[HN Gopher] Inflammation now predicts heart disease more strongl...
___________________________________________________________________
Inflammation now predicts heart disease more strongly than
cholesterol
Author : brandonb
Score : 273 points
Date : 2025-09-30 20:00 UTC (2 hours ago)
(HTM) web link (www.empirical.health)
(TXT) w3m dump (www.empirical.health)
| brandonb wrote:
| For decades, LDL cholesterol has been the main target in
| preventive heart health.
|
| The American College of Cardiology just started recommending that
| everyone measure hs-CRP, a blood test for inflammation. Why?
| Because inflammation now predicts cardiovascular events more
| accurately than cholesterol -- especially in people already on
| statins or those without traditional risk factors.
|
| In some ways, cholesterol has become a victim of its own success.
| With routine screening and statins, most heart attack patients
| now have artificially lowered cholesterol. That leaves the
| remaining risk hidden in non-traditional biomarkers -- beyond the
| usual SMuRFs (standard modifiable risk factors).
| Night_Thastus wrote:
| Is this...a summary? The wording is so close to the article in
| parts that I'm not sure.
| brandonb wrote:
| This is a summary -- I'm the article author and the author of
| that comment, so I would hope my wording is consistent. :)
| Night_Thastus wrote:
| Oh, missed the username. Normally when people post a
| comment like that they prepend it with something like
| "Author here, just wanted to add X/Y/Z"
|
| I think there's supposed to be some kind of green highlight
| for comments by the poster but that's missing as well.
|
| Mea culpa.
| CleverLikeAnOx wrote:
| Green highlight is for new users.
| Night_Thastus wrote:
| Oh. They should add a highlight for comments written by
| the poster as well. Or some kind of [poster] tag, not
| sure. Would be useful in these cases.
| brandonb wrote:
| Fair point!
| pinkmuffinere wrote:
| Thanks for the summary! I haven't read tfa yet, so my apologies
| if this is answered in there, but: does this mean that we've
| already reduced the contribution from cholesterol to events? Or
| that cholesterol was simply associated and not causative? I
| imagine the truth is somewhere in between, perhaps we can guess
| that's it's 70% due to one and 30% due to the other?
| brandonb wrote:
| It's more the former -- we've gotten so good at detecting
| high cholesterol and reducing it, that the majority of
| residual risk is now in the other factors.
|
| (There are some people who dispute whether cholesterol is
| causative, but most cardiologists believe LDL cholesterol, or
| ApoB, causes heart attacks and strokes --based on both
| mechanistic evidence and randomized control trials.)
| pigeonhole123 wrote:
| I'm interested in this subject. Can you cite some of the
| RCTs and mechanistic evidence?
| pinkmuffinere wrote:
| 1. Thanks for the reply!
|
| 2. Having now read the article, i see that my question was
| indeed already addressed in the article -- sorry for asking
| silly questions
|
| 3. Your good-natured, approachable response is great
| marketing for your company! I'm not the target audience,
| but I did click through your marketing material, and
| probably trust it more because of your response.
| SpicyUme wrote:
| Does this mean this test is recommenced in place of cholesterol
| for people who are not taking statins? Or is the test in
| addition?
| brandonb wrote:
| Recommended in addition to cholesterol (or better yet, ApoB).
| And recommended for everyone, not just those taking statins.
| SpicyUme wrote:
| Interesting, thanks. I'm changing docs/insurance and
| thinking about the tests I should be paying attention to.
| rodrig3 wrote:
| Very interesting recommendation - very much in line with this
| paper from a few weeks ago:
| https://pubmed.ncbi.nlm.nih.gov/40878356/
|
| TLDR: women who would otherwise be missed by current algorithms
| might be picked up by this inflammatory marker (hs-CRP)
| brandonb wrote:
| I suspect Lp(a) is next, since there are now drugs in clinical
| trials that directly lower it.
| uniqueuid wrote:
| It's important to put this in context.
|
| Lp(a) is a largely distinct risk factor from "ordinary"
| cholesterol and cannot be changed by diet or exercise. Survey
| papers show practically no effective treatment (statins help
| all cause mortality in patients but do not lower lp(a)).
| There are two (iirc) ongoing trials for new, effective drugs.
| But those are not available yet and will probably be
| prohibitively expensive, going by the advertisements that the
| companies run.
|
| So yeah, get an Lp(a) test once (it doesn't vary too much
| over time) and reduce your other risk factors, but don't put
| too much hope into an easy solution to this specific cause
| yet.
|
| edit: found the two papers that were a good read:
|
| Kamstrup, P. R. (2021). Lipoprotein(a) and Cardiovascular
| Disease. Clinical Chemistry, 67(1), 154-166.
| https://doi.org/10.1093/clinchem/hvaa247
|
| Schwartz, G. G., & Ballantyne, C. M. (2022). Existing and
| emerging strategies to lower Lipoprotein(a). Atherosclerosis,
| 349, 110-122.
| https://doi.org/10.1016/j.atherosclerosis.2022.04.020
| scythe wrote:
| > The ACC is now recommending that everyone measure inflammation
| (specifically, hs-CRP)
|
| Burying the lede a little, here. The ACC has decided on a
| standard way to _measure_ inflammation, which decades ago was a
| centerpiece of some very woo-woo "following the squizledoff diet
| will decrease your gomperblorp"-style health 'advice'. "Systemic
| inflammation" was a very tricky physiological parameter to nail
| down.
| PantaloonFlames wrote:
| Oh yes I agree with you. This seems important.
| brandonb wrote:
| Do you have a link to an article that covers the history? In
| the time that I've been following this topic (about 10 years),
| hs-CRP has been the go-to biomarker of inflammation. It'd be
| interesting to learn about the process required to get there.
| jrjarrett wrote:
| So statins lower LDL; what lowers inflammation?
| bequanna wrote:
| Improvements in diet, stress, and environment.
| luv2code wrote:
| and sleep.
| jgalt212 wrote:
| Statins also have an anti-inflammatory response.
| PantaloonFlames wrote:
| Avoid allergenic foods, Highly processed foods. Get plenty of
| sleep. Manage stress. Avoid toxins like alcohol or smoking.
| Avoid chemical irritants including perfumes, dyes, fragrances
| in detergent or soap, ....
| amatecha wrote:
| Not sure why this is downvoted, this is correct on all
| points. I've been on a journey to lower chronic inflammation
| and you would not believe how hard it is to find stuff that
| doesn't have "fragrance" or other mysterious potentially-
| inflammation-causing substances.
|
| https://cancerblog.mayoclinic.org/2025/02/17/want-to-
| reduce-...
|
| https://health.clevelandclinic.org/anti-inflammatory-diet
|
| https://health.clevelandclinic.org/foods-that-can-cause-
| infl...
|
| https://www.heartandstroke.ca/articles/the-anti-
| inflammatory...
|
| https://health.osu.edu/health/general-health/how-
| fragrances-...
|
| https://pmc.ncbi.nlm.nih.gov/articles/PMC9163252/
|
| https://www.amjmed.com/article/S0002-9343(25)00549-2/abstrac.
| ..
| maerF0x0 wrote:
| from the heartandstroke.ca
|
| > Grains (mainly whole grains): 7-8 servings > 1 slice
| bread
|
| Who the heck is eating 7-8 slices of bread -- A DAY??? (or
| the equivalent)... Of a healthy bread that's about 900
| calories just from breads...
|
| That's like 2 bowls of cereal for breakfast, 2 sandwiches
| for lunch, and 2 servings of pasta for dinner, whoa.
