Ticker: Don't die of heart disease

Ticker: Don't die of heart disease(myticker.com)

600 points by colelyman 236 days ago | 488 comments

Buttons840 236 days ago |

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.

mac-mc 236 days ago | |

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-date stuff.

[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC3241518/

btilly 236 days ago | | |

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 improvement in actual outcomes. "I told the patient to lose weight and maintain that with a controlled diet." And yet, most people when told to diet, won't. Most people who start a diet won't complete it. And most people who lose weight on a diet, have the weight back within 5 years. Where each "most" actually is "the overwhelming majority". And the likelihood of the advice resulting in sustained weight loss probably being somewhere around a fraction of a percent.

What, then, is the value of the doctor giving this lecture?

(Disclaimer. I have lost 20 of the pounds I gained during COVID, and am making zero progress on the remaining 30. A few months ago I successfully started a good exercise routine. Given my history, I would expect to only follow it for a few years before falling off the wagon. I believe that this poor compliance puts me well above average. But do you know what I do reliably? Take my prescribed medicine!)

kryogen1c 236 days ago | | |

>doctors are shackled to guidelines

To expand, one of the coverage pillars of malpractice insurance (in the US) is the "standard of care". This is basically what most doctors and their associations consider acceptable, which by definition excludes new, better techniques.

This is both a bug and a feature. A move fast and break things philosophy would cause more harm than good, but it also prevents rapid adoption of incremental improvements.

nradov 236 days ago | | |

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.

array_key_first 231 days ago | | |

No, actually, you should improve your lifestyle and diet and also take statins.

Ever cardiologist ever will tell you that statins work best when you make diet and lifestyle changes. They tell you that, to your face. It's not a secret. This actually goes for A LOT of medications. Usually, medication + diet and exercise is better than medication alone. They also test medications like this.

31carmichael 235 days ago | | |

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.

hshdhdhj4444 236 days ago | | |

Licensing but also insurance.

I think only recently have insurance companies started covering APoB testing in your annual exams (or that may just be my insurance…).

Aurornis 236 days ago | |

> 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.

ApoB is shaping up to be an incremental improvement in measurements, but health and fitness influencers have taken the marginal improvement and turned it into a hot topic to talk about.

This happens with everything in fitness: To remain topical and relevant, you always need to be taking about the newest, most cutting edge advances. If it’s contrarian or it makes you feel more informed than your doctor, it’s a perfect topic to adopt for podcasts and social media content.

ApoB is good, but it’s not necessarily the night and day difference or some radical medical advancement that obsoletes LDL-C. For practical purposes, measuring LDL-C is good enough for most people to get a general idea of the direction of their CVD risk. The influencers like to talk about edge cases where LDL-C is low but then ApoB comes along and reveals a hidden risk, but as even this article shows there isn’t even consensus about where the risk levels are for ApoB right now. A lot of the influencers are using alternative thresholds for ApoB that come from different sources.

> 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?

30% reduction in a life threatening issue is huge. I don’t see why you would want to diminish that.

If you were given the choice of two different dangerous roads where one road had a 30% lower chance of getting into a life-threatening car crash, you would probably think that the choice was obvious, not that the two roads were basically the same.

flenserboy 236 days ago | | |

numbers often quoted in favor of statins use relative instead of absolute risk. when seen in absolute terms there is little case for statins except in some possible particular cases. they also do little, if anything, when it comes to life extension — the expected lifespan of a statin user is often estimated to be four days longer than that of those who do not use them. not only is this essentially statistical noise, it discounts the lowered quality-of-life side effects experienced by many who have been put on statins.

endominus 236 days ago | | |

>If you were given the choice of two different dangerous roads where one road had a 30% lower chance of getting into a life-threatening car crash, you would probably think that the choice was obvious, not that the two roads were basically the same.

You could absolutely think that they were basically the same, depending on the base rate. The differece between a one-in-a-million and 0.7-in-a-million is 30%, but it wouldn't be humanly perceivable. We're all likely faced with situations like that regularly. Differing airlines probably have much greater variances in their crash statistics, but it just doesn't matter in 99.99999% of flights.

sixtyj 236 days ago | |

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.

Aurornis 236 days ago | | |

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.

cthalupa 236 days ago | | |

https://www.lipidjournal.com/article/S1933-2874(25)00317-4/f...

Guidance from the National Lipid Association, based on a review of the current understanding of the science across quite a few different meta-studies, analysis, etc. Many of the referenced studies are meta-studies significantly larger than the one here.

We have mountains of studies showing the negative impact of LDL-C (and inflammation! Which statins also reduce) on health. We have mountains of studies showing positive impact from statins. We have specific mechanistic understanding of how LDL-C and other atherogenic particles cause heart disease. We have mountains of studies show that statins directly lower the amount of atherogenic particles you have.

This has been studied enough and sliced enough ways that yeah, there is evidence on both sides. But one side is effectively a mountain range, and the other is a small hill. I know which way I'm going to land on it.

zargon 236 days ago | | |

Concentration of ApoB-carrying lipoproteins in the bloodstream as the driver of heart disease is one of the most strongly proven facts in medicine. Statins are proven to lower LDL (a close-enough substitute for ApoB in most situations) by about 30%. I can't look at the study now, but most likely it's a situation where patients' cholesterol has not been lowered enough by medication to make a meaningful difference. If you have an LDL of 160, statins aren't going to be sufficient. The issue is doctors/patients not targeting a sufficiently low cholesterol level.

hshdhdhj4444 236 days ago | |

> 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

Because this is a recent understanding and healthcare tends to be a conservative industry that moves slowly. Sometimes too slowly.

And also because LDL remains an excellent measure. The risk with LDL isn’t false positives. If someone has high LDL they likely have an elevated risk of heart disease. The problem with LDL testing is that someone with low LDL may still have a high risk of heart disease which may be captured in APoB testing.

brandonb 236 days ago | |

> 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.

Part of this is just that insurance coverage lags science. We've known that ApoB is more accurate than LDL since the 1990's or 2000's, but to be covered by insurance, several more steps have to happen.

First, the major professional societies (like the American College of Cardiology or National Lipid Associations) have to issue formal guidelines.

Then, the USPSTF (US Preventive Services Task Force) needs to review all of the evidence. They tend to do reviews only every 5 or 10 years. (Countries aside from the US have different organizations that perform a similar role.)

If the USPSTF issues an "A" or "B" rating, then insurance companies are legally obligated to cover ApoB testing. But that also introduces a year or two lag since medical policies are revised and apply to the next plan year.

The net effect is that the entire system is 17 years, on average, behind research.

nradov 236 days ago | | |

ApoB blood tests are relatively cheap. You can pay out of pocket about $70 if you really want one and insurance won't cover it.

Most commercial health plans will cover an ApoB test for members with certain cardiac risk factors or medical conditions. But they generally won't cover it as a preventive screening for all members. I don't think we have enough evidence to justify broad screening yet, although that may be coming.

logifail 236 days ago | |

> 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 the results(!), because she said I have zero arterial plaques and there's simply no need for us to meet.

I feel really quite lost with this stuff :/

Buttons840 236 days ago | | |

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.

