13 ms·
Ticker: Don't die of heart disease
- GrzegorzWidla 10mo 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)”.
- qgin 10mo agoI love this sort of documentation-style guide to medical issues. Reminds me of https://www.fourmilab.ch/hackdiet/e4/ https://www.fourmilab.ch/hackdiet/e4/
- camel_gopher 10mo agoTl;dr be affluent enough to be able to afford great medical care and have enough free time for preventative actions
- adi4213 10mo agoYou should try www.betterbrain.com/insurance! It covers this set of bloodwork and 92% of covered patients pay $0
- hshdhdhehd 10mo agoI 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 10mo agoA colleague of mine was a vegan, took care of himself, still died of pancreatic cancer. It is what it is.
- tonymet 10mo agoWalking 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.
- yinser 10mo agoPromoting 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.
- tonymet 10mo agoIt’s safer than taking unlicensed tech advice from an Internet forum
- loeg 10mo agoMost people aren't on and don't need statins. Everyone would be well served to eat well and exercise regularly. It's not a replacement.
- 31carmichael 10mo agoYou right. You don't need statins. Nobody does. But look at the statistics. You might also drop dead tomorrow. It's hard to know. If you think eating and exercising would solve heart disease, you are mis-informed. It's the number one killer. If we all died at 30, the drugs would not need to exist. I'm sure you would like to live as long as you can. Taking statins is cheap and simple for most people.
- loeg 10mo agoWhat are you talking about. People who need statins should take statins; this is informed by a basic metabolic panel, something every doctor does.
- pstuart 10mo ago
- evantbyrne 10mo ago90 day supply of Atorvastatin costs $10. Running costs a pair of shoes.
- camel_gopher 10mo agoYou 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.
- evantbyrne 10mo ago$10 is the cash price. Your doctor diagnoses, not insurance, and you don't need a specialist to get diagnosed regardless of what your insurer wants. Even a nurse practitioner can prescribe you a statin.
- hshdhdhehd 10mo agoIt 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.
- lateforwork 10mo agoThe 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.
- loloquwowndueo 10mo agoWhy is heart disease a “good” cause of death?
- lateforwork 10mo agoLess suffering. Stroke on the other hand... you become partially disabled, which causes suffering not just for you, but also for your loved ones.
- deleted 10mo ago[deleted]
- poszlem 10mo agoI think you are confusing "getting a stroke" and "dying from stroke". If you get a heart attack and don't die from it you might become a burden on your family too.
- Avalaxy 10mo agoFunnily enough, the things you can do to prevent stroke line up entirely with the things you can do to avoid heart disease.
- lateforwork 10mo agoThe article doesn't mention antioxidants at all, which help prevent atherosclerosis.
- masfuerte 10mo ago
- tonymet 10mo agoFabulous 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.
- jasonjmcghee 10mo agoManaging stress shouldn't be overlooked
- tonymet 10mo 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.
- Jimmc414 10mo agoManaging cortisol shouldn't be overlooked
- tonymet 10mo ago“Sleep better, eat better, get less stress, get more activity” is about as helpful as saying “don’t die”.
- Jimmc414 10mo agoTrue that “sleep better, eat better, exercise” is generic advice ignoring constraints. Like telling someone with insomnia, three kids, and a night shift to “sleep better” or telling someone broke to “have more money.” But being difficult to put into action doesn’t mean the advice is wrong. Sleep deprivation measurably increases cortisol and inflammatory markers. Exercise measurably reduces them. These actions have quantifiable sometimes immediate effects regardless of how we define stress.
- cogman10 10mo agoI 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 10mo agoRight? It started okay even if a bit too verbose, then there was a second introduction. There I lost interest.
- Scubabear68 10mo agoSomewhat related, one of my thoughts was “what if these concierge doctors just keep running tests until they find something, anything, to justify their fees”?
- rustman123 10mo agoIt’s also demonizing doctors and the healthcare system a bit too much for my liking. I’m located in Europe, so I may have a slightly different view, but my doctors clearly care and discuss with me about prevention, risks, tradeoffs, … They praise the methods of the „good“ doctors and stamps the others as driven by financial gain. Who says the expensive ones are any better in this regard? Who says they are more or less exaggerating the importance of test results to make you come back?