| amatecha wrote:
| Sorry, where did you find that text? I can't find the
| words "mainly whole grains", or even the word "servings"
| anywhere on https://www.heartandstroke.ca/articles/the-
| anti-inflammatory... .. maybe you navigated to another
| page afterward or something?
| breadwinner wrote:
| Low dose aspirin can lower inflammation.
| hn_throw2025 wrote:
| Please be very careful with low dose aspirin.
|
| I am 5 months into NSAID Gastritis. Would not recommend.
| alexey-salmin wrote:
| How low was your dose? 75-125mg?
| hn_throw2025 wrote:
| It was 75mg. Soluble, not gastro resistant ones.
| breadwinner wrote:
| Yes, there is that risk. On the other hand there is the
| risk of stroke, which I am more scared of, which is why I
| take aspirin. What is the impact of NSAID Gastritis? How
| bad is it and can you recover from it?
| georgeburdell wrote:
| I was taking a lot of Ibuprofen due to frequent illnesses
| while simultaneously needing to be healthy. I started to get
| terrible heartburn that caused me to hunch over at times.
| Tried dietary changes. Finally, I happened to read that this
| and ulcers is a side effect of NSAIDs. Switched to
| acetaminophen, and was generally more judicious about taking
| fever meds, and I haven't had heartburn in months now.
| cheald wrote:
| Acetaminophen doesn't deteriorate the stomach lining like
| NSAIDs, but it also isn't anti-inflammatory. It's an
| analgesic and antipyretic.
| georgeburdell wrote:
| Yes, I mention this all in the context of needing a fever
| reducer
| nickpp wrote:
| Did you take your Ibuprofen with some food?
| hn_throw2025 wrote:
| I saw an interesting video that mentioned a study. Even though
| 10K steps a day is considered an arbitrary amount, this study
| found that level of activity counteracted inflammation.
|
| https://youtu.be/bDGA82wts2g?t=2015&si=lmZeD_KE1F7TvOPA
| bradleyjg wrote:
| Click the link.
| maerF0x0 wrote:
| > Lifestyle: Anti-inflammatory diets (Mediterranean, DASH),
| regular exercise, smoking cessation, and maintaining a
| healthy weight all lower hs-CRP and reduce risk.
|
| also they list a big list of drugs that are in various stages
| Workaccount2 wrote:
| Exercise.
|
| I don't even know. But exercise is the god-tier reigning
| champion of all things health. You can count on it pretty
| reliably to show up as a positive effect source in any health
| study.
|
| "Just exercise" should be a meme at this point.
| RajT88 wrote:
| It's quite a lot harder than just taking a pill every day, of
| course.
| ltbarcly3 wrote:
| It's not though.
|
| To get a statin you have to go to the doctor, get a blood
| test, get a prescription for the statin, and start taking
| it, get blood retested, adjust dose (possibly), etc. Then
| you have to go to the pharmacy, pay for it and take it
| every single day.
|
| To exercise you literally have to walk for 30 minutes.
| That's it.
| themagician wrote:
| Only because people drive everywhere. If you live in a well
| designed city you just walk everywhere and you don't have
| to do anything extra.
|
| It's only hard because we make it hard.
| bcrosby95 wrote:
| I walk my kids to school every morning. And I walk to
| pick them up. It's a 10 minute walk to get them, so
| that's about 40 minutes of walking each day. I could
| drive and get there in 2 minutes then wait in a line. It
| would probably cut the time in half, but walking is
| better for the environment (noise, pollution, safety,
| wear and tear), me, and my relationship with the kids
| (we, y'know, talk while we walk).
|
| There's people that live even closer that drive their
| kids to school. One of them lives literally 19 houses
| down the street from it.
|
| I also have a rule where if I can go somewhere within 20
| minutes on a bike, I'm taking my bike. Most places I go
| fall under this rule, and I live in what most would call
| a suburban hellscape.
|
| My wife used to drive to work. Driving took longer than
| walking. But she still drove.
|
| I think it's less about easy vs hard and more about the
| culture around driving in the US.
| underdeserver wrote:
| That's great - for me the problem is weather. Where I
| live it's hot, >80s Fahrenheit, >28 celsius, for 4 months
| a year. So unless I want to always be sweaty, I can't
| really walk more then 10 minutes at a time.
| pixl97 wrote:
| In the US a large number of people have moved to suburbs
| in the south. On a bad year our lows are in the 90F
| range. Add in asphalt architecture and in the sun temps
| are commonly 125F+
| bluGill wrote:
| Carry a water bottle and take showers. Sweat is normal,
| if you don't like it wash it off.
| iberator wrote:
| Homeless are walking (exercise) miles daily 365/7 yet they
| are unhealthy. lol
| cogman10 wrote:
| There are often other comorbidities with being homeless.
| MarcelOlsz wrote:
| I don't know man some of those guys are absolutely
| shredded. Maybe they're just platonists?
| floxy wrote:
| Diogenesists? Diogenesers? Followers of Diogenes?
| MarcelOlsz wrote:
| I'm low on ancient Greek knowledge, what are you getting
| at?
| floxy wrote:
| Why would they be platonists? Diogenes was the Greek
| philosopher who shunned material things and famously
| lived in a barrel. Seems like that would be the ancient
| Grecian philosopher that might inspire some form of
| voluntary homelessness.
| stryan wrote:
| There's a (apparently un-substantiated[0]) claim that
| Plato was buff; "Plato" was apparently a nickname and
| meant "broad" in Classical Greek, referring to his
| wrestlers physique.
|
| [0] I heard this claim a long time ago, but according to
| Wikipedia (https://en.wikipedia.org/wiki/Plato#Life) it's
| apocryphal. The Talk page has a decent argument for it
| not being the case.
| MarcelOlsz wrote:
| Ah fair, I meant in that they're homeless so they must
| live in their heads/in ideas which are more real to them
| (hence Plato), so they're shredded from always being
| active and outside.
| jerkstate wrote:
| I believe followers of Diogenes are called Cynics
| floxy wrote:
| Ah, yes.
| FollowingTheDao wrote:
| Exercise actually increases oxidative stress.
|
| https://pmc.ncbi.nlm.nih.gov/articles/PMC7498668/
|
| What lowers oxidative stress is nutrition, specifically
| selenium, vitamin C, manganese, zinc, and copper.
| goopypoop wrote:
| I knew I should be eating more soil
| phkahler wrote:
| Selenium can elevate your PSA, so stop taking it a couple
| week prior to a test. It also increases fluid production
| from the prostate.
| toomuchtodo wrote:
| GLP-1s.
|
| https://www.derekthompson.org/p/why-does-it-seem-like-glp-1-...
| (Control-F "Theory 2: GLP-1 is a miraculous "moderation
| molecule," and it has docking portals all throughout the body
| that reduce inflammation.")
|
| https://www.health.harvard.edu/diseases-and-conditions/do-gl...
| bgnn wrote:
| Lifestyle.
|
| Not sitting a lot (more than 1 hour at a time), walking or
| cycling everywhere, not eating a kot of sugar/refined carbs..
| purplerabbit wrote:
| Just to throw into the mix: apparently sitting in a hyperbaric
| oxygen chamber does. Who would've thought.
| lr4444lr wrote:
| Prednisone and other corticosteroids. They are not good to use
| long term for many reasons.
|
| There is no free lunch or magic bullet (yet) to health. We're
| all going to die.
| cheald wrote:
| I'm not a doctor, but I am passionate about this stuff in my
| own life.
|
| tl;dr: Exercise, sleep, and diet. Plus a zillion different
| supplements and medicines as adjuncts to a healthy lifestyle.
