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Ticker: Don't die of heart disease

528 points by colelyman

by Buttons840

21 subcomments

I am not a statin skeptic--or rather, I don't want to be a statin skeptic. I've done the research and it makes sense to me, but I still feel some social and psychological pressures to reject statins.
When I see that it is widely accepted that ApoB is better to measure than LDL-C, but the industry continues to measure LDL-C, but not ApoB, I wonder why. It makes me skeptical.
When I see that the purpose of statins is to reduce plaque buildup in the arteries, and that we have the ability to measure these plaque buildups with scans, but the scans are rarely done, I wonder why. Like, we will see a high LDL-C number (which, again, we should be looking at ApoB instead), and so we get worried about arterial plaque, and we have the ability to directly measure arterial plaque, but we don't, and instead just prescribe a statin. We're worried about X, and have the ability to measure X, but we don't measure X, and instead just prescribe a pill based on proxy indicator Y. It makes me skeptical.
In the end statins reduce the chance of heart attack by like 30% I think. Not bad, but if you have a heart attack without statins, you probably (70%) would have had a heart attack with statins too. That's what a 30% risk reduction means, right?
As you can see, I'm worried about cholesterol and statins.

by Waterluvian

4 subcomments

I’m sensing a potentially significant misallocation of resources. My mental model is that there’s a hypothetical quantification of not just your time and money, but your anxiety, attention bandwidth, mental energy, etc.
I think, in some ways, the trick is being able to short circuit the entire journey represented by this website in favour of some form of, “I’m 40. I should be more mindful of heart disease. I should add a 30 min walk to my mornings.” And then move on with your life.
I think many cultures, but especially American healthcare culture, foment a growing background noise of constant anxieties and stressors. Life is sufficiently complex but there’s always a peddler eager to throw you a new ball to juggle (and pay for).

by carbocation

5 subcomments

```
    Key Takeaway: Get a CT or CTA scan, and if you can afford it go for the CTA with Cleerly.
```
There is a reason that we don't recommend getting imaging for everyone, and that reason is uncertainty about the benefit vs the risks (cost, incidentalomas, radiation, etc, all generally minor). Most guidance recommends calcium scoring for people with intermediate risk who prefer to avoid taking statins. This is not a normative statement that is meant to last the test of time: it may well be the case that these tests are valuable for a broader population, but the data haven't really caught up to this viewpoint yet.

by kingofmen

2 subcomments

There's something I deeply don't understand about this.
> I shared these results with a leading lipidologist who proclaimed: “Not sure if the lab or the primary care doc said an LDL-C of 116 mg/dL was fine but that concentration is the 50th percentile population cut point in the MESA study and should never ever be considered as normal.
> It’s also important to note that, according to a lipidologist friend, an ApoB of 96 is at a totally unacceptable 50th percentile population cutpoint from Framingham Offspring Study.
So... the exact median value is "totally unacceptable" and "should never ever be considered as normal"? I'm open to the possibility that the US population is so deeply unhealthy that this is true, but then that needs to be argued for or at least mentioned. Like, you can't say "you're exactly average in this respect" and expect your and that's terrible to be taken seriously without any followup.
Or if I'm misunderstanding what's meant by "50th percentile population cut point" then again, I think this jargon should be explained, as it's plainly not the usual meaning of "50th percentile".

by Aurornis

4 subcomments

Going deep on biomarkers, blood tests, and debates about optimal levels is okay for some people who derive motivation from obsessing over topics, but I’m starting to notice a trend where people obsess about these things for a couple years before burning out and moving on to the next topic.
The best thing you can do for yourself is to establish healthy diet and lifestyle habits that are sustainable. A lot of people who jump from obsession to obsession do a great job at optimizing for something for a few years, but when their life changes they drop it completely and fall back to forgetting about it.
Fad diets are the original example of this: They work while the person is doing it, but they’re hard to maintain for years or decades. CrossFit and other exercise trends have the same problem where some people get extremely excited about fitness for a couple years before falling off completely because it’s unsustainable for them. Some people are able to continue these things for decades, but most people do it for a short while and then stop.
I’m now seeing the same pattern with biomarker obsessives: They go a few years obsessing over charts and trying things for a few months at time, but when the interest subsides or they get busy with life most of it disappears.
The most successful people over a lifetime are those who establish healthy habits that are easy to sustain: Eating well enough, reducing bad habits like frequent alcohol or fast food consumption, some light physical activity every day, and other common sense things.
The most important factor is making it something easy to comply with. The $300 biomarker panels are interesting, but most people don’t want to pay $300 every year or more to get snapshots that depend largely on what they did the past week. Some people even get into self-deceiving habits where they eat well for a week before their blood tests because the blood test itself has become the game.