- lotyrin 10mo agoIn the US my best doctors produce out of date advice about obvious things, have a very distinct gap between "everyday" (stuff they actually see) and "incredibly rare" (stuff unique enough to be a case study they heard about) in their knowledge/understanding and rarely advise things that require me to be a proactive and rational person (because they don't serve these often), so they'll spend two seconds being like "diet and exercise" without a discussion on how that'd work or what adjustments I'd actually make (leaving me to do this research myself) and then suggest a prescription (because even their least proactive patient will probably take a pill). They'll wait until things become a disorder before addressing them (or discussing with me how to address them). The worst will basically laugh me out of their office for daring to belong to a marginalized identity or failing to already have the health knowledge I'm there trying to gain from them. Maybe I have awful luck... but I have very little faith at this point. The most effective relationship I had was with a hack who was willing to just prescribe whatever I asked him for and order whatever tests I asked him for (I think most of his patient base were college students seeking amphetamine salts).
- hackama 10mo agoVery 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 10mo agoNo, 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/treatment/ https://www.nhs.uk/conditions/coronary-heart-disease/treatme...
- johnrob 10mo agoIf 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 10mo agoIt's a bit like saving money.
- arjie 10mo agoIn 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.
- k__ 10mo agoThere doesn't seem to be any mention of hypertension on that page.
- Zak 10mo agoIf you're going to press ctrl+f and post a critique, I recommend including a synonym or two in your search terms.
- jeffbee 10mo agoAs 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.""
- fullStackOasis 10mo agoActually, 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__ 10mo agoGood point. I've forgotten that blood pressure is another word for it, as all medical papers use hypertension. Thanks!
- pstuart 10mo agoA 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.
- Buttons840 10mo agoWhat price have you paid?
- pstuart 10mo agoI 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.
- 31carmichael 10mo agoI recommend the same. There are other interventions, but these two medications are straightforward to obtain with low or no side effects.
- lisbbb 10mo agoMy 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.
- Buttons840 10mo agoI 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.)
- dawnerd 10mo agoWas 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.
- esseph 10mo agoYou should always have questioned the validity, but now you feel the need because of LLMs.
- OutOfHere 10mo agoPlease 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 10mo agoI 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.
- stavros 10mo agoWe don't really know the author. For all I know, the LLM is more accurate than the specific human, in which case I'd want the article to be written by an LLM. Saying "LLM bad, human good" is both false and uninteresting.
- OutOfHere 10mo agoNo. It is false criticism. It is like calling one a witch in historical times. Anyone gets accused of it without hard evidence. For all I know, your comment was AI generated. You relied on AI and are now passing that along. It's not helpful.
- 10mo ago
- AaronAPU 10mo agoI 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.
- rogerrogerr 10mo agoAs someone who would like to do this but has generally been choosing the easy paths - curious what your diet and exercise regime looks like.
- AaronAPU 10mo agoWell “fortunately” I’m forced to have a strict diet due to some sort of IBS issues. For that, I use the MacroFactor app and talk through my daily recipes with ChatGPT, making sure to hit the macros and calories targets while also optimizing for heart health and IBS. Fat, protein, carbs, fiber. Taking AG1 to fill gaps. For fitness I’m obsessed with biking so I do like 90 minutes of endurance/tempo pace 5 days a week and usually a race once a week. Zwift is great with a Tacx when weather is bad (often). That isn’t a time option for everyone but it is also likely well beyond what is necessary for most people. I also don’t drink or smoke or vape which I think is important. Not going to say I’m an expert or an exemplar of health but I am really trying everything I know to do at this stage.
- sn9 10mo agoThere are specific recommended minimums in the physical activity guidelines about strength training and endurance training where meeting them is likely to significantly reduce your disease risk and improve your health: https://www.barbellmedicine.com/blog/where-should-my-priorities-be-to-improve-my-health/ https://www.barbellmedicine.com/blog/where-should-my-priorit...