|
| First, consider what inflammation _is_. It 's fundamentally an
| immune response designed to attack unhealthy tissue and to
| facilitate repair of healthy tissue - the effects of
| inflammation are largely driven by cytokines like TNF-alpha
| (which is responsible for killing unhealthy cells and
| recruiting immune cells), IL-1 (which recruits immune cells),
| and IL-6 (which drives cRP production - the biomarker that you
| usually look for to gauge systemic inflammation). The
| production of these is mediated by nuclear factor kappa B (NF-
| kB).
|
| Other major factors are things like reactive oxygen species (or
| "free radicals"), which can oxidize all sorts of things in the
| body and cause damage (which is good when the thing being
| damaged is a pathogen or damaged cell, bad when it's healthy
| tissue). Damaged tissue provokes immune responses.
|
| So, if you want to "reduce inflammation", you want to:
|
| 1. Reduce stimuli or downregulate processes which are causing
| the production of inflammatory cytokines
|
| 2. Upregulate the production of anti-inflammatory cytokines
|
| 3. Ensure sufficient antioxidant capacity to deal with ROS
| production and oxidative stress
|
| If you've got a chronic illness or autoimmune disorder, you're
| dealing with inflammation just because your "make immune
| defenses" signals are stuck on. But you can also have chronic
| inflammation through too much fat (adipose tissue is an
| endocrine organ!), environmental or diet factors, or just
| behaviors which result in an imbalance between pro- and anti-
| inflammatory responses in the body (for example: smoking
| induces consistent tissue damage, which drives immune
| responses).
|
| Exercise upregulates production of anti-inflammatory cytokines
| and improves mitochondrial efficiency, which results in less
| ROS production during cellular respiration. Sugar surges cause
| elevated ROS production, and chronically-elevated blood glucose
| results in insulin resistance, which promotes inflammatory
| cytokine production. Lipopolysaccharides from gut bacteria in
| the bloodstream stimulate immune responses. Insufficient sleep
| upregulates NF-kB directly, but also contributes to dysfunction
| of other systems which can upregulate NF-kB.
|
| If you're sleeping plenty, eating well, and exercising, and you
| don't have a chronic health condition, your inflammation levels
| are probably pretty good. But you can generally further reduce
| them with supplementation of things like:
|
| * Omega-3 fatty acids (which compete with omega-6 fatty acids -
| "seed oils", which produce inflammatory prostaglandins) - this
| is why your doctor wants you to take fish oil
|
| * Turmeric, resveratrol, and green tea extracts (which contain
| compounds which inhibit NF-kB and are ROS scavengers),
|
| * Vitamin D (which inhibits cytokine production and supports
| your natural antioxidant systems)
|
| * NAC, which replenishes glutathione (the primary driver of the
| body's antioxidant systems)
|
| There are medications, of course, like your regular old aspirin
| and ibuprofen, which reduce prostoglandin production (which is
| one upstream of NF-kB), corticosteroids (which block NF-kB), as
| well as more exotic entries such as GLP-1 peptides (which,
| among other things, improve insulin sensitivty and reduce
| adipose tissue, which results in reduced systemic inflammation)
| or BPC-157 peptides (which acutely inhibit NF-kB, upregulate
| antioxidant enzymes, and help regulate nitrous oxide, which is
| how they can help heal NSAID-induced leisons).
|
| This is by no means comprehensive - there are plenty more
| mechanisms and interventions to explore - but it should be a
| pretty good clue as to why "diet and exercise" are standard
| health advice. You don't want to turn _off_ your inflammation
| responses - they 're responsible for taking out pathogens,
| killing tumors and maintaining a healthy body - but you don't
| want them chronically upregulated, either.
| breadwinner wrote:
| Cholesterol and statins have always been suspect science in any
| case:
|
| https://medium.com/@petilon/cholesterol-and-statins-e7d9d8ee...
| bkandel wrote:
| From https://www.cochrane.org/evidence/CD004816_statins-
| primary-p...:
|
| > Of 1000 people treated with a statin for five years, 18 would
| avoid a major CVD event which compares well with other
| treatments used for preventing cardiovascular disease. Taking
| statins did not increase the risk of serious adverse effects
| such as cancer. Statins are likely to be cost-effective in
| primary prevention.
| guerby wrote:
| Published 2013
| malfist wrote:
| The human body evolves on a much slower time scale than
| decades
| guerby wrote:
| Piles of money at stake, misinterpreting data, cherry
| picking data, misplaced pride leading to hiding data or
| worse, etc...
|
| What the BMJ has to say on this very topic of statins:
|
| https://www.bmj.com/campaign/statins-open-data
|
| So no settled science here.
|
| And remember that the largest ever study on saturated fat
| and cholesterol lowering was just not published by their
| original author because it didn't proove their
| hypothesis.
|
| https://pmc.ncbi.nlm.nih.gov/articles/PMC4836695/
| FollowingTheDao wrote:
| It's not that lowering cholesterol does not decrease heart
| disease, but the fundamental problem of heart disease is not
| cholesterol, it's the inflammation.
|
| Lowering cholesterol lowers the amount of oxidized
| cholesterol that is caused from inflammation. The fact is is
| that in inflammation is the fundamental disorder, not high
| cholesterol on its own.
| guerby wrote:
| And after 2013 in the BMJ on statins:
|
| https://www.bmj.com/campaign/statins-open-data
| timr wrote:
| You should actually read the article. In particular:
|
| > Fourteen trials recruited patients with specific conditions
| (raised lipids, diabetes, hypertension, microalbuminuria).
| All-cause mortality was reduced by statins (OR 0.86, 95% CI
| 0.79 to 0.94); as was combined fatal and non-fatal CVD RR
| 0.75 (95% CI 0.70 to 0.81), combined fatal and non-fatal CHD
| events RR 0.73 (95% CI 0.67 to 0.80) and combined fatal and
| non-fatal stroke (RR 0.78, 95% CI 0.68 to 0.89). Reduction of
| revascularisation rates (RR 0.62, 95% CI 0.54 to 0.72) was
| also seen.
|
| So the evidence base is a collection of studies where most of
| the participants had at least one prior indicator of CVD or
| diabetes, and their outcome is a relatively weak benefit to
| all-cause mortality, CVD, CHD and stroke. For primary
| prevention, what you _really_ want is a strong outcome in a
| study of people without any prior indication of disease [1].
|
| I think the article posted by parent is exaggerating, but
| even the Cochrane review is pulling its punches here, saying
| specifically _" cost-effective in primary prevention"_,
| instead of the stronger claim. Common jokes about putting
| statins in the water supply aside, there's not a ton of
| evidence for giving them to, say, otherwise healthy
| 20-somethings.
|
| [1] Imagine the following, not-uncommon scenario: you have an
| otherwise healthy patient who is both pre-diabetic, as well
| as presenting with elevated cholesterol. Statins have a
| tendency to _elevate blood glucose_. So which risk do you
| choose?
|
| The available evidence provides poor guidance.
| bluGill wrote:
| Careful. You are correct at what we want for primary
| prevent. However for primary prevention we need much larger
| sample sizes and thus data is much harder to get.
|
| Lack of data doesn't mean the treatment won't work. There
| is plenty of reason to think statins work for primary
| prevention even though it hasn't been proved yet. For most
| the side effects are acceptable, and the cost is low. Thus
| for most it is worth trying as primary prevention even if
| we don't have data to show it works. Remember you are
| playing with your own life here, and the best evidence we
| have is on the side of stains for primary prevention - this
| may change in the future when we get data of course.