by starchild3001

0 subcomment

Lowering LDL cholesterol is arguably the most evidence-backed longevity intervention available today. Mendelian randomization studies suggest that each standard deviation of lifelong LDL reduction translates to roughly +1.2 years of additional lifespan, implying ~+2.4 to +3.6 years from sustained, meaningful lowering alone.
Pair this with tight blood-pressure control (aim systolic <130 mmHg) and a healthy BMI—every incremental improvement helps. Together, LDL, BP, and BMI form the most potent triad of interventions most people can implement now and expect to see substantial benefits 20–40 years down the line.
A few references: https://mylongevityjourney.blogspot.com/2022/08/a-short-summ...

by js2

1 subcomments

> Sticking to a Mediterranean diet that is light on carbohydrates and saturated fats is almost always the safest bet. Almost every health diet is some permutation of this.
A permutation that's currently making the rounds in the press (even though the original research is from 20 years ago) is the "portfolio diet":
https://jamanetwork.com/journals/jama/fullarticle/196970
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.0...
Some press mentions:
https://www.health.harvard.edu/heart-health/the-portfolio-di...
https://www.nytimes.com/2025/11/04/well/eat/health-benefits-...
https://www.cnbc.com/2025/11/05/the-portfolio-diet-what-it-i...

by Tempest1981

2 subcomments

Summarizing:
- Get a regular physical, or at least a blood test. (Don't wait 5 or 10 years)
- If it shows cholesterol issues, get an advanced lipids blood test, which can indicate whether it's caused by genetics (LipoA/ApoB?)
- If eating and exercise alone aren't helping, consider taking statins for cardiovascular health
- Consider a CT scan to check for calcium build-up, which is not reversible (afaik)
fwiw, I think the advice is much more than just "eat well and exercise".

by dust42

5 subcomments

Long story short care about your health. If you don't do already, maybe now is a good time to start.
What you put into your body: no processed food, cook yourself, lots of variety of veggies and fruits, little meat, little alcohol.
What you do with your body: regular exercise, low stress, enough sleep.
What you do with your mind: good social environment, good relationships.
And an apple a day keeps the doctor away!

by embedding-shape

4 subcomments

The author says this about smoking:
> If you smoke, don’t. It’s going to kill you.
And then this about alcohol:
> I think it’s unreasonable to tell people not to drink alcohol if they like it.
Why is it unreasonable to tell people not to drink alcohol, but reasonable to tell people to stop smoking? Shouldn't the smoking section also get a "at least make sure it’s really good tobacco that you enjoy and don’t smoke too much of it"?
It seems like the personal preferences (don't like smoking, but does like alcohol) is getting in the way of their medical-but-not-medical advice, instead of being able to apply their recommendations equally regardless of what they personally like.

by giardini

2 subcomments

The discussion seems unduly focused on lipids, whereas I would think that blood pressure would be a, if not the, primary concern.
Also for those who do take blood pressure medication: never quickly change the dosage, and especially never quit taking it w/o supervision!
I've seen several untimely deaths b/c someone ran out of their BP medication and could not get to a pharmacist quickly enough. Alternatively the person became irritated with the medication and simply stopped taking it.
Maybe part of starting BP medication should be the doctor giving you a "safety package" that includes a full month's worth of the drug and is to be put on a shelf somewhere where you can get to it should your usual prescription run out.

by cogman10

3 subcomments

I might just be tired, but this seems highly repetitive. The author mentions friends in the field and concierge doctors multiple times in as much as I read.
Feels like the whole thing could be shortened to just say "here's the tests you run, the drugs you might take, the lifestyle changes you should consider".

by AaronAPU

4 subcomments

I was planning to start getting scans ordered for specific risks like aneurysm or heart attack but what holds me back is the idea the scans will harm me worse than those things.
It is very difficult to have any level of confidence with the medical industry so my current approach has been to eat as healthy as possible while staying as fit as I can without undue extreme stress.