MPSimmons 236 days ago | | |

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.

netfortius 236 days ago | |

I was found to have high cholesterol in my late 20s. At the time the doctors (my cardiologist, then a second one brought in for advice) determined that the source was hereditary, but the effects would be the same. So they put me on statins. It's been 40 years now. I changed the statins three times since, when the actual one, at a specific time was no longer able to keep the values within acceptable limits. Approximately 8-9 years ago (I think) I ended up on Rosuvastatin 20mg, which I'm still taking every day. I do not maintain any diet (it'd be very hard, as I'm a heavy meat eater) and cholesterol levels are still staying within acceptable limits. Of course YMMV

iaaan 236 days ago | | |

No heart attacks or strokes? I'm in the same boat (hereditary issue), and altering my diet has never had any substantial effect on my numbers. I'm not overweight and rarely eat red meat, but have had trouble keeping onto a primary care physician long term (the people I keep picking seem to move between clinics constantly) in order to retain consistent access to a statin prescription, but as I continue to age I've been getting increasingly anxious that my time is coming.

EasyMark 236 days ago | |

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.

collingreen 236 days ago | |

I ALSO want to not be a statin-skeptic but, like you, these things look very weird to me. The most prescribed drugs in the country and we don't even try to check if they are addressing the actual problem?

cthalupa 236 days ago | | |

We have checked to see if they are addressing the problem more than probably any drug in history. The idea that we haven't is the result of skeptics cherry picking results that back up their point while ignoring the huge quantities of evidence supporting the efficacy of statins and other LDL lowering medications like ezetimibe, pcks9 inhibitors, etc.

Statins are so good at what they do they even reduce the risk in people who are already at low risk for heart disease.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

nerdponx 236 days ago | | |

There is a financial incentive not to look.

lateforwork 236 days ago | |

There are plenty of statin skeptics and for good reasons; see prior discussion here: https://news.ycombinator.com/item?id=45430939

m_a_g 236 days ago | | |

> 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 famous.

snthpy 236 days ago | |

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.

liveoneggs 236 days ago | |

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.

cthalupa 236 days ago | | |

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.

fcpk 236 days ago | |

one better simple indicator than large panels, if you can't get access to them or don't have them is simply your triglycerides/hdl ratio. aim to be under 2 if using mg/dl and under 0.87 if using mmol/L. it's one of the strongest correlated indicators of cardiovascular disease. way better than any classic cholesterol ratios.

nradov 236 days ago | |

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.

RiverStone 236 days ago | |

5mg daily Crestor (a very small dose) cut my ApoB in half from ~130 mg/dL to 61. I’ve had no negative side effects.

matthewdgreen 236 days ago | |

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.

martin82 236 days ago | |

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...

cthalupa 236 days ago | | |

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 common, they mistakenly believe it was the statin, which just reinforces this idea. And that's for muscle pain.

https://www.ahajournals.org/doi/10.1161/atv.0000000000000073

https://academic.oup.com/eurjpc/article-abstract/26/5/512/59...

https://pubmed.ncbi.nlm.nih.gov/15572716/

For actual significant muscle injury? Even lower. 1 or less per 10,000 patient years.

Effectively, you might get one muscle ache per year per 100 people and at most a 1 in 10,000 chance of serious myotoxicity.

As for diabetes, rosuvstatin usually has a neutral to positive impact on insulin sensitivity, and pitvastatin almost always has a positive impact. Some statins do have negative impact, but it's not universal.

It's not like duct tape on a leaking pipe - it's like removing items in a pipe that damage the pipe walls. Yeah, ideally they're not in the pipe to begin with, but removing them is better than letting them stay, and diet and exercise only do so much to remove said items.

Your body can synthesize LDL de novo in the organs that use it, and one of the heaviest users, the brain, can't get cholesterol out of your diet/serum levels at all - LDL cannot pass the blood brain barrier.

There are people with genetic mutations that mean they don't produce LDL, or at least not at high levels - their increased longevity and incredibly rare incidents of ASCVD is what drove the creation of PKCS9 inhibitors.

Statins also lower LDL-C levels - they don't make your body stop producing cholesterol in general, or even LDL-C. Even if your body couldn't make it on-demand where needed, statins aren't going to drop your serum levels to 0.

hermanzegerman 236 days ago | |

> 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.

That's pretty simple to explain. No conspiracy.

LDL-C is much much cheaper to measure. ApoB costs 36x times as much, so Insurance Companies don't like to pay for it

mrlongroots 236 days ago | | |

> LDL-C is much much cheaper to measure. ApoB costs 36x times as much, so Insurance Companies don't like to pay for it

Unfortunately American retail prices might as well be generated by a PRNG, and do not mean much.

On Ulta, a basic lipid panel vs an ApoB test are $22 and $36 respectively. Looking at Indian lab prices, (approx. INR->USD), both are under $10 there.

https://www.ultalabtests.com/test/cholesterol-and-lipids-tes... https://www.ultalabtests.com/test/cardio-iq-apolipoprotein-b...

gropo 236 days ago | |

How about moderate cardio and more fats in your diet

jimmydddd 236 days ago | |

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.

Buttons840 236 days ago | | |

Plaque won't show as calcium until it has been in your arteries for decades and has calcified. It is a delayed indicator.

For anyone under 40, it's expected to have zero calcium. Even a measure of 1 or 2 when you're below 40 would be a bad sign.

cthalupa 236 days ago | | |

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.

Waterluvian 236 days ago |

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 add a 30 min walk to my mornings.” And then move on with your life.

I think many cultures, but especially American healthcare culture, foment a growing background noise of constant anxieties and stressors. Life is sufficiently complex but there’s always a peddler eager to throw you a new ball to juggle (and pay for).

carbocation 236 days ago |

    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.

kingofmen 236 days ago |

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 96 is at a totally unacceptable 50th percentile population cutpoint from Framingham Offspring Study.

So... the exact median value is "totally unacceptable" and "should never ever be considered as normal"? I'm open to the possibility that the US population is so deeply unhealthy that this is true, but then that needs to be argued for or at least mentioned. Like, you can't say "you're exactly average in this respect" and expect your and that's terrible to be taken seriously without any followup.

Or if I'm misunderstanding what's meant by "50th percentile population cut point" then again, I think this jargon should be explained, as it's plainly not the usual meaning of "50th percentile".

Aurornis 236 days ago |

Going deep on biomarkers, blood tests, and debates about optimal levels is okay for some people who derive motivation from obsessing over topics, but I’m starting to notice a trend where people obsess about these things for a couple years before burning out and moving on to the next topic.

The best thing you can do for yourself is to establish healthy diet and lifestyle habits that are sustainable. A lot of people who jump from obsession to obsession do a great job at optimizing for something for a few years, but when their life changes they drop it completely and fall back to forgetting about it.

Fad diets are the original example of this: They work while the person is doing it, but they’re hard to maintain for years or decades. CrossFit and other exercise trends have the same problem where some people get extremely excited about fitness for a couple years before falling off completely because it’s unsustainable for them. Some people are able to continue these things for decades, but most people do it for a short while and then stop.

I’m now seeing the same pattern with biomarker obsessives: They go a few years obsessing over charts and trying things for a few months at time, but when the interest subsides or they get busy with life most of it disappears.