| timr wrote:
| > Lack of data doesn't mean the treatment won't work
|
| In drug development, that is the default presumption, and
| rightfully so: almost nothing ever works.
|
| > There is plenty of reason to think statins work for
| primary prevention even though it hasn't been proved yet.
|
| Define "primary prevention" -- do you propose giving this
| to a healthy 20 year old with no other signs of illness?
| Younger? Should we "put it in the water", as they say?
| How about older patients? How old? Or, do you mean
| someone with symptoms? If so, then what about the case I
| cited (which is quite common in "primary prevention")
| where you have multiple things in tension?
|
| The evidence provides no guidance here, and anyone who
| tells you otherwise is guessing.
| Calavar wrote:
| That's a hot take of a blog post.
|
| Extraordinary claims require extraordinary evidence. The
| cholesterol to heart disease link is one of the best attested
| in medical science [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13,
| 14, 15]
|
| And yet when making this very extraordinary claim, the author
| fails to cite any quantitative data for or against. He does not
| even attempt to build a qualitative argument by proposing a
| mechanistic theory of why cholesterol is unlikely to be
| causative of heart disease. Then he goes on to claim that
| doctors don't have hard evidence to show that statins reduce
| the incidence of heart disease, despite the fact that such
| evidence exists [5]. The post is just 10 paragraphs of fluff
| that boil down to 'don't trust the medico-industrial complex'
|
| Honestly, I think that blog post is a litmus test on scientific
| literacy - What convinces you more, data and numbers and charts
| and tests of statistical significance, or rail-against-the-
| machine rhetoric and a few scary sounding quotes provided
| without the associated context?
|
| [1] https://jamanetwork.com/journals/jama/article-
| abstract/19216...
|
| [2] https://pubmed.ncbi.nlm.nih.gov/25815993/
|
| [3] https://jamanetwork.com/journals/jamacardiology/article-
| abst...
|
| [4] https://www.ahajournals.org/doi/abs/10.1161/01.CIR.67.4.730
|
| [5] https://jamanetwork.com/journals/jama/fullarticle/2678614
|
| [6] https://pubmed.ncbi.nlm.nih.gov/32507339/
|
| [7]
| https://www.tandfonline.com/doi/abs/10.1080/07315724.2008.10...
|
| [8] https://pubmed.ncbi.nlm.nih.gov/18061058/
|
| [9] https://www.jacc.org/doi/abs/10.1016/j.jacc.2022.03.384
|
| [10] https://www.nature.com/articles/s41598-021-00020-3
|
| [11]
| https://www.ahajournals.org/doi/full/10.1161/JAHA.123.030496
|
| [12] https://www.nature.com/articles/s41467-024-46686-x
|
| [13]
| https://www.sciencedirect.com/science/article/pii/S002191502...
|
| [14]
| https://link.springer.com/article/10.1186/s12872-021-01971-1
|
| [15]
| https://www.jstage.jst.go.jp/article/jat/31/3/31_64369/_arti...
| fny wrote:
| It's a bad blog post for sure. However, I've a few smart
| people say that lower cholesterol may not be what makes
| statins powerful: it's the anti-inflammatory properties. I'm
| too lazy to find papers right now.
| Calavar wrote:
| Yes, there is certaintly data to make that argument. The
| argument that inflammation is a better predictor of heart
| disease than cholesterol is a reasonable one. On the other
| hand the argument that cholesterol is not a good predictor
| of heart disease and cholesterol lowering therapy is a
| fraud is not reasonable in the face of the evidence.
| breadwinner wrote:
| > _It 's a bad blog post for sure_
|
| The blog is merely pointers to, and excerpts from, other
| articles on sources such as New York Times and Bloomberg.
| The blog post can't be bad unless the original sources it
| cites are bad. Which ones are bad?
| breadwinner wrote:
| > _The cholesterol to heart disease link is one of the best
| attested in medical science_
|
| What about this:
|
| Cholesterol lowering is not the reason for the benefit of
| statins. If it was, lowering cholesterol via any means should
| have produced the same benefit, but it doesn't. One obvious
| way to confirm this is to find therapies that lower
| cholesterol by different means (i.e., other than statins) and
| see if they, too, prevent heart attacks. They don't. See:
| https://www.nytimes.com/2008/01/27/opinion/27taubes.html
| (Some will discredit the author Gary Taubes without
| addressing the points he is raising.)
|
| The main reason why statins work may not be because they
| lower cholesterol, but because they reduce the inflammation
| that leads to heart attacks:
| https://www.bloomberg.com/news/articles/2008-04-15/heart-
| dis...
|
| This last link aligns with the new findings.
| carbocation wrote:
| This is not a mainstream view of the science, and it's worth
| noting that this perspective is also not supported by the OP or
| by the JACC article that it's citing.
| e40 wrote:
| And my understanding of the science is that statins reduce
| inflammation.
| timr wrote:
| > This is not a mainstream view of the science, and it's
| worth noting that this perspective is also not supported by
| the OP or by the JACC article that it's citing.
|
| Your comment is an appeal to authority. While I have my
| problems with characterizing statins as dangerous drugs, the
| article is not particularly spicy. In particular, this part:
|
| > Because the link between excessive LDL cholesterol and
| cardiovascular disease has been so widely accepted, the Food
| and Drug Administration generally has not required drug
| companies to prove that cholesterol medicines (such as
| statins) actually reduce heart attacks before approval. So
| drug companies have not had to track whether episodes like
| heart attacks are reduced.
|
| ...is true, and controversial only amongst people who don't
| know the evidence. Which, unfortunately, is many doctors and
| "experts".
|
| In general, saying any variation on "experts disagree" is not
| a rebuttal to a question of medical evidence. You would
| perhaps be surprised to know how many practicing physicians
| have no idea what level of evidence backs the drugs that they
| prescribe.
| ajkjk wrote:
| appeals to authority have some merit, you know.
|
| I for one appreciated the clarification that it was not
| mainstream, since sneaking a random controversial take into
| a comment thread as if it was fact without noting that it's
| contentious is disingenuous.
| timr wrote:
| > appeals to authority have some merit, you know.
|
| No, they don't. If you don't know enough to argue on the
| merits, don't argue. A count of opinions is not an
| argument.
|
| > sneaking a random controversial take into a comment
| thread as if it was fact without noting that it's
| contentious is disingenuous.
|
| And again, you're justifying your judgment and dismissal
| based on hearsay. Saying _" I refuse to believe it
| because experts disagree"_ is fine if you're unable or
| unwilling to look into an issue yourself, but in that
| case you have to realize you're basically ignorant.
|
| I realize that we all go through life taking most things
| on faith, but that _also_ means that you should not cling
| to the opinions of others as a substitute for thought.
| ajkjk wrote:
| yes they do. for one thing you do not make the rules
| around here; no one cares what you think counts as
| suitable grounds for arguing. For another, yes, authority
| has some merit. Doesn't make it fact, but certainly the
| prior we ought to assign for "medical authorities are
| correct" is quite high. Not certainty, but pretty
| confident, all else being equal.
|
| edit: I see you added "I realize that we all go through
| life taking most things on faith, but that also means
| that you should not cling to the opinions of others as a
| substitute for thought."
|
| Don't worry, nobody's doing that here. It's a question of
| weighting, not clinging. Maybe you mistook "this is not
| mainstream" to mean "this is definitely false because
| it's not mainstream"? It does not mean that. It is just
| helpful context for evaluating credibility.
| timr wrote:
| > for one thing you do not make the rules around here; no
| one cares what you think counts as suitable grounds for
| arguing.
|
| You're asserting that a extremely well-known logical
| fallacy is not a fallacy. It's not an HN rule, it's
| argumentation 101.
