It is a long read and I want to make time for it. Quick search check and calc (for calcify etc.) and diet appear alot in the article which is not surprising based on other things I have watched on the subject.
The title of the article says "don't die of heart disease", but given that we all have to die at some point, if you could choose what natural cause to die of, wouldn't you pick heart disease? It is the best way to die. The worst is stroke. So once you cross a certain age, say 60, don't worry about heart disease, worry instead about stroke.
Definitely not the best way to die. Heart disease is palpitations, fibrillation, chest pain, back pain, angina. It's leg swelling, breathlessness, dizziness, fatigue, slow wound healing. It's statins, beta blockers, stents, pacemakers, defibrillators, coronary bypasses, valve replacements, open heart maze scarring, angioplasty. It's not all widowmakers and sudden death. I would pick one of those "fell alseep and didn't wake up" things.
Fabulous information, but lacking information isn’t the issue. The behavioral changes are obvious and well evangelized : lose weight, regular activity (walking), and if necessary, take meds. (Yes I know your marathon runner cousin who died suddenly of a heart attack, but these are still your best odds)
Telling people what to do rarely fixes anything. People need dozens of impressions for those changes to sink in. Friends, family, social outings, commercials, movies, songs all promoting overindulgence won’t be overcome with a helpful pamphlet or nagging.
I might just be tired, but this seems highly repetitive. The author mentions friends in the field and concierge doctors multiple times in as much as I read.
Feels like the whole thing could be shortened to just say "here's the tests you run, the drugs you might take, the lifestyle changes you should consider".
In a real sense, you've spent decades likely increasing your risk unnecessarily when taking action early would have given you the greatest leverage to lower your lifetime risk.
But you can't change the past. If you didn't plant a tree 20 years ago, plant it today and you'll still get some benefit, minimizing any future increase in risk and maybe even lowering it.
You could realistically have almost half your life left before you, and you can still end up being fitter and healthier than you've ever been in your life if you adopt healthy habits around diet, strength training, and endurance training.
I was planning to start getting scans ordered for specific risks like aneurysm or heart attack but what holds me back is the idea the scans will harm me worse than those things.
It is very difficult to have any level of confidence with the medical industry so my current approach has been to eat as healthy as possible while staying as fit as I can without undue extreme stress.
Health guidelines take into account when screening/testing is a net harm or benefit for patients in general, and when they move from being a net harm to a net benefit conditional on specific factors like existing diseases, obesity, etc.
Any decent doctor should be at least following those, and you can pretty easily find them from the major disease-focused organizations.
Importantly, there are also recommendations for how often you see a doctor based on things like age and known disease risk. You might discover you have risk factors that are genetically resistant to lifestyle factors, and the earlier you find out, the more leverage you have to decrease your lifetime risk with appropriate medication.
I don't like this kind of content. The author might have a personal motivation for it, but for the general public, it's just more mental load.
We are all going to die one day.
When I was younger, I would fret over this kind of article. Great, one more thing I have to worry about. Now I just mostly ignore it. It's impossible otherwise. If I dedicate hours and days and months to all the heart best practices, what about when the liver, esophagus, kidney, bladder, brain articles come out?
We all know the good practices. Don't be a dumbass. Don't drink too much, exercise and so on. Besides that, I'm very much going to be reactive, as the article cautions against. I just don't have time or mental energy to do otherwise.
I recently did a comprehensive panel of my own volition with Quest Labs and was pleasantly surprised by the entire process. It was super easy to schedule, affordable, and their online platform is surprisingly sleek.
The value of the biomarkers are they applicable for all age range? What if someone already had a heart attack, then what should be the normal values post incident?
AFAIU, for LDL and ApoB, the real danger lies in the area under the curve. Lifetime exposure. That's not to say that lifestyle improvement can't help in other ways, but the damage caused by LDL is very difficult (impossible) to reverse.
So, if you hit the point where you already had a heart attack, you really want to prevent any further damage, but the "accumulated" risk is still there.
I think that's part of what makes LDL so tragic. You should care about it your whole life, but when you are young, you just don't.
Worse, high LDL is becoming a thing in children as well, that's an extra decade of accumulation which has historically not happened.
I don't think people should panic about these things, but I think it highlights the importance of developing good habits early, and the role parents and society has in making those habits easy for young people to adopt.
Great post but quite surprised there is no mention of cutting red meat. There is a lot of evidence that especially the American diet is dangerously high in red meat to the point of elevating Heart Disease risk.