The most successful people over a lifetime are those who establish healthy habits that are easy to sustain: Eating well enough, reducing bad habits like frequent alcohol or fast food consumption, some light physical activity every day, and other common sense things.

The most important factor is making it something easy to comply with. The $300 biomarker panels are interesting, but most people don’t want to pay $300 every year or more to get snapshots that depend largely on what they did the past week. Some people even get into self-deceiving habits where they eat well for a week before their blood tests because the blood test itself has become the game.

js2 236 days ago |

> Sticking to a Mediterranean diet that is light on carbohydrates and saturated fats is almost always the safest bet. Almost every health diet is some permutation of this.

A permutation that's currently making the rounds in the press (even though the original research is from 20 years ago) is the "portfolio diet":

https://jamanetwork.com/journals/jama/fullarticle/196970

https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.0...

Some press mentions:

https://www.health.harvard.edu/heart-health/the-portfolio-di...

https://www.nytimes.com/2025/11/04/well/eat/health-benefits-...

https://www.cnbc.com/2025/11/05/the-portfolio-diet-what-it-i...

wocram 236 days ago | |

This is a lot of words to say eat a plant-based/vegan diet.

starchild3001 236 days ago |

Lowering LDL cholesterol is arguably the most evidence-backed longevity intervention available today. Mendelian randomization studies suggest that each standard deviation of lifelong LDL reduction translates to roughly +1.2 years of additional lifespan, implying ~+2.4 to +3.6 years from sustained, meaningful lowering alone.

Pair this with tight blood-pressure control (aim systolic <130 mmHg) and a healthy BMI—every incremental improvement helps. Together, LDL, BP, and BMI form the most potent triad of interventions most people can implement now and expect to see substantial benefits 20–40 years down the line.

A few references: https://mylongevityjourney.blogspot.com/2022/08/a-short-summ...

dust42 236 days ago |

Long story short care about your health. If you don't do already, maybe now is a good time to start.

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!

cogman10 236 days ago |

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".

naIak 236 days ago | |

Right? It started okay even if a bit too verbose, then there was a second introduction. There I lost interest.

embedding-shape 236 days ago |

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 much of it"?

It seems like the personal preferences (don't like smoking, but does like alcohol) is getting in the way of their medical-but-not-medical advice, instead of being able to apply their recommendations equally regardless of what they personally like.

AaronAPU 236 days ago |

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.

Tempest1981 236 days ago |

Summarizing:

- Get a regular physical, or at least a blood test. (Don't wait 5 or 10 years)

- If it shows cholesterol issues, get an advanced lipids blood test, which can indicate whether it's caused by genetics (LipoA/ApoB?)

- If eating and exercise alone aren't helping, consider taking statins for cardiovascular health

- Consider a CT scan to check for calcium build-up, which is not reversible (afaik)

fwiw, I think the advice is much more than just "eat well and exercise".

cthalupa 236 days ago | |

You really should push for an ApoB test in general - most people are bit by LDL-C and not other atherogenic particles like Lp(a), but it's still common enough to find out. The good news is Lp(a) is largely genetic so if you know you have low levels you likely don't need to test again anytime soon.

A CAC will show calcified build-up, not reversible (or at least not in any appreciable way)

A CTA will show soft plaque buildup, which IS reversible with a low enough atherogenic particle load. This generally means keeping your LDL-C below the 50-70 range, though if Lp(a) is the cause you'll likely need a PKCS9 inhibitor or an upcoming CETP inhibitor to drive it down.

CalChris 236 days ago | |

A regular lipid panel won't test for Lp(a) which is genetic. So you need to test specifically for Lp(a) once in your lifetime because you need to know your risk factors. The test was $35.20 when I had it done by LabCorp last year. 20-30% of the population (including me) have high Lp(a). Statins don't reduce Lp(a).

giardini 236 days ago |

The discussion seems unduly focused on lipids, whereas I would think that blood pressure would be a, if not the, primary concern.

Also for those who do take blood pressure medication: never quickly change the dosage, and especially never quit taking it w/o supervision!

I've seen several untimely deaths b/c someone ran out of their BP medication and could not get to a pharmacist quickly enough. Alternatively the person became irritated with the medication and simply stopped taking it.

Maybe part of starting BP medication should be the doctor giving you a "safety package" that includes a full month's worth of the drug and is to be put on a shelf somewhere where you can get to it should your usual prescription run out.

sn9 236 days ago | |

Blood lipids and blood pressure are both significant risk factors for heart disease.

It makes zero sense to prioritize one over the other, any more than it makes sense to ignore diet and exercise.

maxnevermind 236 days ago | |

I was also surprised by that. It is relatively cheap to measure as you can just buy BP monitor and do it yourself at home. Considering that high BP is very often asymptomatic, I, for example, even feel better with high BP, many people walking around accumulating damage for years. Not to mention it also goes with a baggage of other side-effects like increased chances of a stroke and kidney failure. For some reason it hits differently when you go eat something salty or drink coffee or get all stressed out for now reason and then see increased BP with your own eyes. That was what motivated me to stick to a better diet, cut caffeine and chill out.

throwaway89201 236 days ago |

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".

Esophagus4 236 days ago | |

Yes - in addition, medical professionals warn against “overdiagnosis” from unnecessary screenings.

This can happen when we choose to treat otherwise benign issues that would have had few negative consequences for our health or longevities. Those treatments can have negative effects that are worse than the ailment we’re trying to treat.

I know it’s a natural tech-guy impulse to quantify everything and get access to as much data as you can, but that myopic focus can actually lead us to optimize for the wrong thing.

[1]https://pmc.ncbi.nlm.nih.gov/articles/PMC4077659/

[2]https://pmc.ncbi.nlm.nih.gov/articles/PMC6135119/

dumbmrblah 236 days ago | |

I agree. As a physician, this is sticking out to me as bad / dangerous advice. By getting unneeded regular CT scans, you’re dramatically increasing your risk of developing cancer. Beyond the radiation exposure itself, there is also the very real possibility of incidental findings that can lead to further testing, invasive biopsies, and unnecessary interventions, all of which compound your overall risk. You might solve one problem, but you’ve just guaranteed a much bigger, more explosive one down the line.

bluGill 236 days ago | | |

You won't die of heart diesease if you die of cancer first. So I guess it sortof checks out, but not what I would choose.

jmpman 236 days ago |

My good friend just died from a heart attack at 60. 90% blockage in 2 arteries, even though he exercised regularly and appeared perfectly healthy. This triggered my exploration of my own risk and I came to the realization that although my lipid panels were ok, I could also have a 90% blockage and be completely unaware. I ended up getting a Calcium CT scan which showed no blockages, but I realized that without my friends death, I’d have no idea of my score. In the US, insurance doesn’t cover the screening. I’m now a believer of all people having a scan at 50, and likely every 5 or 10 years afterwards.

tonymet 236 days ago |

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.

Zak 236 days ago | |

This site isn't necessarily meant to have a big sociological impact; it provides enough information that someone with sufficient motivation, but a lack of resources and expertise can take concrete steps to reduce their risk. That seems useful to me.

tonymet 236 days ago | | |

in this case “useful” means applying the facts and making changes. A detailed map that goes unused is useless. A hand drawn map that gets you home is priceless.

People don’t need more facts and information – those are in surplus. In fact, for most people when they receive too many facts, they just glaze over.