- captainkrtek 10mo agoA relevant anecdote. I’m very athletic and skinny, eat well, have a resting heart rate in the 40s, but was recently prescribed a statin at 30, due to my very high LDL cholesterol and lipoprotein A. My family has a history of cardiovascular disease despite us doing what we can w.r.t eating and exercise. I’d encourage you to get some tests at least. My mother similarly was put on statins and is getting a cardiovascular work up (calcium scan) because she now has early atherosclerosis. She eats super healthy and is a former olympic sprinter.. Bonus anecdote: In my free time I do shifts as an EMT with my fire dept (911), that is a big wake up call to wanting to be as healthy as can be. The number of patients I see who are 50+, nearly all are on 5-10+ meds, few are just one 0, 1, or 2. At that age I see type 2 diabetes, hypertension, high cholesterol, and more.
- lbrito 10mo agoI 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 10mo agoI 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 https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
- fire_forager 10mo ago[dead]
- bwfan123 10mo 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.
- FlamingMoe 10mo agoI 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.
- potato-peeler 10mo agoThe 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 10mo agoAFAIU, 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.
- lisbbb 10mo agoLove 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.
- zamiang_brennan 10mo agoGreat 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 10mo agoIMO, 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 10mo agoYeah 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.
- mac-mc 10mo agoNo, I mean for some, a high saturated fat diet can do amazing wonders. And for others, it causes horrible issues. The studies are not well segmented genetically and by body state since that is signficantly more expensive and genetics only got cheap in the past 10 years or so, so they wash out these large sub-population dynamics.
- sn9 10mo agoIt's the sort of thing you can just experiment with and see for yourself. Try eating the usual health-promoting diet high in fiber and low in saturated fats from animal sources, mostly whole foods, lots of fruits and veggies and legumes and whole grains, lean meats, etc. After a few months, check your blood work. Then reintroduce fattier cuts of meat into your diet and see what your numbers do after a few months.
- 10mo ago
- throwaway89201 10mo agoI'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".
- dumbmrblah 10mo agoI 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 10mo agoYou 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.
- Esophagus4 10mo agoYes - 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/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4077659/ [2]https://pmc.ncbi.nlm.nih.gov/articles/PMC6135119/ https://pmc.ncbi.nlm.nih.gov/articles/PMC6135119/
- carbocation 10mo agoKey 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.
- safety1st 10mo agoRight. Hang on a second. This guy is making a big big claim. The central point of his article is that he went to a doctor who followed the guidelines, tested him and found he wasn't at risk for heart disease. But then he went to another, very expensive concierge doctor, who did special extra tests, and discovered that he was likely to develop heart disease and have a heart attack. Therefore he is arguing that THE STANDARD GUIDELINES ARE WRONG AND EVEN IF YOU DO EVERYTHING RIGHT AND YOUR DOCTOR CONFIRMS IT YOU MAY BE LIKELY TO DIE OF HEART DISEASE ANYWAY, SO ONLY THE SPECIAL EXTRA TESTS CAN REVEAL THE TRUTH. I want a second opinion from a doctor. Is this true? Is this for real? Because it smells funny.
- sixtyj 10mo agoIf there are two contradictory conclusions you should ask for the third one, independent on the previous ones.
- Apes 10mo agoThe year is 1846, and a doctor has a radical new idea: doctors should wash their hands between performing autopsies and delivering babies! You're not sure of whether this is a good idea or not, so you ask various physicians, and the consensus is unanimous: the very suggestion is offensive, do you think doctors are unclean? A clear conclusion has been achieved.
- Buttons840 10mo agoI 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.
- deleted 10mo ago[deleted]
- mac-mc 10mo agoIf 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/ https://pmc.ncbi.nlm.nih.gov/articles/PMC3241518/
- kryogen1c 10mo 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.
- aktuel 10mo agoThis 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".
- amsterdorn 10mo agoCurious 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 10mo agoYou 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.
- dust42 10mo agoLong 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!
- echelon 10mo ago> lots of variety of veggies and fruits, little meat This is wrong. Our bodies evolved to rend flesh and eat meat. They are optimized by millions of years of evolution to process and run on meat. The biochemical pathways of carb-heavy diets put more oxidative stress on the body.
- slumpt_ 10mo agopodcast science is a bit low-brow for hn brother
- cd4plus 10mo agoThis is wrong. Our bodies evolved to eat a diverse omnivorous diet and complex carbs + the antioxidants present in vegetables and fruits are anti-oxidative.