Love the chart at the bottom--it really puts on display media bias and lack of integrity and using fear to push idiotic policies which area really just a way to put everyone in the pocket of government and keep them there permanently with zero real improvement to public health. Fear get eyeballs. the Covid mass hysteria proves that, too.
As far as heart disease goes, yes, it's the big killer and it's time people started waking up from the media haze, but to do that, you have to admit you were wrong, and for many, that is far too tall a hill to climb.
I'm not sure that non-medically indicated CT scans are a great idea, as you're at least doubling your yearly dose of radiation in the year of the CT scan. Perhaps it's warranted, but the article doesn't seem to balance that at all against doing a CT scan "every 1-5 years".
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 statement that is meant to last the test of time: it may well be the case that these tests are valuable for a broader population, but the data haven't really caught up to this viewpoint yet.
Not sure I follow or maybe you skipped typing a word.
You listed the risks and concluded “all generally minor.” The benefit is absolutely nonzero. So, what’s the hold up?
And how have the data not caught up? People outside the US are getting the CT scans, while US doctors prefer to lick their finger to guess the weather.
My wife’s last interaction with a doctor: patient presents with back and chest pain accompanied by occasional shortness of breath at the age of 39, doctor reluctantly asks for a EKG - which takes 5-10 minutes and is done in the next room, right away and covered by insurance with a small copay - and has the gall to be surprised when EKG showed subtle abnormalities. If she hadn’t advocated for herself, as the OP argues, doctor would just skip the EKG.
This experience left me thinking maybe doctors are discouraged from asking for imaging and guidelines are there to protect their criminally negligent behavior. I have no proof or even proxy data for the claim about doctors being discouraged from asking for imaging. But it is objectively criminally negligent to not ask for imaging in a case like this.
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 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. Like, we will see a high LDL-C number (which, again, we should be looking at ApoB instead), and so we get worried about arterial plaque, and we have the ability to directly measure arterial plaque, but we don't, and instead just prescribe a statin. We're worried about X, and have the ability to measure X, but we don't measure X, and instead just prescribe a pill based on proxy indicator Y. It makes me skeptical.
In the end statins reduce the chance of heart attack by like 30% I think. Not bad, but if you have a heart attack without statins, you probably (70%) would have had a heart attack with statins too. That's what a 30% risk reduction means, right?
As you can see, I'm worried about cholesterol and statins.
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.
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.
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 pipe - the leak is still there and it will likely quietly get worse over time and then eventually kill you anyways.
I find it unbelievable that our society swallows any drug without second thought. You body produces cholesterol on purpose. There must be reason why it produces it. "Ah well, who cares, let's just throw in a wrench and make it stop producing the cholesterol" and hope for the best...
I'm a big statin sceptic so just putting that up front.
I think things haven't changed because most people underestimate how slow institutional scale change is. There is a reason why HR departments and consultants have Change Management experts. The inertia is huge. Young people don't appreciate this because they thrive on new ideas. Old folks don't and will subconsciously push back, like a form of institutional homeostasis.
Also, while I believe your heart attack stats are correct, I'm more interested in all cause mortality. I believe there statins are a net negative.
I haven't had to touch statins to get my lipids profile much better. I used zepbound to lose about 50lbs and then weaned myself off that. I was a little afraid my “completely normal after 8 months of weight loss” blood panel status at the end of my zepbound journey would go back to the “bad” region, but I have maintained going on a year with a much better whole foods/lean meats based diet and moderate exercise (I do let myself have some red meat on Saturdays, otherwise I would explode from hamburger desires). So it was done through a combination of lifestyle changes and zepbound to help me bury the hunger monster long enough to learn new habits and get to a new normal. Him suggesting that “probably” most people should be on statins whether they need them or not seems like covering up the source of the problem. I do know that some people just naturally have lipid issues even when doing “all the healthy things” though. My mom is one of them.
This is all very interesting, but far too detailed and technical for 99% of people. The TLDR should include an easy to understand summary without jargon like "VO2" and "a set of HIIT at Zone 4".
Curious about how accessible these tests are in Europe. Living in a country (NL) that doesn't value annual checkups makes me assume detailed, preventative blood testing like this is hard, let alone possible to get in non-extreme situations.
You can order all blood tests you want online in NL. E.g. bloedwaardentest.nl, mijnlabtest.nl, perfectlab.nl. But it isn't cheap so you need to know what to test for to keep the price reasonable.