The changes needed are trivial

jasonjmcghee 236 days ago | |

Managing stress shouldn't be overlooked

tonymet 236 days ago | | |

“Stress” is so abused and nebulous that it’s impossible to define. Nearly every condition is worsened by “stress” but there’s no way to measure it. And there’s no conclusive way to manage stress either. Medication, psychotropics, self medication, meditation. Nearly all of those are more broadly abused and yet stress “worsens”.

One person may run an intense soup kitchen 15 hours a day and feel little stress, and another can sit at a computer for 9 hours sending pointless emails and feel tremendous stress.

lotsofpulp 236 days ago | |

> The behavioral changes are obvious and well evangelized : lose weight, regular activity (walking), and if necessary, take meds.

More specifically, it’s “change your diet and eat/drink less”, which is the hardest part. Diet’s impact eclipses regular activity, and it’s consequences build up and compound over decades.

tonymet 236 days ago | | |

i agree. Under-eating with baseline activity is better than overeating with excessive activity, excluding the extremes.

georgeburdell 236 days ago |

I’m not even a few screens into this and I’m already nodding my head in agreement. Having parents of the age where hospital trips are now a yearly occurrence at least, the level of care a patient gets is so much better if relatives are involved and knowledgeable. The medical system does not give a shit about you, they just want to make sure you don’t die in their care.

My sister is a hospital doctor and was remotely checking in with my dad’s care team every shift when he got sepsis after TWO different ERs missed pneumonia even with chest Xrays. Mistakes she corrected included getting him off the ventilator after the need had passed and also preventing him from being discharged directly home — instead he went to a rehab facility for 2 weeks. When I arrived after a few days in rehab he would barely stay awake long enough to eat. He went on to make a full recovery.

zamiang_brennan 236 days ago |

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.

mac-mc 236 days ago | |

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.

sn9 236 days ago | | |

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.

zoeysmithe 236 days ago | |

Also processed red meats or processed meats in general. Processed meats are the ones strongly linked with heart disease. At least for those who dont want to go vegetarian.

Processed meats are so bad, they should be eliminated entirely from everyone's diet. The World Health Organization has classified processed meat as a Group 1 carcinogen. No amount of it is considered safe.

Unprocessed read meat is still a problem and WHO advises less than 350g a week. Which is 12–18 ounces of cooked meat. 12g is about one adult serving of steak. So you really are looking at 1.5 servings per week of unprocessed red meat to be safe. At most! You probably should try for less or closer to 12g.

And really if you're at a healthy weight, then I'm not sure how helpful this is. Obesity is a bigger risk factor. This is a bit of the elephant in the room for heart health. Not only should we not be eating things associated with heart disease but also we need to keep ourselves at a healthy weight.

hackama 236 days ago |

Very interesting, but do the numerous mentions of taking action in your 20s, 30s and 40s mean it's too late for someone in their 50s?

Nitpick: he mentions LDL-C but the test results don't mention that at all. Only later do I see that is "LDL Cholesterol".

daveguy 236 days ago | |

No, it is never too late to take action. Even taking action after a stent procedure reduces further risk:

https://www.nhs.uk/conditions/coronary-heart-disease/treatme...

arjie 236 days ago | |

In general, when science is done, recruitment requirements force the experimenters to bucket the participants. One thing that often happens is an open bucket, say 35+.

The resulting science is then reported as “When you cross 35, your chances of being pregnant immediately drop” or “The brain stops developing at 18” and so on.

Almost nothing in the body is really like this, though. You can quit smoking later in life and it will help. You can eat better later and it will help. You can exercise and it will help. Very few things are “the damage is done”.

The only constraints are that the later you start the more risks you face. E.g. if you first deadlift in your 50s and you decide to follow Starting Strength you’re going to have trouble.

johnrob 236 days ago | |

If you start exercising in your 20s, and never stop, it will be so much easier to maintain fitness in 40s 50s etc. The challenge is that the benefits are not yet visible in your 20s (when you’ll probably be healthy and at a proper weight regardless). Gotta lay that foundation for older age though!

EDIT - I misread the comment. It’s never too late to start, just be careful for injuries as that will block your ability to exercise.

HPsquared 236 days ago | | |

It's a bit like saving money.

sn9 236 days ago | |

It's like time in the market.

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.

lateforwork 236 days ago |

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.

amsterdorn 236 days ago |

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.

Avalaxy 236 days ago | |

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.

programmertote 236 days ago |

> All of these can be accessed through bloodwork and urinalysis and can be done at a local Quest Labs (I’d venture to bet there’s one within a 10-mile radius of your home), prescribed by your doctor, and will likely cost anywhere between $80-$120 out of pocket.

A frustrating thing about this suggestion -- if I tell my physician (I live in the US) that I want these unusual tests prescribed, s/he would scorn at me (as if I'm acting like a know-it-all and am questioning his/her wisdom attained through years of medicine school and practice).

I truly don't understand about US healthcare is why we allowed medical practitioners to put up barriers around medicine (sure, ban opioids,chemo drugs and maybe a handful of other toxic-with-low-dose meds) and testing by requiring everything doctor's prescription?!

For example, my wife had an swollen eyelid (through infection) recently. She is an oncologist in training (is a board-certified internal medicine doctor). She knows how to treat it -- by putting clean, warm cloth over her eyes to allow pores to expand and let secretions seep out (to treat the symptom); by adding anti-bacterial eye drop like Tobramycin ('mycin' means it's Penicillin-variant, which is usually used to treat bacterial infection) OR by taking antibacterial medicine like Azithromycin. If we were in our home country (in SE Asia), we'd just go to a nearby pharmacy and buy either the anti-bacterial eye drop or pill, and get it sorted. Since we live in the US (for now), my wife has to asked one of her coworkers to prescribe her the medicine (she wasn't sure if she can self-prescribe because we just moved to CA and don't want her to lose her license). Then she took the anti-bacterial pill three times (with the warm cloth treatment for symptom), and the infection was treated completely.

I strongly believe that this kind of infection treatment or self-prescribed blood tests should be allowed without any doctor prescription. Otherwise, it only adds more (unnecessary) patient volume to doctors, clinics and hospitals. I remember reading someone from India advocating for similar approach on HN or Reddit a year or so ago too. In India (just like my SE Asian country), they could just go buy medicines over the counter from a local pharmacy. No doctor's prescription needed (maybe the law is there, but it's not enforce strictly).

reducesuffering 236 days ago |

"This means regular exercise (both strength training, ideally 3x per week, and cardio training that helps to improve V02 max like Zone 2 training)"

Actually, V02 max is best improved through High Intensity Interval Training (HIIT) like doing 400m sprints 8x with a couple minutes rest inbetween. V02 max is famous for being one of the best predictors of longevity.

Zone 2 training (light jogging) is important in tandem (80% of exercise ideally), especially for overall cardiovascular health and lowering heart rate.

Best thing I ever did for my health was start running (mostly jogging) 4-5 times a week. It's amazing how much your health can be improved with 4x 45 minute jogs (just 3 hours/wk). I can consume practically any caloric food for needed energy and all my health metrics have been substantially linearly increasing since I started.

"the stuff that’s not good for you: pasta and pizza and bread."