- NotGMan 10mo agoThis is wrong. Humans have eaten complex carbs only for the last 10k years since agricultural revolution. Before that, outside of a small part of Africa, there physically wasn't enough carbs available to say that they made any substantial amount of our diet. Most ancenstral carbs were uber high in fiber, and very low in glucose (starch) and fructose.
- DennisP 10mo agoI've taken courses in primitive wilderness survival, and one of the staple foods was grass seed. Also lots of roots are edible with cooking, and it looks like we've been cooking for about a million years. Then there's wild rice, cattails, beans, berries, all sorts of stuff. I agree that most wild plants are high in fiber and low in sugar, but there are are a lot of complex carbs to be had, if you have fire.
- guzik 10mo 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 10mo agoI 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.
- everdrive 10mo agoWhat 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 10mo agoNew 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 10mo agoHeart 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 10mo agoMy 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).
- bambax 10mo 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?
- CapitalistCartr 10mo agoYou'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.
- adrianN 10mo agoIf you prevent every ailment you don’t become frail and just take care of yourself.
- js2 10mo 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://jamanetwork.com/journals/jama/fullarticle/196970 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.065551 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.0... Some press mentions: https://www.health.harvard.edu/heart-health/the-portfolio-diet-a-smart-investment-for-your-heart https://www.health.harvard.edu/heart-health/the-portfolio-di... https://www.nytimes.com/2025/11/04/well/eat/health-benefits-portfolio-diet-cholesterol.html?unlocked_article_code=1.zk8.hXUl.iioOor1Ga8BD&smid=url-share https://www.nytimes.com/2025/11/04/well/eat/health-benefits-... https://www.cnbc.com/2025/11/05/the-portfolio-diet-what-it-is-and-how-it-works-from-experts.html https://www.cnbc.com/2025/11/05/the-portfolio-diet-what-it-i...
- wocram 10mo agoThis is a lot of words to say eat a plant-based/vegan diet.
- mac-mc 10mo agoIf 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 https://x.com/gregmushen/status/1924676651268653474
- jeffnv 10mo agoFor 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-priorities-be-to-improve-my-health/ https://www.barbellmedicine.com/blog/where-should-my-priorit...
- bad_username 10mo 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...
- mmaunder 10mo agoStop 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.
- reidrac 10mo agoThere 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 10mo 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 10mo agothey 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 10mo agoYes, you should probably visit a dermatologist regularly (once every year or two) for a routine skin check.
- Aurornis 10mo agoGoing 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.
- Flere-Imsaho 10mo agoI learnt a great trick about exercise: find a podcast or audio book that you really enjoy listening to. Here's the trick: you're only allowed to listen when you're exercising. Also with food and drink: place friction between the treat and yourself. The easiest example is to not have biscuits / alcohol in the house. Bonus tip: alcohol free beer is really good these days.
- portaouflop 10mo ago
- hmontazeri 10mo agoTriglyceride-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.
- kingofmen 10mo agoThere'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".
- kqr 10mo agoI had assumed "the MESA study population" was a particularly unhealthy bunch in terms of this measurement, meaning the 50th percentile puts one in the worst half of an already bad off group.
- in_cahoots 10mo agoI don't know the exact details, but I thought the Framingham survey was just a cross-section of the population. So getting upset about a 50th percentile score makes no sense at a population level. A quick Google says that the Mesa study was actually of people without cardiovascular disease at the beginning of the study. So again, these conclusions don't make any sense to me.
- wrs 10mo agoOf course it makes sense. 30% of this population will die of heart disease. You don’t want to be at the median of that population if you can avoid it. And as a society we need to move the median, not just accept it. Which means giving people better advice based on better data.
- jorvi 10mo agoThe "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 10mo agoMy 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 10mo 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 10mo agoBehaving like docile, compliant cattle benefits only the farmer.
- arjie 10mo agoThe 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 10mo agoI got all the same labs through Function Health. That’s the standard pay-to-play these days, but there are others.
- arjie 10mo agoPerfect. Looks like everything I’d get from Ulta for $800 but for much less. The self serve model is great. Thank you.
- dreamcompiler 10mo 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.
- puttycat 10mo agoI 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.