> It's not sexy, and as a result an overwhelming majority of the population is unaware about how to avoid succumbing to it
When I started building an ECG Holter in my early 20s, I tried to get some friends to use it and kept hearing "yeah, but it’s not exactly sexy to wear that thing." That’s when it hit me how little people care about prevention until something goes wrong. We still have a huge awareness gap to close.
What if heart disease saves me from dementia? I'm not just being contrarian. I think about this a lot of the time. I'm already 40. I'm being healthy now, but whatever damage has already been done is baked in. (plus whatever is in my genetics) A quick death at 65-70 might be much more preferable to a slow terrible decade-long decline.
My in-laws are over 95. They refuse to go to an elderly home and as a result make everyone miserable, starting with themselves and inflicting infinite suffering on their children who each have a family of their own, and need to take care of them all of the time.
I don't want to do that to my own children. I don't want to not die. I don't esp. want to die but I'm not really afraid of it, it's just a normal part of life.
Preventing heart disease is probably a good thing, but if one prevents every ailment conceivable then how does this work eventually?
118 comments
[ 4.2 ms ] story [ 103 ms ] threadDick Cheney (former USA Vice President) died a few days ago. Let's recap his publically known health:
- 1978 heart attack, age 37
- 1984 heart attack
- 1988 heart attack
- 1988 quadruple bypass surgery
- 2000 heart attack
- 2000 stent
- 2001 balloon angioplasty
- 2001 implantable defibrillator
- 2005 atery repair vascular surgery, stents behind the knees
- 2006 shortness of breath, hospitalized, blood clot
- 2006 travels everywhere with an ambulance standing by. Accidentally shoots friend. Friend has heart attack.
- 2007 deep vein thrombosis treatment, atrial fibrillation
- 2008 minor heartbeat irregularity
- 2010 January heart attack
- 2010 July Left-Ventricular Assist Device (LVAD) surgery for worsening congestive heart failure.
- 2012 heart transplant, cardiologist said "it would not be unreasonable for an otherwise healthy 71-year-old man to expect to live another 10 years".
- 2025 death, age 84, from complications of pneumonia and cardiac and vascular disease.
Or President Dwight Eisenhower:
- 1955 heart attack
- ? heart attack
- ? heart attack
- 1968 heart attack, heart attack, heart attack, heart attack
- 1968 cardiac arrest, cardiac arrest, cardiac arrest, cardiac arrest, cardiac arrest, cardiac arrest, cardiac arrest, cardiac arrest, cardiac arrest, cardiac arrest, cardiac arrest, cardiac arrest, cardiac arrest, cardiac arrest
- 1969 death from heart disease
Definitely not the best way to die. Heart disease is palpitations, fibrillation, chest pain, back pain, angina. It's leg swelling, breathlessness, dizziness, fatigue, slow wound healing. It's statins, beta blockers, stents, pacemakers, defibrillators, coronary bypasses, valve replacements, open heart maze scarring, angioplasty. It's not all widowmakers and sudden death. I would pick one of those "fell alseep and didn't wake up" things.
Telling people what to do rarely fixes anything. People need dozens of impressions for those changes to sink in. Friends, family, social outings, commercials, movies, songs all promoting overindulgence won’t be overcome with a helpful pamphlet or nagging.
Feels like the whole thing could be shortened to just say "here's the tests you run, the drugs you might take, the lifestyle changes you should consider".
Nitpick: he mentions LDL-C but the test results don't mention that at all. Only later do I see that is "LDL Cholesterol".
In a real sense, you've spent decades likely increasing your risk unnecessarily when taking action early would have given you the greatest leverage to lower your lifetime risk.
But you can't change the past. If you didn't plant a tree 20 years ago, plant it today and you'll still get some benefit, minimizing any future increase in risk and maybe even lowering it.
You could realistically have almost half your life left before you, and you can still end up being fitter and healthier than you've ever been in your life if you adopt healthy habits around diet, strength training, and endurance training.
It is very difficult to have any level of confidence with the medical industry so my current approach has been to eat as healthy as possible while staying as fit as I can without undue extreme stress.
Any decent doctor should be at least following those, and you can pretty easily find them from the major disease-focused organizations.
Importantly, there are also recommendations for how often you see a doctor based on things like age and known disease risk. You might discover you have risk factors that are genetically resistant to lifestyle factors, and the earlier you find out, the more leverage you have to decrease your lifetime risk with appropriate medication.