by jmpman

0 subcomment

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

by throwaway89201

2 subcomments

I'm not sure that non-medically indicated CT scans are a great idea, as you're at least doubling your yearly dose of radiation in the year of the CT scan. Perhaps it's warranted, but the article doesn't seem to balance that at all against doing a CT scan "every 1-5 years".

by georgeburdell

0 subcomment

I’m not even a few screens into this and I’m already nodding my head in agreement. Having parents of the age where hospital trips are now a yearly occurrence at least, the level of care a patient gets is so much better if relatives are involved and knowledgeable. The medical system does not give a shit about you, they just want to make sure you don’t die in their care.
My sister is a hospital doctor and was remotely checking in with my dad’s care team every shift when he got sepsis after TWO different ERs missed pneumonia even with chest Xrays. Mistakes she corrected included getting him off the ventilator after the need had passed and also preventing him from being discharged directly home — instead he went to a rehab facility for 2 weeks. When I arrived after a few days in rehab he would barely stay awake long enough to eat. He went on to make a full recovery.

by harleyk

0 subcomment

A recent report from the American College of Cardiology emphasizes the prediction power of hsCRP:
"High-sensitivity C-reactive protein (hsCRP) is an inexpensive and widely available blood test. While there has been debate within the medical community regarding the utility of hsCRP, this statement details the data confirming its value in clinical decision making in primary and secondary prevention."
https://www.acc.org/latest-in-cardiology/journal-scans/2025/...

by tonymet

4 subcomments

Fabulous information, but lacking information isn’t the issue. The behavioral changes are obvious and well evangelized : lose weight, regular activity (walking), and if necessary, take meds. (Yes I know your marathon runner cousin who died suddenly of a heart attack, but these are still your best odds)
Telling people what to do rarely fixes anything. People need dozens of impressions for those changes to sink in. Friends, family, social outings, commercials, movies, songs all promoting overindulgence won’t be overcome with a helpful pamphlet or nagging.

by zamiang_brennan

3 subcomments

Great post but quite surprised there is no mention of cutting red meat. There is a lot of evidence that especially the American diet is dangerously high in red meat to the point of elevating Heart Disease risk.

by js2

0 subcomment

Merck has a promising pill (enlicitide) coming that blocks PCSK9, lowering LDL-C:
- up to a 60% reduction in LDL cholesterol, with sustained reductions at 52 weeks;
- a 53% reduction in non-HDL, a combination of all types of cholesterol except for HDL (“good cholesterol”);
- a 50% reduction in ApoB, a protein that helps carry fat and various “bad” types of cholesterol throughout the body;
- a 28% reduction in Lp(a), a different type of lipoprotein that is structurally similar to LDL, determined by genetics and a risk factor for heart disease; and
- a similar rate of serious side effects (10% in enlicitide vs. 12% in placebo), a small proportion of participants left the study early because of side effects (3% vs.4%, respectively).
https://newsroom.heart.org/news/investigational-daily-pill-l...
Blocking PCSK9 isn't new, but thus far only available as an injectable:
https://my.clevelandclinic.org/health/drugs/22550-pcsk9-inhi...

by hackama

4 subcomments

Very interesting, but do the numerous mentions of taking action in your 20s, 30s and 40s mean it's too late for someone in their 50s?
Nitpick: he mentions LDL-C but the test results don't mention that at all. Only later do I see that is "LDL Cholesterol".

by lateforwork

11 subcomments

The title of the article says "don't die of heart disease", but given that we all have to die at some point, if you could choose what natural cause to die of, wouldn't you pick heart disease? It is the best way to die. The worst is stroke. So once you cross a certain age, say 60, don't worry about heart disease, worry instead about stroke.

by amsterdorn

1 subcomments

Curious about how accessible these tests are in Europe. Living in a country (NL) that doesn't value annual checkups makes me assume detailed, preventative blood testing like this is hard, let alone possible to get in non-extreme situations.

by programmertote

2 subcomments

> 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).

by Beijinger

0 subcomment

There is an old pharmaceutical product that was available in Germany, but can not be obtained anymore. Ouabain /Strophanthin
"Ouabain /wɑːˈbɑːɪn/[1] or /ˈwɑːbeɪn, ˈwæ-/ (from Somali waabaayo, "arrow poison" through French ouabaïo) also known as g-strophanthin, is a plant derived toxic substance that was traditionally used as an arrow poison in eastern Africa for both hunting and warfare."
It was later found naturally occuring in the human body:
Key Paper: Gottlieb SS, et al. "Elevated concentrations of endogenous ouabain in patients with congestive heart failure." Circulation. 1992;86(3):846-849. Details: Researchers measured plasma EO in 21 patients with severe heart failure (NYHA class III-IV), finding mean levels of 1.59 nM—over 3x higher than in controls. EO correlated inversely with cardiac index (r = -0.62) and positively with mean arterial pressure, but not with atrial pressures, suggesting a compensatory role in cardiac output regulation rather than simple volume overload.