| onethought wrote:
| You are confusing what "Appeal to Authority" fallacy is.
| Namely you are ignoring the fallaciousness of it.
|
| The fallacy is where you use an authority in place of
| evidence. It is not fallacious to refer to consensus or
| experts.
|
| Else, you end up basically in the "Do your own
| research"/vaccine denier/climate deniers/flat earth
| territory. Appeals to experts is not a logical fallacy.
| It's actually smart, because you get to leverage agreed
| facts (the earth is round) even though you've never
| actually been to space to see it for yourself.
| leephillips wrote:
| There is no logical fallacy in play here. Nobody is
| saying "the argument is wrong because of who said it".
| When assessing the probable significance of an
| agglomeration of empirical data, it's valuable to know
| what experts in the field think about the data and their
| consensus about the inferences we can draw from it--even
| if the consensus might be mistaken: because the consensus
| is usually right.
| timr wrote:
| > There is no logical fallacy in play here. Nobody is
| saying "the argument is wrong because of who said it".
|
| The OP literally dismissed the parent based on nothing
| more than the opinions of others.
|
| > When assessing the probable significance of an
| agglomeration of empirical data, it's valuable to know
| what experts in the field think about the data and their
| consensus about the inferences we can draw from it--even
| if the consensus might be mistaken
|
| I already conceded that, if you have no ability or
| capacity to think or investigate the issue yourself, it's
| perfectly fine to defer to the opinions of others. But in
| doing so, you remain ignorant on the matter.
|
| > because the consensus is usually right.
|
| No. I understand that's a comforting belief -- and even
| politically charged, today -- but it's just an assertion.
| leephillips wrote:
| More than just an assertion: the consensus is that the
| consensus is usually right, you see.
| timr wrote:
| Well yes, exactly: it's just consensuses all the way
| down. Which is just another way of saying _" I feel like
| it's right and you're wrong, even though I have no actual
| evidence either way."_
| ajkjk wrote:
| as others have noted, you seem to be unaware of what
| exactly the fallacy refers to. You might want to look it
| up. It is not "citing an authority at all" but rather
| "citing an authority's opinion as though it were logical
| fact". Which nobody is doing here.
| timr wrote:
| You started this subthread by saying:
|
| > I for one appreciated the clarification that it was not
| mainstream, since sneaking a random controversial take
| into a comment thread _as if it was fact without noting
| that it 's contentious is disingenuous._
|
| (emphasis mine)
|
| In other words, you didn't just passively ignore the
| parent (which would be fine), you posted about it, and
| not only that, _you called it a lie._ [1].
|
| When you call something a lie like that, you're making an
| argument, so you'd better be prepared to bring the
| evidence.
|
| [1] I realize that you're actually saying that it's
| "disingenous" that they posted this without some kind of
| disclaimer that it's a "controversial argument", but to
| the core of the issue: _if you need that disclaimer, you
| aren 't qualified to judge the content._
| dragonwriter wrote:
| > You're asserting that a extremely well-known logical
| fallacy is not a fallacy.
|
| There are two _distinctly different_ fallacies of appeal
| to authority (which overlap, since all of the second are
| also the first), this form is the form which is a
| deductibe fallacy (appeal to status), but not the form
| that is a fallacy in inductive argument (which is appeal
| to _false_ authority). It is important to distinguish
| them because while deductive fallacies are much more
| clear cut, they are also far less _relevant_ to most real
| world debate, which rarely is about proving something is
| _true by logical necessity assuming some set of axioms_ ,
| but that is the only place that deductive fallacies are
| inappropriate, since all a deductible fallacy is is a
| form of argument in which the conclusion does not follow
| from the premise by logical necessity.
| pdabbadabba wrote:
| The view among "authorities" is certainly something I find
| relevant in assessing a highly opinionated but thinly
| sourced medium article from someone who, respectfully, I've
| never heard of and know nothing about. Certainly it would
| be defeasible by a closer look at the research itself. But,
| barring that, it's a very useful heuristic.
| timr wrote:
| I'm not suggesting you should take the medium article at
| face value either. Just that if you don't know enough to
| evaluate the evidence, you don't know enough to dismiss
| any particular opinion.
|
| People are far too willing, today, to defer their
| thinking blindly to a consensus of opinions, but worse,
| to accuse anyone _who also doesn 't defer_ of being
| malicious.
| alphazard wrote:
| It's true that most doctors and pharmaceutical companies
| maintain that statins are effective. But there are plenty of
| statistically educated people that don't think they have much
| of an effect on all-cause mortality.
|
| There are conflicting incentives here, and as usual we don't
| care about someone else's p value, we care about argmaxing
| our own utility functions.
| fny wrote:
| But statins are incredibly good at reducing inflammation
| anyway.
|
| https://pmc.ncbi.nlm.nih.gov/articles/PMC5633715/
| azan_ wrote:
| Not really, the evidence that ldl causes heart disease and
| statins prevent deaths is very, very, very strong (lots of
| clinical trials, lots of causal evidence e.g. Mendelian
| randomization). LDL is extremely harmful!
| breadwinner wrote:
| So you are saying the human body manufactures a substance
| that is extremely harmful to the body. And yet lowering it
| artificially can lead to issues such as loss of short term
| memory. The body _needs_ cholesterol! You could qualify your
| argument by saying that _excess_ LDL is harmful.
| bluGill wrote:
| The body needs SOME. Evolution doesn't care about when you
| die, just that you reproduce first. Even the highest
| cholesterol cases generally have kids old enough to have
| their own kids before they day. That is enough for
| evolution to not care.
|
| As someone who lost the genetic lottery (has the high
| cholesterol gene) you bet I care. There is every reason to
| think that treating cholesterol will increase my lifespan -
| I'm hoping for quite a few more healthy years.
| karlosvomacka wrote:
| What a boatload of crap.
|
| > Statins can be beneficial in patients who have already
| suffered heart attacks. Cholesterol lowering is not the reason
| for the benefit of statins. If it was, lowering cholesterol via
| any means should have produced the same benefit, but it
| doesn't.
|
| What a blatant lie! Ppcsk9 inhibitors have produced excellent
| results, even better than statins.
| timr wrote:
| I'm unaware of any evidence for ppcsk9 inhibitors outside of
| the same cohorts (people with existing CVD) that the OP is
| citing.
|
| Do you have any?
| breadwinner wrote:
| What about Vytorin trial?
|
| Vytorin is a combination of cholesterol-lowering drugs, one
| called Zetia and the other a statin called Zocor. Because the
| two drugs lower LDL cholesterol by different mechanisms, the
| makers of Vytorin (Merck and Schering-Plough) assumed that
| their double-barreled therapy would lower it more than either
| drug alone, which it did, and so do a better job of slowing
| the accumulation of fatty plaques in the arteries - which it
| did not.
|
| See: https://www.nytimes.com/2008/01/27/opinion/27taubes.html
| dreamcompiler wrote:
| Any cardiologist will tell you statins have saved millions of
| lives. And that they also have side effects that make them not
| an option for a significant chunk of the population.
|
| Statins are not evil and they're not a scam, but we definitely
| need to replace them with something better.
| breadwinner wrote:
| Sure statins may have saved lives, but the question is how.
| Is it by controlling LDL, or by reducing inflammation? This
| story says it is the latter:
| https://www.bloomberg.com/news/articles/2008-04-15/heart-
| dis...
| pessimizer wrote:
| Age-standardized cardiovascular mortality dropped steadily from
| 1975 to 2010 (with no particular discontinuity when statins
| were introduced), and _has not budged_ since 2010.
