: Ticker: Don't die of heart disease

#476

Post by calenti »

EasyMark wrote: post #436
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…

Yeah this prickles my hackles too. It took a fairly high dosage of zepbound and many months for me to get to a normal set of eating habits after a couple of decades of bad, but a prediabetes scare surprise on my labs pushed me into the program, but I would not have done it by "white knuckling". I needed some medication to help me along. All these people just saying "calories in and calories out" "just start exercisin…

To me the terms mix and it helps to separate the things that are externally manageable from the things that are not. The physical is complex but straightforward - the body biochemistry operates on material in, biochemistry mix, expenditure out. The brain is physical - neurons, pathways, etc. The mind, OTOH, is a virtual little candle isolated in a prison of meat and bone trying to understand how to interact with the world around it. External forces can alter the body and brain, but only the mind can change the mind. And does, in ways that are very difficult to control because the sole operator is part of the mechanism. People who try to change on their own and can't aren't failing or weak, it's just really f-ing hard.

Re: Ticker: Don't die of heart disease

#477

Post by sn9 »

exhilaration wrote: post #378
sn9 wrote: post #299

Earlier quoted context omitted.

The most current and up-to-date risk calculator for heart disease risk is the PREVENT score. https://professional.heart.org/en/guidelines-and-statements/...

Thanks for posting this. I was able to plug in all the required values from my last checkup and blood work. Even EGFR was there, I've never paid attention to that before.

I learned about it on the Barbell Medicine podcast! They had an episode dedicated to it.

Highly recommended to search their episodes for anything about health or fitness you've been curious about.

Re: Ticker: Don't die of heart disease

#478

Post by sn9 »

mac-mc wrote: post #463
sn9 wrote: post #308

Earlier quoted context omitted.

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.

It's the sort of thing you can just experiment with and see for yourself.

Try eating the usual health-promoting diet high in fiber and low in saturated fats from animal sources, mostly whole foods, lots of fruits and veggies and legumes and whole grains, lean meats, etc.

After a few months, check your blood work.

Then reintroduce fattier cuts of meat into your diet and see what your numbers do after a few months.

Re: Ticker: Don't die of heart disease

#479

Post by lateforwork »

cthalupa wrote: post #470
lateforwork wrote: post #445

Earlier quoted context omitted.

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 ve…

You can do a "study" to prove anything you want. And study outcomes often do vary depending on who is paying for it. The FDA is a neutral party. I recommend prioritizing the FDA warnings over "studies".

Re: Ticker: Don't die of heart disease

#480

Post by calf »

cthalupa wrote: post #415
martin82 wrote: post #412

Earlier quoted context omitted.

There is no reason take statins, ever. They will destroy your muscles, then cause diabetes and thus indirectly kill you. They will prevent a heart attack by... four days. If biomarkers are elevated, the question must always be, "why is this elevated", and "is there a natural change in habit and diet that can reverse this elevation". Artifically lowering the marker with a drug is like pasting duct tape on a leaking pi…

Arguing against nonsense like this gets so exhausting. Statins do not destroy your muscles. Newer statins make this already exceedingly rare side effect even rarer, but let's look at them as a general class: https://pubmed.ncbi.nlm.nih.gov/36049498/ Blinded RCT/Meta-analysis shows about 11 complaints per 1k patient years, with 90% of them not actually being due to the statin. But because people act like they're commo…

I feel like statins are harder to accept than vaccines. With vaccines we can say it is just training our existing immune system to recognize and fight something. So how would you straightforwardly explain statins to a scientifically literate adult so they can make an informed decision. But part of that means honestly acknowledging whatever scientific unknowns and uncertainties there are in this area of human biology.
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