Tell that to the paragons of fitness in marathon running or olympic swimming. There are none of them on low carb. The best cardio health requires cardio exercise and cardio exercise requires carbs as energy. Of course if you're not going to exercise and are okay with 50th percentile health, ya carbs will hurt you then because youre not using them.

AstroBen 236 days ago | |

Is V02 max still the best predictor in people optimizing for it specifically above everything else, or only in people that train generally and have a high V02 max as a side effect?

My guess is the latter

loeg 236 days ago | |

He might be talking about zone 2 in a 3-zone model? Otherwise, I agree, zone 2 in a 5- or 7-zone model is not intense enough to provide VO2 adaptation.

js2 236 days ago |

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...

Beijinger 236 days ago |

There is an old pharmaceutical product that was available in Germany, but can not be obtained anymore. Ouabain /Strophanthin

"Ouabain /wɑːˈbɑːɪn/[1] or /ˈwɑːbeɪn, ˈwæ-/ (from Somali waabaayo, "arrow poison" through French ouabaïo) also known as g-strophanthin, is a plant derived toxic substance that was traditionally used as an arrow poison in eastern Africa for both hunting and warfare."

It was later found naturally occuring in the human body:

Key Paper: Gottlieb SS, et al. "Elevated concentrations of endogenous ouabain in patients with congestive heart failure." Circulation. 1992;86(3):846-849. Details: Researchers measured plasma EO in 21 patients with severe heart failure (NYHA class III-IV), finding mean levels of 1.59 nM—over 3x higher than in controls. EO correlated inversely with cardiac index (r = -0.62) and positively with mean arterial pressure, but not with atrial pressures, suggesting a compensatory role in cardiac output regulation rather than simple volume overload.

arjie 236 days ago |

The primary thing I did was ask a cardiovascular surgeon in my network to send the lab requisition form to a lab. This is the gate for much of this stuff, even if you pay out of pocket. If someone knows a simple “pay and play” testing service that would be fantastic.

Most doctors recommend against these and against the full body MRI one can get because they believe you’ll always find things you don’t expect and that will make you indulge in interventions that have weak support, resulting in deleterious iatrogenic effects.

I found that I had no such impulse with the data I had. But a friend of mine, supplied with evidence of a little arrhythmia went through a battery of tests and experimentation. He was in line for getting a cardiac ablation when he finally quit his job and stopped having the problem. So I get why they say that. There’s people like that.

Anyway, if you’re curious what you can get for $800 email me and I’ll post here. I’d do it proactively but I’m traveling so it will take a little work.

rootusrootus 236 days ago | |

I got all the same labs through Function Health. That’s the standard pay-to-play these days, but there are others.

arjie 236 days ago | | |

Perfect. Looks like everything I’d get from Ulta for $800 but for much less. The self serve model is great. Thank you.

GrzegorzWidla 229 days ago |

>> Sticking to a Mediterranean diet that is light on carbohydrates and saturated fats is almost always the safest bet.

Majority of calories on a Mediterranean diet come from carbohydrates. I think the author meant “light on processed sugars (unless warranted by a high endurance training volumes)”.

gehsty 236 days ago |

Eat healthier (less processed foods, more fruit and veg, healthy carbs, low sugar and alcohol), exercise regularly and get enough sleep. Take a blood pressure measurement every week / month or so. Track your weight. React if either start going up. Don’t go start getting uneasy ct scans.

harleyk 236 days ago |

A recent report from the American College of Cardiology emphasizes the prediction power of hsCRP:

"High-sensitivity C-reactive protein (hsCRP) is an inexpensive and widely available blood test. While there has been debate within the medical community regarding the utility of hsCRP, this statement details the data confirming its value in clinical decision making in primary and secondary prevention."

https://www.acc.org/latest-in-cardiology/journal-scans/2025/...

bebb 236 days ago |

Read the article, felt worried.

Came back here and read all the cynical and critical comments, felt a lot better.

Thanks guys.

aucisson_masque 236 days ago |

> I experienced this repeatedly. We were admitted to the hospital for over a week when my daughter contracted viral meningitis (the scariest experience of my life). Even while working with incredible infectious disease doctors, I still had to fight and constantly remind people what the next steps were during our admission. Nobody is watching over you - it’s your job to organize things and ensure they’re on track. I had to coordinate between the infectious disease departments and neurology departments and make sure the people doing the lumbar puncture on my 9-month-old daughter weren’t just residents practicing on my child but experts who had conducted the procedure countless times before. You must Advocate for yourself and the ones you love.

Don't know why his behavior wasn't noticed more in the comments but he's absolutely entitled.

Hospitals and everything have limited resources, by being the asshole who request things to go fast for him and only have the best of the best to practice on his daughter, he just deprived someone else daughter from good care.

This is selfishness, unless the nurses and doctors were napping, he shouldn't have that kind of behavior detrimental to everyone else. I couldn't read further what he got to say but, coming from this man, i don't see how it could be interesting or useful.

I don't have anything to prove it but the whole thing smell fishy, when he goes to these 'concierge doctors', of course they are going to find things that are not right and were 'missed' by his regular doctor. That's literally their business.

if you went there and you were told 'nop, everything is fine. Keep doing what you do', you would go back to your GP and forget about it. But if he frightens you with bloodwork that show 'not optimal' in big red, tells you how wrong your gp is and how you should listen to him, you're going to think this guy know so much more and deserve my money. It's business.

I trust the national health guidelines: eat healthy, do at least 30 min of activity per day and lift weights.

Everything else feel like nuisance, especially coming from folk like that.

AstroBen 236 days ago |

> what most primary care physicians will do with patients to help them avoid heart disease is not enough. The status quo simply does not work

The reason the status quo doesn't work is that people don't actually follow the guidelines set

Barely anyone (like 10% last I saw) meets the recommended amounts of fruit and vegetable intake or exercise. We're all addicted to terrible foods, are sedentary, have high blood pressure and are overweight

Before you start micro optimizing everything just fix your diet, avoid saturated fat and sodium and get enough moderate intensity or better exercise every week

The 95/5 of it is just basic stuff everyone knows and yet barely anyone does

qgin 236 days ago |

I love this sort of documentation-style guide to medical issues. Reminds me of https://www.fourmilab.ch/hackdiet/e4/

mathgeek 236 days ago |

> You should be scared of heart disease.

No, you should not be scared of this. Those are the wrong words to use for what this site is promoting. Conscious choices are much better than settling for fear.

tamimio 236 days ago |

Heart disease is the leading cause for death, but the root cause is definitely obesity. There’s a an obesity-pandemic that no one’s talking about it, there should be a national program that encourages people getting fit and discourages them from getting obese. And by encouraging/discouraging I don’t mean some random posters posted around, no, things like tax cut for fit people, free access to xyz if your bmi is less then abc, cheaper flights and insurance if you are fit, and so on.

potato-peeler 236 days ago |

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?

themk 236 days ago | |

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.

mac-mc 236 days ago |

If you dig into research and follow the low-risk experiments that people do online to reduce their Lp(a), you can find techniques and evidence to do so. It doesn't have to be an impossible-to-fix issue.