|
| Since 2010, however, the number of statin prescriptions has
| gone up 75%, and there have been proclamations that not only is
| the science "settled" because of a meta-analysis laundering
| past studies (that could never find a convincing benefit to
| lowered cholesterol), but that 1) _twice_ as many people should
| be taking statins, and 2) maybe we should just put them in the
| water!*
|
| What passes for science in medicine is usually bad, but it's
| exceptionally bad in the cases of the two classes of drugs that
| are the most prescribed, meant to be taken for the rest of your
| life, and coincidentally the biggest moneymakers: statins and
| SSRIs. They both also, even at best, claim very small benefits.
|
| This thread is just going to consist of sloganeering and people
| calling you ignorant. Or a "denier," in order to compare
| disbelief in the tiny effect that statins claim (25-35%, under
| particular conditions) to disbelief in the Holocaust.
|
| * Which was suggested every five years _before_ any of these
| new, "conclusive" studies appeared. They'll just keep pitching
| it until they get that payday.
| softwaredoug wrote:
| I have genetically high cholesterol. But otherwise I exercise
| quite a lot and healthy. I've been told not to worry about
| cholesterol unless other indicators start to climb. So I just
| generally avoid high saturated fat foods (sat fat in food matters
| more to blood cholesterol than food cholesterol).
| brandonb wrote:
| Have you measured your Lp(a)? It's the strongest hereditary
| risk factor for heart disease. (Each Lp(a) particle is
| essentially a "normal" cholesterol particle with an extra
| protein that makes it 6x more atherogenic.)
| NoThisIsMe wrote:
| > sat fat matter more to blood cholesterol than food
| cholesterol
|
| Can you expand on this? I don't understand.
| softwaredoug wrote:
| Eating excessive saturated fat is what your liver turns into
| too much "bad cholesterol" and what you need to watch if
| you're having cholesterol problems. Cholesterol in food
| doesn't usually translate to you having more cholesterol in
| your blood.
| bluGill wrote:
| How old are you? I'm not a doctor, but my impression is
| treatment for cholesterol is not considered worth it until you
| are "older". Depending on how high, older can range from 35 to
| 50. (actually a better marker is probably when did your
| grandparents have heart attack, start treating somewhat before
| then). Which is to say get regular checkups because you will
| likely be put on treatment in the future, but not today.
|
| Again, I'm not a doctor. I talk to my doctor and see what
| others hear from their doctors and am able to make some
| educated guesses off of that.
| baxtr wrote:
| Anyone know how weight lifting might be related to this?
|
| Weight lifting causes short bursts of inflammation right after
| training, which is part of the repair process. But in general it
| is considered very beneficial.
| hkt wrote:
| I'd guess this is persistent, systemic inflammation. So I, as
| someone with IBD, have higher levels of CRP, so am probably a
| prime candidate for this kind of early death (despite having
| quite good cholesterol)
| diordiderot wrote:
| I believe IBD only had a slight impact on all cause mortality
| figures.
| maerF0x0 wrote:
| I dont know the direct answer to your question, and am not a
| Doctor nor researcher... but using a generally applicable
| health pattern -- it's important not to equate acute anything
| with chronic anything. Eg: Acute fat loss via exercising while
| fasting does not seem to relate to body composition changes
| over 12 weeks. Similarly the self protective process of
| hormesis seems to actually create greater health - like
| reactions to heat from sauna usages for example.
| ashu1461 wrote:
| Fundamentally weight lifting should reduce inflammation, but at
| the same time I'm less certain about how things like protein
| powders or very high protein intake factor into this.
| SoftTalker wrote:
| Does "inflammation" refer to a general systemic thing? Or does
| this refer to something specific such as tendonitis or
| inflammation due to injury?
| gwbas1c wrote:
| Upvoted because I was going to ask the same thing: What is
| "inflammation" in this context?
| pizzathyme wrote:
| hs-CRP is the specific biomarker
| brandonb wrote:
| Chronic inflammation (a general systemic thing) is the thing
| we're mostly concerned about for heart health. The hs-CRP
| metric itself will pick up both acute inflammation (if you get
| sick) and chronic inflammation.
| FollowingTheDao wrote:
| CRP is a protein produced by the liver in response to
| inflammation. Elevated CRP levels indicate inflammation in the
| bodY.
|
| High levels of CRP are associated with high levels of oxidative
| stress.
|
| https://pubmed.ncbi.nlm.nih.gov/15585208/
|
| Inflammation is a synonym for high levels of oxidative stress.
| Keep your oxidative stress low and you will not get heart
| disease.
| SketchySeaBeast wrote:
| > Keep your oxidative stress low and you will not get heart
| disease.
|
| I think we should always be careful when we speak in
| absolutes. The conclusion from the article:
|
| > This result suggests that oxidative stress may be a
| determinant of [C-reactive protein] levels and promote pro-
| atherosclerotic inflammatory processes at the earliest stages
| of [coronary heart disease] development.
|
| I'm not saying the result is wrong, but I am saying "if you A
| you will not get B" is over-promising.
| autoexec wrote:
| Easier said than done. Even microplastics have been liked to
| oxidative stress and inflammation.
| drdrey wrote:
| > Keep your oxidative stress low and you will not get heart
| disease.
|
| if you take this advice literally, you should stop exercising
| FollowingTheDao wrote:
| Yes, you are correct. Nothing wrong with walking, helps
| keep weight low and fat cells are a huge source of
| oxidative stress. Better to eat low calorie, high nutrient
| dense foods.
| jawilson2 wrote:
| I have always read it as systemic. Which is why low carb diets
| seem to do wonders for a lot of people's cardiovascular
| systems, somewhat paradoxically. If you go really low carb
| (<20g / day), the first week or two you can lose a ton of
| weight, but much of it is water, which detractors point to as
| "well, you're not losing fat!" But, imagine what this does for
| inflammation. That is 7 pounds of fluid you are no longer
| carrying and pumping against. It's basically a gallon. The
| first round of keto I did, I lost a ton of weight the first
| month (~20 lbs), and my blood pressure plummeted to the point
| where I was dizzy all the time, and I had to supplement with
| salt and magnesium. I remember a study I read probably 15 years
| ago where they looked at cross-sections of arteries before and
| after starting a ketogenic diet, and there was significant
| reduction in inflammation after just a few weeks, IIRC. I just
| tried finding it on pubmed, but can't find the right
| incantation of search terms to dredge it up. There are
| countless studies like this.
|
| I've been mostly on a keto diet since 2014, and it is probably
| the most important health choice I've ever made. At the time I
| worked in Neurology at a Children's hospital, and a keto diet
| is one of the treatment options for epilepsy. I talked with the
| clinical dietician at the time, and asked if these kids were
| having heart attacks in their 20s. On the contrary, much of the
| department was on the diet, or a low glycemic diet, as was much
| of the oncology dept. Obviously, this is an N of 1, and I'm not
| an MD, but every single aspect of my physiological and mental
| health has improved over the last 10+ years.
| nelox wrote:
| Could it be either of these studies?
|
| "Dietary Intervention to Reverse Carotid Atherosclerosis"
| (Circulation, 2010) -- participants were randomized to low-
| fat, Mediterranean, or low-carbohydrate diets; carotid
| arteries were imaged with 3-D ultrasound cross-sections at
| baseline and follow-up. After 2 years there was a ~5%
| regression in carotid vessel-wall volume, with similar
| regression across all diets (i.e., including the low-carb
| arm). [1]
|
| Volek et al., 2009 (Metabolism) -- 12-week very-low-carb vs
| low-fat trial; ultrasound of the brachial artery showed
| improved post-prandial flow-mediated dilation (a marker of
| endothelial function/inflammation) in the low-carb group. Not
| carotid 3-D slices, but still vascular imaging with
| before/after comparisons. [2]
|
| [1] https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAH
| A.1...