I'd check out the Barbell Medicine podcast episode on the health priorities they recommend patients focus on: https://www.barbellmedicine.com/blog/where-should-my-priorit...
We are all going to die one day.
When I was younger, I would fret over this kind of article. Great, one more thing I have to worry about. Now I just mostly ignore it. It's impossible otherwise. If I dedicate hours and days and months to all the heart best practices, what about when the liver, esophagus, kidney, bladder, brain articles come out?
We all know the good practices. Don't be a dumbass. Don't drink too much, exercise and so on. Besides that, I'm very much going to be reactive, as the article cautions against. I just don't have time or mental energy to do otherwise.
So, if you hit the point where you already had a heart attack, you really want to prevent any further damage, but the "accumulated" risk is still there.
I think that's part of what makes LDL so tragic. You should care about it your whole life, but when you are young, you just don't.
Worse, high LDL is becoming a thing in children as well, that's an extra decade of accumulation which has historically not happened.
I don't think people should panic about these things, but I think it highlights the importance of developing good habits early, and the role parents and society has in making those habits easy for young people to adopt.
As far as heart disease goes, yes, it's the big killer and it's time people started waking up from the media haze, but to do that, you have to admit you were wrong, and for many, that is far too tall a hill to climb.
You listed the risks and concluded “all generally minor.” The benefit is absolutely nonzero. So, what’s the hold up?
And how have the data not caught up? People outside the US are getting the CT scans, while US doctors prefer to lick their finger to guess the weather.
My wife’s last interaction with a doctor: patient presents with back and chest pain accompanied by occasional shortness of breath at the age of 39, doctor reluctantly asks for a EKG - which takes 5-10 minutes and is done in the next room, right away and covered by insurance with a small copay - and has the gall to be surprised when EKG showed subtle abnormalities. If she hadn’t advocated for herself, as the OP argues, doctor would just skip the EKG.
This experience left me thinking maybe doctors are discouraged from asking for imaging and guidelines are there to protect their criminally negligent behavior. I have no proof or even proxy data for the claim about doctors being discouraged from asking for imaging. But it is objectively criminally negligent to not ask for imaging in a case like this.
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 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. Like, we will see a high LDL-C number (which, again, we should be looking at ApoB instead), and so we get worried about arterial plaque, and we have the ability to directly measure arterial plaque, but we don't, and instead just prescribe a statin. We're worried about X, and have the ability to measure X, but we don't measure X, and instead just prescribe a pill based on proxy indicator Y. It makes me skeptical.
In the end statins reduce the chance of heart attack by like 30% I think. Not bad, but if you have a heart attack without statins, you probably (70%) would have had a heart attack with statins too. That's what a 30% risk reduction means, right?
As you can see, I'm worried about cholesterol and statins.
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 pipe - the leak is still there and it will likely quietly get worse over time and then eventually kill you anyways.
I find it unbelievable that our society swallows any drug without second thought. You body produces cholesterol on purpose. There must be reason why it produces it. "Ah well, who cares, let's just throw in a wrench and make it stop producing the cholesterol" and hope for the best...
I think things haven't changed because most people underestimate how slow institutional scale change is. There is a reason why HR departments and consultants have Change Management experts. The inertia is huge. Young people don't appreciate this because they thrive on new ideas. Old folks don't and will subconsciously push back, like a form of institutional homeostasis.
Also, while I believe your heart attack stats are correct, I'm more interested in all cause mortality. I believe there statins are a net negative.
What you put into your body: no processed food, cook yourself, lots of variety of veggies and fruits, little meat, little alcohol.
What you do with your body: regular exercise, low stress, enough sleep.
What you do with your mind: good social environment, good relationships.
And an apple a day keeps the doctor away!
When I started building an ECG Holter in my early 20s, I tried to get some friends to use it and kept hearing "yeah, but it’s not exactly sexy to wear that thing." That’s when it hit me how little people care about prevention until something goes wrong. We still have a huge awareness gap to close.
Why the f* not.
My in-laws are over 95. They refuse to go to an elderly home and as a result make everyone miserable, starting with themselves and inflicting infinite suffering on their children who each have a family of their own, and need to take care of them all of the time.
I don't want to do that to my own children. I don't want to not die. I don't esp. want to die but I'm not really afraid of it, it's just a normal part of life.
Preventing heart disease is probably a good thing, but if one prevents every ailment conceivable then how does this work eventually?