I like this list of experiments by Greg Muschen: https://x.com/gregmushen/status/1924676651268653474

guzik 236 days ago |

> 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.

giardini 236 days ago | |

I asked a heart doctor for a calcium scan. He said I didn't need that, but he wanted me to wear a Holter monitor for a few days (reasons unknown). I did not.

That was years ago. I have different doctors now but still no calcium scan. Time to ask again possibly.

pstuart 236 days ago |

A key takeaway is: don't be afraid of taking statins if you need them. I fell for the "statins are bad" BS for years and have paid the price.

lisbbb 236 days ago | |

My dad would disagree--he's 84, was on statins for years and they did terrible things to his body. I'm sure the drugs kept him alive, but the side effects, as he describes them, particularly to his legs and kidneys, were pretty severe. He only got better when he stopped taking them.

pstuart 236 days ago | | |

Obviously we all differ in how we respond to medications -- apparently it's 10% - 15% that have issues with statins.

I think a pragmatic approach would be to try them if warranted by testing and be prepared to stop or change them if it has issues.

We're learning more and more about the mechanisms of cholesterol and there's a variety of medications out there: https://www.heart.org/en/health-topics/cholesterol/preventio...

And that doesn't address the role that fiber plays in managing it (and the virtues of fiber for health in general that are coming to light at a rapid clip)

Buttons840 236 days ago | | |

I believe statins reduce risk by about 30%, so there's a roughly 30% chance the statins have done good things for your dad.

(I think that's what the stats mean, right? I'm open to correction on this. I do believe the statin studies, I'm not a science denier. I think what I've said matches the science, as far as I understand.)

Buttons840 236 days ago | |

What price have you paid?

pstuart 236 days ago | | |

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.

joquarky 236 days ago |

Unfortunately, the time in our lives when we need to most pay attention to these things is when ageism kicks in and yeets us completely off of health insurance.

I'm coming up on two years unemployed and feel like an idiot for not better preparing for ageism in our industry. I foolishly assumed that experience would make up for age.

Don't make the same mistake! Plan to have most of your income shrink drastically in your mid-40s.

jorvi 236 days ago |

The "be an advocate" thing is both true but also incredibly selfish and egotistical.

If everyone did that, the whole system would grind to a halt. Doctors aren't in a rush because they enjoy so, they are because they're already overworked. 1 out of every 25 patients (their family) demanding extra attention is possible although still a burden. 21 out of every 25 is not possible.

JKCalhoun 236 days ago | |

My assumption was that we have to be our own advocate because the system itself is non-ideal.

My takeaway: if bloodwork were broader, covered more markers, there would be one less reason to have to advocate for your own health.

I find it odd that you would instead "advocate" for not being an advocate for your own health? Are we waiting for a friend to say, "Hey, you're looking a little rough."

jorvi 236 days ago | | |

> Are we waiting for a friend to say, "Hey, you're looking a little rough."

If you are "looking rough", unless you are in imminent danger you should just go to the GP. Your GP is there to triage care. He'll recommend whether you need something prescribed from the pharmacy, a blood test or see a specialist.

If you get refered to a specialist, the hospital will try to ascertain if you need a really experienced specialist or if you have a relatively simple case that can be handled by one with, say, 11 years experience. If he decides the case is too complex, he can ask the more experienced specialist to preside.

If you short-circuit that and demand to be seen by the most experienced specialist, you are robbing a patient that might need that experienced hand of extremely valuable care, when you could have done with less. Like I said, egotistical.

> My takeaway: if bloodwork were broader, covered more markers, there would be one less reason to have to advocate for your own health.

Blood work needs lab workers who also have limited time. They could indeed do 10 tests but that means more labs and more lab workers which increases costs, which are already exploding. Better tests would be good.

gbacon 236 days ago | |

Behaving like docile, compliant cattle benefits only the farmer.

jorvi 236 days ago | | |

Perhaps you could feed the cattle with your strawman instead.

jeffbee 236 days ago | |

Yeah insisting that you are qualified to choose the members of the medical staff qualified to do X or Y procedure isn't advocating, it's being a prick.

jeffnv 236 days ago |

For what it's worth, this article by the doctors at Barbell Medicine has been my go to recommendation for what to prioritize for health and longevity: https://www.barbellmedicine.com/blog/where-should-my-priorit...

bad_username 236 days ago | |

<quote>

ALL individuals (both youth and adults) should meet and/or exceed the following:

150 to 300 minutes per week of moderate-intensity aerobic physical activity, OR;

75 to 150 minutes per week of vigorous-intensity aerobic physical activity, AND;

Resistance training of moderate or greater intensity involving all major muscle groups on 2 or more days per week

</quote>

This boolean expression needs some parentheses...

bargainbin 236 days ago |

Anyone note where to get this full blood panel done in the UK? I’ve got issues with high blood pressure and swelling in the lower extremities. Blood tests and ECG showed nothing.

Both granddads died in their 50s from heart attacks. I’m convinced I have an issue with my circulation but the blood tests I had done doesn’t seem to cover everything stated here.

ac29 235 days ago | |

> I’ve got issues with high blood pressure and swelling in the lower extremities

Edema in the lower legs is a relatively common side effect of some types of blood pressure medication. If you are on BP medication, talk to the prescribing doctor about it.

If you aren't on medication, you should discuss starting something with your doctor. High blood pressure is a risk factor for many things you dont want to happen and is very treatable. (Of course, the standard health advice to improve your diet and exercise more very much applies here as well).

darepublic 236 days ago |

My dad went to doctor who was like his friend as long as I can remember. Always received a clean bill of health. Until he suddenly got heart disease and a stroke on the operating table. His doctor basically said that he had seen this coming. Doctors secretary, probably twenty years his junior was a stunner.

m_a_g 236 days ago |

I'd argue that even the CT scan is unnecessary for a lot of people who want to start a preventative regimen to tackle heart disease. Especially if you're in your 20s or 30s with no family history of heart disease and no absurdly high ApoB results combined with really high lp(a).

floundy 236 days ago |

I didn’t know who this author was previously (Jared Hecht) but I looked up pictures of him and he definitely does not look like he exercises regularly. He’s skinny (e.g. not overweight) but if I passed by him on the street I would not peg him for someone who exercises seriously.

gscott 236 days ago |

Not an ad but I use https://www.walkinlab.com to order labs then get them done easily without a doctor. I have regular health insurance but it doesn't cover as many labs as I want done.

tlarkworthy 236 days ago |

well that inspired me to research getting those tests in Germany.

=> heart panel plus

https://en.minu.synlab.ee/heart-panel-plus/

I don't need doctors, I can get ChatGPT to analyse the results.

wyldfire 236 days ago |

I was a bit distracted by the capitalization of the word "Advocate". Both when used as a noun and a verb. Peculiar.

But a great article with really great suggestions. Too bad there's not better medical care by default but good to hear that we can take control.

dennis_jeeves2 235 days ago |

IMO the war on dietary saturated fat and dietary cholesterol is misplaced big time. It's minority view though. What's worse is that avoiding saturated fat and cholesterol may partly fuel your progress to heart disease.

joshcsimmons 235 days ago |

A lot of good information but bordering on neurotic. If everyone just did lipids, walked 3x a week, and got on glp drugs it would significantly reduce the number of heart attacks.