|
| [2] https://lowcarbaction.org/wp-
| content/uploads/2019/12/Volek-e...
| olejorgenb wrote:
| "But, imagine what this does for inflammation. That is 7
| pounds of fluid you are no longer carrying and pumping
| against. It's basically a gallon. The first round of keto I
| did, I lost a ton of weight the first month (~20 lbs), and my
| blood pressure plummeted to the point where I was dizzy all
| the time, and I had to supplement with salt and magnesium."
|
| Are you saying losing the waterweight decreased your blood
| pressure?
|
| AFAIK the water lost was bound to the carbohydrates being
| stored. It's not in liquid form.
| dottjt wrote:
| What if you're trying to put on muscle? I found it was very
| difficult to push myself to the extent that I wanted without
| high carbohydrate intake.
| taink wrote:
| What exactly does your diet consist in? What other
| adjustments have you made, e.g. in sleep or exercise?
|
| From what I've read[1] the risk with a long-term keto diet is
| an increase in cholesterol (LDL and total), which can be
| attributed to lower micronutrient and fiber intake, replaced
| by more animal-derived foods.
|
| Reducing inflammation is interesting, I'll have to look into
| it.
|
| [1] e.g. https://doi.org/10.1093/advances/nmaa006
| alphazard wrote:
| This is a good question.
|
| Inflammation broadly refers to destructive immune activity (or
| sometimes any immune activity). If you get a cut, immune cells
| show up, they kill germs, sometimes they kill somatic cells
| too. Different cells show up to heal and close the wound.
| That's all immune activity.
|
| When you need it, it's a net good, but you don't want any of
| that going on when you don't need it. Increasingly people seem
| to have more immune activity than they should and it causes
| cumulative low grade damage. That's the "systemic inflammation"
| that you've probably heard about.
|
| hs-CRP (high sensitivity C-reactive protein) is a test which
| seems to be a good biomarker for systemic inflammation,
| although CRP is just one chemical involved in immune activity.
| This article is advocating for using that particular biomarker
| (related to systemic inflammation) to predict heart disease.
| calebm wrote:
| Just thinking out loud here, but I wonder if the immune
| activity is not the problem, but some kind of destructive
| process that is triggering the immune response. A continuous
| onslaught of destruction tends to make things break down
| faster.
| sciencesama wrote:
| How do you measure inflammation !
| senthil_rajasek wrote:
| hs-CRP levels from a blood test.
| sequoia wrote:
| Is this an advertisement? There's a CTA for a $190 service above
| the fold.
| ed wrote:
| It is, but as siblings note the evidence is real. You can
| purchase the test directly from Labcorp for $59 -
| https://www.ondemand.labcorp.com/lab-tests/inflammation-hs-c...
| brandonb wrote:
| Note that the $190 panel includes not just hs-CRP ($59), but
| also the other major heart health biomarkers: ApoB ($69),
| Lp(a) ($49), A1c ($39), lipid panel ($59), eGFR ($99), other
| biomarkers, and a video consultation with a doctor to
| actually explain the results and what to do about them.
| malfist wrote:
| I'm wary of trusting new health science from a company trying to
| sell me the cure to what they just discovered was the _real
| cause_ of my ills.
|
| This article might be truthful, it might not. But it is
| absolutely trying to sell you something.
| johncolanduoni wrote:
| In fairness, the literature has been trending this way for a
| long time. Well before anyone had figured out a way to profit
| off of it.
| alphazard wrote:
| Yes, and the internet has helped quite a bit with this.
| Instead of a small group of people having access to research
| through university or hospital publishing networks,
| everything circulates on the internet for anyone to look at.
|
| My prediction is that this leads to many secular trends in
| diet and lifestyle. People have called keto a fad, but to me
| it looks like what happens when basic human endocrinology and
| how to manipulate it becomes widely known. I don't expect
| people to go back to high carb/low fat diets as a weight loss
| intervention, ever, even once the hype has worn off.
| rsanek wrote:
| The article is merely summarizing new recommendations from the
| American College of Cardiology. You can read the source if you
| prefer it: https://www.jacc.org/doi/10.1016/j.jacc.2025.08.047
| adolph wrote:
| Thank you for linking. The first few paragraphs sound like
| this is kind of big deal, like print out and read.
| brandonb wrote:
| I certainly get the skepticism. You might find the JACC article
| (which is an American College of Cardiology consensus
| statement) interesting, since the ACC is a neutral party here
| (and reviewed all the evidence around hs-CRP).
| wyattchang11 wrote:
| So does this mean apoB or hs-CRP is a better predictor of heart
| disease?
| mrjay42 wrote:
| Single author
|
| Unknown editor
|
| No journal? Committee? Conference?
|
| Ew.
| p00dles wrote:
| https://www.jacc.org/doi/10.1016/j.jacc.2025.08.047
| brandonb wrote:
| The post links to the JACC article (which is an American
| College of Cardiology consensus statement).
| cryzinger wrote:
| Curious about infliximab being unhelpful or even harmful for
| cardiovascular risk; I'm not sure if there were any confounding
| factors re. people on infliximab not generally being in great
| health to begin with. But back when I was on infliximab I had
| some not-awesome systemic side effects, so I wouldn't be chocked
| if it's just not great for your cardiovascular health in general.
| (And that's still probably a worthwhile tradeoff if you're the
| kind of person who's being prescribed infliximab.)
| Aurornis wrote:
| Before you assume that LDL isn't a good biomarker, read the
| entire article. Specifically this section:
|
| > Why? In some ways, cholesterol has become a victim of its own
| success. We now screen the whole population for high cholesterol,
| give statins to those with high LDL (or ApoB), and so then the
| majority of people who end up having heart attacks have lower
| cholesterol than they would naturally have
|
| In other words, in the study population patients who would have
| had high LDL were likely to be on statins. The had a lower
| measured LDL value even though they might still be consuming a
| poor diet and living an unhealthy lifestyle, for example. Statins
| don't fix everything about poor diet and lifestyle, but they do
| help with cholesterol.
|
| So don't go throwing LDL out yet. It's still the best measure we
| have, though you should obviously know that LDL measured while on
| statins is lower than it would be normally.
|
| The headline, therefore, is somewhat clickbait from a company
| trying to sell these tests to you outside of your insurance. I
| recommend checking your insurance to see if the tests would be
| covered before you go the self-pay route.
|
| Edit to add: If your doctor won't order hs-CRP for some reason,
| you can order it from sites like privatemdlabs.com for $50 (less
| if you take their 25% off coupon).
| FollowingTheDao wrote:
| Yes, LDL is the best we have since they won't bother to measure
| oxidative stress nor inflammation in the human body.
|
| But lowering your LDL does not prevent heart disease. There are
| many many people with normal LDL who have heart attacks.
|
| In fact, it is the norm. And I can't imagine how many people
| are being told. They have no heart disease risk just because
| their LDL is normal. It's a crime and it needs to be stopped.
|
| https://www.uclahealth.org/news/release/most-heart-attack-pa...
|
| A new national study has shown that nearly 75 percent of
| patients hospitalized for a heart attack had cholesterol levels
| that would indicate they were not at high risk for a
| cardiovascular event, based on current national cholesterol
| guidelines.
| p1esk wrote:
| How can inflammation be measured?