- kakacik 10mo agoYeah its a self-made-help article, if you don't know any better this is what you do. It doesn't make it the best choice overall though. It feels like the guy had a... mediocre GP, got scared by skin cancer diagnosis and over-corrected to most expensive path possible and since stuff was found out we have this article, roughly correct but written in a sensationalist (or freaked out) style. Some claims are outright false (like GPs not knowing heart disease is the biggest killer... really). Wife is a doctor with overreach between public and private healthcare, and those private services also have their own motivations which aren't often straightforward help-as-much-as-possible, rather milk-as-much-as-possible with tests, scans, long term treatments and so on. Especially CT scans pour non-trivial amount of radiation on the body that on itself can cause cancer down the line. With public healthcare you at least know primary motivation isn't cash flow but helping patients, the issue is rather overwhelmed resources with limited time per patient. It always depends on individual, as with engineering there are better and worse, yet we all somehow expect every single doctor to be 100% stellar infallible expert with 150 years of experience across all branches of medicine (absolutely impossible for any human being). Look around at your work if you are an engineer and perceive the spread of quality/seniority of each colleague. Same happens in medicine, just stakes are (much) higher.
- Auracle 10mo agoChatGPT is amazing for interpreting test results. Of course you should back it up with a doctor. Back when 3.5 came out I gave it some information about me when I was a teenager on a condition that (multiple) doctors totally misdiagnosed. It immediately told me three tests I should have done, two of which would have diagnosed it right away. Instead, I had to deal with extreme fatigue for over a decade until I finally did research on my own and had those same tests done. As far as test results go, right now we’re dealing with our dog having increased thirst. She’s been on prednisone for a year, and that’s not an uncommon side effect. We brought her in to the vet and they tested her and diagnosed in as stage one kidney disease, with no mention of the prednisone. I put those results and her details into ChatGPT and it told us it could absolutely be the prednisone, and told us we could use an inhaler for what we were using the prednisone for - chronic bronchitis. Our vet never offered than option. We’ll find out in a few months if she actually has kidney disease or not, but chances are it was just the prednisone. As a bonus, the vet before this one diagnosed her bronchitis as heart failure. They didn’t run any tests, scans, etc. Just “sorry, your dog is going to die soon.” What a fun week that was. ChatGPT is an amazing second opinion tool. Obviously you need to ask it neutral, well formed questions.
- wyldfire 10mo agoI 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.
- jokoon 10mo agoyeah, 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
- Waterluvian 10mo agoI’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).
- adammarples 10mo agoI think the article makes a valid point: stop worrying about 90% of the other stuff and focus on the thing that will almost certainly kill you - heart disease - for which there are easy diagnostic and preventative measures. I think they're arguing for a better allocation of resources, if anything.
- ericmcer 10mo agoIsn't the global population like 50% obese? What is your actual risk of dying from it if you are relatively in shape and in your 40s?
- Fire-Dragon-DoL 10mo agoWe don't know how to treat obesity 100% though
- tschellenbach 10mo agoYou can run a full blood panel on your whoop by clicking a button and showing up at a quest diagnostics
- m_a_g 10mo agoI'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).
- righthand 10mo agoReally 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 10mo agowe’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 10mo agoIt’s not as bad as you think until OpenAI begins selling it’s data profile they’ve been collecting on you.
- ef2k 10mo agoThis 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 https://youtu.be/BXyfCGDnuWs?t=332
- darepublic 10mo agoMy 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.
- AstroBen 10mo 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
- joquarky 10mo agoUnfortunately, 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.
- tlarkworthy 10mo agowell that inspired me to research getting those tests in Germany. => heart panel plus https://en.minu.synlab.ee/heart-panel-plus/ https://en.minu.synlab.ee/heart-panel-plus/ I don't need doctors, I can get ChatGPT to analyse the results.
- embedding-shape 10mo agoThe 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.
- 6510 10mo agoIf you tell people they cant drink they kill you.
- embedding-shape 10mo agoI've never told anyone to stop drinking alcohol, yet drunk people keep killing sober people all the time. So what would the difference be?
- cindyllm 10mo ago[dead]
- mrtksn 10mo agoFor alcohol, the default is social drinking which is why you don't have widespread alcoholism in most countries where people consume plenty of alcohol. For smoking the default is constant nicotine top up(the nicotine delivery is instant, lasts seconds to minutes and the withdrawal symptoms starts in an hour). Both harmful of course but the alcohol has much less harmful defaults.