Ordinary people don’t need to be obsessing to do better.

deadbabe 236 days ago |

Unless you're willing to take pills the rest of your life, spending a ton of money to study your risk of heart disease is always going to lead you to the same conclusion: Don't smoke, don't drink, eat healthy and exercise regularly.

ef2k 236 days ago |

This reminded me of the other extreme to health consciousness: the 109 year old that smoked cigars and ate ice cream every night [0].

[0] https://youtu.be/BXyfCGDnuWs?t=332

ambicapter 236 days ago |

> Even while working with incredible infectious disease doctors, I still had to fight and constantly remind people what the next steps were during our admission.

Can't help but feel this is a factor of the sleep deprivation that doctors seem to celebrate.

dreamcompiler 236 days ago |

> To help manage inflammation, there are new medications like colchicine that are normally only used in very high-risk patients.

Clarification: Colchicine has been used by humans for over 3000 years. What's new is its use for cardiovascular disorders.

ETH_start 236 days ago |

All of this advice seems really good. The only one I am reluctant to follow is getting a CT or CTA scan.

For reference, radiation levels:

Chest X-ray: ~0.1 mSv (millisieverts)

Head CT: ~2 mSv

Chest CT: ~7 mSv

Abdomen–pelvis CT: ~10 mSv

CTA (angiography): often 10–20 mSv

Are there non X-ray diagnostic imaging scans that can detect arterial plaque?

singpolyma3 236 days ago |

So your doctor won't agree that you have heart disease but you need to be on a statin but statins are by prescription only... So if you're not going to hire an expensive doctor what can a normal person actually do?

loeg 236 days ago | |

Ask another regular doctor?

singpolyma3 236 days ago | | |

But the whole premise of this article is that the regular doctors won't get it or do it

FlamingMoe 236 days ago |

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.

hshdhdhehd 236 days ago |

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.

hmontazeri 236 days ago |

Triglyceride-to-HDL Ratio (TG/HDL)

Interpretation: • < 2.0: Insulin sensitive • 2.0–3.9: Moderate insulin resistance risk • ≥ 4.0: High likelihood of insulin resistance

Your ratio = 5.0 → Suggests likely insulin resistance.

reidrac 236 days ago |

There are some points on this post that confuse me.

> In early 2023 during a routine skin check at my dermatologist [...]

Are routine skin checks a thing?

> [...] I’ve spoken with several of the world’s leading cardiologists and lipidologists [...]

How come?

dragonwriter 236 days ago | |

> Are routine skin checks a thing?

If you have a dermatologist, I would imagine so.

Is having someone you can describe as "my dermatologist" a common thing? Probably not for most people who don't have a chronic skin condition of some kind, I would think.

bluGill 236 days ago | |

they are to me. I'm very light skinned and thus have had sigificant sunburn more than once, skin checks have found and removed somewhat likely to turn into cancer. Probably useless if you are 20, but by 50 they can find and prevent cancer and so should become common

loeg 236 days ago | |

Yes, you should probably visit a dermatologist regularly (once every year or two) for a routine skin check.

k__ 236 days ago |

There doesn't seem to be any mention of hypertension on that page.

fullStackOasis 236 days ago | |

Actually, there is. You have to search for "pressure". For example, "Other Tests: There are some other things that are important to know as well. You must know your blood pressure".

k__ 236 days ago | | |

Good point.

I've forgotten that blood pressure is another word for it, as all medical papers use hypertension.

Thanks!

Zak 236 days ago | |

If you're going to press ctrl+f and post a critique, I recommend including a synonym or two in your search terms.

jeffbee 236 days ago | | |

As much as the HN trend is against AI features in client software, this is an excellent use of Gemini-in-Chrome. Instead of wracking your brain for English synonyms, you can just ask it if the page discusses hypertension, a kind of weapons-grade ctrl+f. Mine said

"Yes, the article discusses hypertension, referring to it as "high blood pressure.""

n8cpdx 236 days ago |

Depends on the doctor. My doctor at One Medical proactively ordered an ApoB test just to be safe after I successfully got my LDL in check through diet and exercise.

bambax 236 days ago |

> Don’t Die!

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?

adrianN 236 days ago | |

If you prevent every ailment you don’t become frail and just take care of yourself.

CapitalistCartr 236 days ago | |

You're almost certainly going to die by or before 110, anyway. (Ir)Regardless of your efforts, or lack thereof, our bodies typically give out in the 100-110 year range with very few exceptions.

goblin89 236 days ago |

It seems to be nearly impossible for me to advocate for myself at a place like a hospital.

It might be easier to do this for someone else, but it seems narcissistic to assume I of all the patients is so special. If there’s nobody to advocate for me, clearly I’m not!

Let’s say I try it anyway. I tend to be a slow rational thinker in real-time situations, especially under pressure. If I try to advocate for myself and ask questions, I would need to have time to consider the responses (did I even get the information I requested, what are the implications) and maybe do some research in order to make an informed choice as to whether to proceed or not, or whether to ask further questions. However, if I actually request time and have people wait for me, I enter a high-pressure mode in which I can’t think well. The clock is ticking, the stakes are high.

Even if it’s a simple routine case, I am entrusting myself to people who have the power to kill me. If it’s anything beyond routine, killing or harming me may not even be consequential to them (mistakes happen). It is a very particular type of situation.

The natural thing for me to believe is that all of these people are professionals. If I have reasons to supervise them, it automatically implies I believe they are either unprofessional or malicious, in which case I really should not be there in the first place. The arrangement is that I am not supposed to know better than them. If I try to supervise them, that implies I think I do. At worst it would be disrespectful or offensive and would make them hostile on a personal level (which is always at play between humans, regardless of the protocol), at best it would make me look like a crackpot not to be taken seriously anyway. Besides, if I already assume they make mistakes or are unprofessional, their answers can be false anyway.

On the other hand, I am aware that many, many mistakes are made in hospitals daily, so I know they are not such infallible professionals.

As a result, this makes me very reluctant to go to a hospital or a clinic for any reason. It’s probably bad.

Anyone has advice for overcoming this? Maybe training to think quickly and finding ways out in high-stakes situations like this? Tricking yourself into a mode where you feel natural advocating for yourself and act in a way that makes people treat you seriously without being offensive to them (considering the power they have over you)? Learning to not care what people think in a healthy way? (Please don’t suggest LLMs.)

Fire-Dragon-DoL 236 days ago | |

That would be useful for me too, similar problem

jokoon 236 days ago |

yeah, always the usual: eat better and do physical activity

unfortunately, depression cripples my motivation to do physical activity

I still do some, but it's never enough

loeg 236 days ago | |

Do you treat your depression?

jokoon 234 days ago | | |

yes

dawnerd 236 days ago |

Was this written via LLM? There’s a link early on to some ai search tool which kinda made me question the validity of everything mentioned.

jeffbee 236 days ago | |

It has many markers of that, including being about ten times longer than it needed to have been.

OutOfHere 236 days ago | |

Please strictly cease and desist from accusing material of being written by an LLM, whether on this site or on any other site. If you want to criticize the material, do so under the good faith assumption that it is written by a human.

dawnerd 236 days ago | | |

I think it’s absolutely fair to criticize something for potentially being generated via an llm or heavily utilized by such especially when it comes to medial claims.