| Aurornis wrote:
| > But lowering your LDL does not prevent heart disease. There
| are many many people with normal LDL who have heart attacks.
|
| Wearing a seatbelt does not prevent death in a car accident.
| There are many people who wear seatbelts who still perish in
| car accidents.
|
| While you can find a vocal minority who claim cholesterol is
| not related to heart disease, the best evidence we have is
| that it is. A lot of the doctors pushing cholesterol
| denialism are into quacks, such as Uffe Ravnskov who pivoted
| from denying a link between LDL and CVD into preaching
| Vitamin C to treat COVID when that hit the news.
|
| However, it's not _the only_ actor in determining heart
| attack risk.
| cthalupa wrote:
| Lowering LDL is one of the best preventative measures we have
| for ASCVD.
|
| https://www.lipidjournal.com/article/S1933-2874%2825%2900317.
| ..
|
| That people can still experience a heat attack even with low
| LDL does not change that fact. We have very large studies
| showing the efficacy of lowering LDL.
| brandonb wrote:
| (OP here) LDL is still a good biomarker, but ApoB is a better
| biomarker for the same undelrying risk factor -- each
| atherogenic particle (LDL, VLDL, IDL) has exactly one ApoB
| molecule.
|
| The reason we offer the tests as cash pay is that it's the only
| way we can guarantee the price. In the past, when we've gone
| through insurance, the insurer's "negotiated rate" for the same
| exact panel comes out to $1,400-$1,500. If the insurer later
| decides to deny coverage for any of the tests, it's more
| expensive for the patient.
|
| The $190 price is negotiated to be pretty low. It includes hs-
| CRP ($59 by itself online), but also the other major heart
| health biomarkers: ApoB ($69), Lp(a) ($49), A1c ($39), lipid
| panel ($59), eGFR ($99), other biomarkers, and a video
| consultation with a doctor to actually explain the results and
| what to do about them.
|
| For hs-CRP in particular, it's not covered under the ACA as a
| preventive benefit, so you would usually need to hit your
| deductible before insurance kicks in at all. (That's assuming
| they count it as medically necessary at all -- for example,
| Aetna's current medical policy for hs-CRP requires 2 risk
| factors, LDL in a specific range, and overall cardiovascular
| risk to be in a certain range or the claim would simply be
| denied). It's possible this will change over time as the
| ACC/AHA recommend universal screening, and I hope it does, but
| it's a relatively a slow process since it depends on the US
| Preventive Services Task Force to issue a formal
| recommendation.
| Aurornis wrote:
| FYI the above poster is the founder of the company selling
| these tests (EDIT: He edited his comment to include the "OP
| here" intro after I posted my comment. Thanks!)
|
| > In the past, when we've gone through insurance, the
| insurer's "negotiated rate" for the same exact panel comes
| out to $1,400-$1,500.
|
| hs-CRP is not going to be a $1500 negotiated rate under any
| insurance these days. No sane insurance company is going to
| pay that.
|
| I understand that the negotiated rate you're talking about is
| for an entire panel of many markers, but most of these are
| not necessary for a quick screen and many would already be
| covered by an ACA annual checkup.
|
| > It includes hs-CRP ($59 by itself online),
|
| hs-CRP is $50 right now at privatemdlabs.com before the 25%
| off coupon they're blasting me with in the pop-up. It appears
| to be in the $40-45 range at a few other direct lab
| companies.
| brandonb wrote:
| I updated the above post to say (OP here). I thought it was
| fairly clear from my phrasing of "we offer the tests as
| cash pay", but never hurts to be even more explicit.
|
| I checked privatemdlabs.com, and they're asking $249 for a
| cardiovascular panel that covers the same biomarkers. So I
| think we have the best pricing.
|
| > hs-CRP is not going to be a $1500 negotiated rate under
| any insurance these days.
|
| The $1500 insurance price is for the $190 panel. We've
| actually dealt with this exact situation in the last month,
| since every so often labs will make a mistake when they
| process the order (we obviously fix these situations).
| Perhaps the insurance companies aren't sane (a topic for
| another day), but this is the way the system works today.
| bluGill wrote:
| There have always been people with high LDL who lived to a very
| old age and finally died of something other than a heart attack
| (nobody knows why). Still high LDL after controlling for
| everything we can think of (cholesterol is cheap to measure so
| we have a lot of data!) is a strong sign of a future heart
| attack and so anyone with high LDL should talk to their doctor:
| there is good reason to think statins will reduce your chance
| of a heart attack. Which why we measure it and control it.
|
| If you have normal cholesterol though - we have long known that
| people with normal cholesterol also have heart attacks. It
| isn't as common as people who have high cholesterol, but it is
| still very common for someone normal cholesterol to have a
| heart attack. We don't really know what to do about this
| though. This article is saying we should measure inflammation
| and if found deal with it. Seems reasonable.
|
| What isn't known is if we deal with inflammation will heart
| attacks go away or if there are more factors. If there are more
| factors we don't know what they are or if they are worth
| measuring/treating (though some researchers may have data they
| are trying to get out here). If dealing with inflammation is
| good, can we start ignoring cholesterol - another unknown (one
| for researchers to look into, but the rest of us should for now
| say no cholesterol is independently important - until data says
| otherwise)
| Aurornis wrote:
| LDL is a proxy measure that's cheap and easy to measure. It's
| widely used for screening despite not being perfect, which
| confused some into thinking it's the one and only thing
| measure of CVD risk. It's not, though. Many of the tests we
| look at are proxies and markers, not actually the sole factor
| for a disease.
|
| More in-depth testing would check LDL-P (particle count) and
| ApoB along with hsCRP.
|
| Though realistically, most people could simply look at their
| diet and lifestyle and work on improving both before
| investing in any extra testing. The testing can be useful to
| catch cases where genetics overwhelm even healthy lifestyles,
| but in many cases for younger people the testing basically
| serves as a wake-up call to actually do something about
| lifestyle and diet problems. It's easier to inspire lifestyle
| and diet changes when you're staring at bad numbers on the
| test results and getting a little preview of the consequences
| of your decisions.
| alphazard wrote:
| There is a theory that cholesterol elevates in response to
| circulating endotoxin (dead bacteria cell walls). Lipoproteins
| can bind to the endotoxin, and clear it or at least stop immune
| cells from reacting to it. This response increases LDL, but
| decreases the immune activity that would otherwise be created by
| letting the endotoxin circulate. So LDL is a defense mechanism
| against the body's own response to circulating endotoxin as well
| as the endotoxin itself.
|
| If true, that would explain the link between inflammation, LDL,
| and heart disease. It would also imply that the circulating
| endotoxin is the thing to target. I wonder where all the dead
| bacteria cell walls are coming from, probably where the dead
| bacteria are. That, of course, is the gut.
|
| I don't remember the original paper, but I found something that
| at least explains the theory here.
|
| https://www.sciencedirect.com/science/article/abs/pii/S01406...
| sunshinerag wrote:
| Very interesting
| nabla9 wrote:
| Cholesterol can hide your inflammation.
|
| Cholesterol -> Coronary plaque -> Dormant bacteria within the
| plague biofilm is shielded from the immune system and
| antibiotics. When it ruptures, bacteria is released, sudden
| death.
|
| Viridans Streptococcal Biofilm Evades Immune Detection and
| Contributes to Inflammation and Rupture of Atherosclerotic
| Plaques https://www.ahajournals.org/doi/10.1161/JAHA.125.041521
|
| >Of the bacteria detected, oral viridans group streptococcal DNA
| was the most common, being found in 42.1% of coronary plaques and
| 42.9% of endarterectomies.
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