- floundy 10mo ago“Alcoholism” is outdated and has been widely replaced by AUD (Alcohol Use Disorder). I looked at Germany, according to Wikipedia the average consumption of pure ethanol per person per year in Germany as of 2019 was 12.2 liters. This was the 5th highest in the world, and equivalent to 686 standard 5% beers per year. According to the WHO “moderate drinking” is 1 drink per day for women and 2 drinks per day for men, so the average German is already consuming above WHO guidelines. It gets worse when you consider that about 1/4 of Germans don’t consume alcohol at all, and another 1/4 barely consume any, suggesting that the “average” isn’t really telling us much and the 70th, 80th, and 90th percentiles have very concerning consumption numbers. I assume most of those people consider themselves “social drinkers” but statistically they cannot be.
- gehsty 10mo agoEat 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.
- deleted 10mo ago[deleted]
- programmertote 10mo 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).
- phainopepla2 10mo agoFor the blood tests, at least, you can get them directly from a lab with no physician gatekeeping.
- cthalupa 10mo ago
- goblin89 10mo agoIt 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 10mo agoThat would be useful for me too, similar problem
- deadbabe 10mo agoUnless 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.
- ambicapter 10mo 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.
- bebb 10mo agoRead the article, felt worried. Came back here and read all the cynical and critical comments, felt a lot better. Thanks guys.
- reducesuffering 10mo 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.
- loeg 10mo agoHe 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.
- AstroBen 10mo agoIs 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
- giardini 10mo agoThe 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.
- maxnevermind 10mo agoI 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.
- sn9 10mo agoBlood 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.
- Beijinger 10mo agoThere 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.
- tamimio 10mo agoHeart 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.
- dtgriscom 10mo 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 10mo agoProbably best to start in childhood anyway, not your 30s or 40s.
- aucisson_masque 10mo 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.
- mceachen 10mo agoYou're conflating advocacy, which indeed he is entitled to, with how the hospital is allocating resources and if and how they apply competent resources. Life or death procedures aren't a time for "you get what you get and don't have a fit."
- aucisson_masque 10mo ago
- stefantalpalaru 10mo ago[dead]
- singpolyma3 10mo agoSo 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 10mo agoAsk another regular doctor?
- singpolyma3 10mo agoBut the whole premise of this article is that the regular doctors won't get it or do it
- loeg 10mo agoI think the article is flawed in many ways.
- catchcatchcatch 10mo ago[dead]
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- floundy 10mo agoI 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.
- mathgeek 10mo 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.
- armada651 10mo agoI 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.
- loeg 10mo agoWall 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.
- starchild3001 10mo agoLowering 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-summary-of-antiaging.html https://mylongevityjourney.blogspot.com/2022/08/a-short-summ...
- bargainbin 10mo agoAnyone 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 10mo 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).
- ETH_start 10mo agoAll 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?
- jmpman 10mo agoMy 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.
- grvdrm 10mo agoMy 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.
- n8cpdx 10mo agoDepends 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.
- georgeburdell 10mo agoI’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.
- bzmrgonz 10mo agoDid you take a look at empirical health and what they are doing? Their goal is to prevent 1 million cardiac deaths by 2030.
- Tempest1981 10mo agoSummarizing: - 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".
- CalChris 10mo agoA 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).
- cthalupa 10mo agoYou 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.
- Padriac 10mo agoIf you don't die of heart disease you will die from something else.
- gscott 10mo agoNot an ad but I use https://www.walkinlab.com 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.
- stdclass 10mo agostep 1 to avoid heart disease: do NOT inject yourself with untested mRNA gene therapy with questionable safety profiles
- js2 10mo agoMerck 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-lowered-bad-cholesterol-as-much-as-injectables 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-inhibitors https://my.clevelandclinic.org/health/drugs/22550-pcsk9-inhi...
- harleyk 10mo agoA 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/2025/09/29/20/38/new-acc-scientific-statement-details-role-of-inflammation-in-cvd https://www.acc.org/latest-in-cardiology/journal-scans/2025/...
- kidsil 10mo agoHey, 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!
- dennis_jeeves2 10mo agoIMO 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 10mo agoA 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.