Reading it I couldn’t help but feel the author relied on ai research tools and is now passing that along to everyone reading as if it’s proven fact. When they link out to an ai search engine that’s not helpful when trying to cite sources.

loeg 236 days ago | | |

It's a wall of poorly written text. Whether it was a human or LLM is kind of not the main problem.

floundy 236 days ago | | |

Genuinely, why? More people than ever are using LLMs to flood the internet with textual slop far faster than humans who have respect for the craft of writing can generate their own text.

I checked Jared Hecht (the author of this piece’s blog) at jared.xyz and the oldest piece is from March 2023. Why should we give someone who has no evidence of writing anything before the release of ChatGPT the benefit of the doubt that their work is all human written, when all signs point to otherwise?

esseph 236 days ago | |

You should always have questioned the validity, but now you feel the need because of LLMs.

dtgriscom 236 days ago |

> The best time to make the decision to not die of heart disease and start taking action is in your 30s and 40s.

And the second best time is now.

loeg 236 days ago | |

Probably best to start in childhood anyway, not your 30s or 40s.

bzmrgonz 236 days ago |

Did you take a look at empirical health and what they are doing? Their goal is to prevent 1 million cardiac deaths by 2030.

tschellenbach 236 days ago |

You can run a full blood panel on your whoop by clicking a button and showing up at a quest diagnostics

armada651 236 days ago |

I honestly think we should live more for the now than the far future. Rather than focusing on how to optimally extend my lifespan I'd rather focus on living the life where I'd be satisfied if I dropped dead the next day.

Like the article says this is only one of the many causes you could possibly work to prevent and if you die of something else then all that effort was for naught. Whereas if you put all your effort into living a worthwhile life then it doesn't matter what you die of or when.

I understand this man has kids he wants to live long for and that makes optimizing for living a long life worthwhile to him. But I don't think that a long life should be the goal in and of itself, it should be to live a worthwhile life.

everdrive 236 days ago |

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.

JoshTriplett 236 days ago | |

New medical discoveries happen regularly; you might also die right before the discovery of a preventative/cure for dementia. Living people have options, dead people have none.

Also, given the preferences you expressed in your comment, you especially should want to avoid strokes, or the many side effects of heart disease, which can make you less healthy for a long time.

MattPalmer1086 236 days ago | |

Heart disease can be a slow decade long death, where you become incapable of physically doing anything. It's not just a heart attack out of nowhere and you're dead.

dehrmann 236 days ago | |

My grandfather always said "there's something to be said for a good coronary." He was in his 70's when he said it, and his point was that he had a good run, and there's an argument for going out while things are still good rather than slowly dying over six months in a nursing home (which is what actually happened).

puttycat 236 days ago |

I cannot judge the science in most of the article since I'm not a medical doctor.

But since I have a PhD in computer science in a relevant subdomain, I can certainly judge the part where he recommends the following:

> What should you do with your test results? Throw them into ChatGPT, of course!

Do not count on anything coming out of ChatGPT for medical advice. Period.

Padriac 236 days ago |

If you don't die of heart disease you will die from something else.

kidsil 235 days ago |

Hey, just a friendly reminder that this is HackerNews, not The Lancet.

I have seen past comments here debating many relative basic concepts on medicine. Please don't take medical advice from engineers. Drink water, exercise, eat well. Otherwise seek medical advice from a doctor.

Thanks!

aktuel 236 days ago |

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".

grvdrm 236 days ago |

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 upcoming physical - definitely exploring everything I can.

But, doing basics too. Lot of exercise. Weights. Good diet. Get min 7 hours of sleep if possible. Try not to be a maniac filled with stress.

loeg 236 days ago | |

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

grvdrm 235 days ago | | |

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

mmaunder 236 days ago |

Stop drinking. Replace cheese and butter with olive oil in copious amounts. Only eat fish meats. Don’t smoke or vape. Eat salads and other prebiotics. Get some cardio - even walking your dog is great. Your brain fog will lift, your skin will clear, your mood will improve and your doctor will gasp at how clear your carotids are next time they’re ultrasounded.

stdclass 236 days ago |

step 1 to avoid heart disease: do NOT inject yourself with untested mRNA gene therapy with questionable safety profiles

lisbbb 236 days ago |

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.

camel_gopher 236 days ago |

Tl;dr be affluent enough to be able to afford great medical care and have enough free time for preventative actions

tonymet 236 days ago | |

Walking and eating sensibly is free. Even a balance oatmeal, rice & beans with infrequent meat servings would defend against heart disease better than expensive medicine, at less than $1 / day.

lotsofpulp 236 days ago | | |

Lentils/legumes are cheap. There is probably no better bang for the buck. Yogurt is also cheap.

yinser 236 days ago | | |

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.

pstuart 236 days ago | | |

And not smoking or drinking saves you money!

hshdhdhehd 236 days ago | |

I think the point is it is cheap to prevent. The weird tip is doing a different test to the standard one, which costs little for typical HNers (but admit every $ counts for many people esp. with current inflation, poverty, bad governance) but sounds like on par with a dentist doing anything beyond a checkup.

lisbbb 236 days ago | | |

A colleague of mine was a vegan, took care of himself, still died of pancreatic cancer. It is what it is.

evantbyrne 236 days ago | |

90 day supply of Atorvastatin costs $10. Running costs a pair of shoes.

camel_gopher 236 days ago | | |

You have to be able to get the prescription. HMOs (Kaiser specifically) will generally not provide any sort of preventative care in this area unless your numbers are very high. You can’t get access to a cardiologist unless you’ve already had an adverse event.

If you can get time off work and have a PPO, you can get the preventative care.

adi4213 236 days ago | |

You should try www.betterbrain.com/insurance! It covers this set of bloodwork and 92% of covered patients pay $0

loeg 236 days ago |

Wall of text, jeez. This reads as neurotic.

The big levers anyone can do (but most don't) are:

1. Exercise regularly (anything aerobic)

2. Minimize your saturated fat / cholesterol intake

That's a better tl;dr than the useless one presented in the article.

righthand 236 days ago |

Really surprised at the last few paragraphs! Read with caution this is not Real medical advice!

This was a good read until they recommended using ChatGPT instead of working with your doctor. Also they have some delusion about the actual cost of using ChatGPT.

> Pretty incredible. Also free.

Not free at all. Not a good idea to feed a private corporation your health data!

a13n 236 days ago | |

we’re not far from the point where ChatGPT is superior than going to the doctor in terms of cost, accessibility, speed, and quality

it’s honestly not as bad as y’all think

ChatGPT isn’t perfect but neither is your doctor (or your lawyer or accountant)

righthand 235 days ago | | |

It’s not as bad as you think until OpenAI begins selling it’s data profile they’ve been collecting on you.

lbrito 236 days ago |

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.

bbor 236 days ago | |

I share your general emotional reaction, but to be fair, heart disease is far and away more important than other type of disease. More people die of it in the US than die of all cancers combined: https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

bwfan123 236 days ago | |

> We all know the good practices. Don't be a dumbass

In theory yes, but in practice we are all dumbasses to some extent.

I used to have your attitude until I saw a friend die of a heart attack at an early age - and it appeared to me that he would have survived if he had an indication. So, now I have changed my attitude to one of more data does not hurt.