by arjie

1 subcomments

The primary thing I did was ask a cardiovascular surgeon in my network to send the lab requisition form to a lab. This is the gate for much of this stuff, even if you pay out of pocket. If someone knows a simple “pay and play” testing service that would be fantastic.
Most doctors recommend against these and against the full body MRI one can get because they believe you’ll always find things you don’t expect and that will make you indulge in interventions that have weak support, resulting in deleterious iatrogenic effects.
I found that I had no such impulse with the data I had. But a friend of mine, supplied with evidence of a little arrhythmia went through a battery of tests and experimentation. He was in line for getting a cardiac ablation when he finally quit his job and stopped having the problem. So I get why they say that. There’s people like that.
Anyway, if you’re curious what you can get for $800 email me and I’ll post here. I’d do it proactively but I’m traveling so it will take a little work.

by gehsty

0 subcomment

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

by aucisson_masque

2 subcomments

> 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.

by mathgeek

0 subcomment

> 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.

by bebb

0 subcomment

Read the article, felt worried.
Came back here and read all the cynical and critical comments, felt a lot better.
Thanks guys.

by gscott

0 subcomment

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

by AstroBen

0 subcomment

> 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

by qgin

0 subcomment

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

by bargainbin

0 subcomment

Anyone note where to get this full blood panel done in the UK? I’ve got issues with high blood pressure and swelling in the lower extremities. Blood tests and ECG showed nothing.
Both granddads died in their 50s from heart attacks. I’m convinced I have an issue with my circulation but the blood tests I had done doesn’t seem to cover everything stated here.

by joquarky

0 subcomment

Unfortunately, the time in our lives when we need to most pay attention to these things is when ageism kicks in and yeets us completely off of health insurance.
I'm coming up on two years unemployed and feel like an idiot for not better preparing for ageism in our industry. I foolishly assumed that experience would make up for age.
Don't make the same mistake! Plan to have most of your income shrink drastically in your mid-40s.

by potato-peeler

1 subcomments

The value of the biomarkers are they applicable for all age range? What if someone already had a heart attack, then what should be the normal values post incident?

by mac-mc

0 subcomment

If you dig into research and follow the low-risk experiments that people do online to reduce their Lp(a), you can find techniques and evidence to do so. It doesn't have to be an impossible-to-fix issue.
I like this list of experiments by Greg Muschen: https://x.com/gregmushen/status/1924676651268653474

by guzik

1 subcomments

> 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.

by jorvi

3 subcomments

The "be an advocate" thing is both true but also incredibly selfish and egotistical.
If everyone did that, the whole system would grind to a halt. Doctors aren't in a rush because they enjoy so, they are because they're already overworked. 1 out of every 25 patients (their family) demanding extra attention is possible although still a burden. 21 out of every 25 is not possible.

by jeffnv

1 subcomments

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

by darepublic

0 subcomment

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

by n8cpdx

0 subcomment

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

by singpolyma3

1 subcomments

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

by ambicapter

0 subcomment

> 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.

by m_a_g

0 subcomment

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

by tlarkworthy

0 subcomment

well that inspired me to research getting those tests in Germany.
=> heart panel plus
https://en.minu.synlab.ee/heart-panel-plus/
I don't need doctors, I can get ChatGPT to analyse the results.

by ef2k

0 subcomment

This reminded me of the other extreme to health consciousness: the 109 year old that smoked cigars and ate ice cream every night [0].
[0] https://youtu.be/BXyfCGDnuWs?t=332

by wyldfire

0 subcomment

I was a bit distracted by the capitalization of the word "Advocate". Both when used as a noun and a verb. Peculiar.
But a great article with really great suggestions. Too bad there's not better medical care by default but good to hear that we can take control.

by bzmrgonz

0 subcomment

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

by dreamcompiler

0 subcomment

> 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.

by FlamingMoe

0 subcomment

I recently did a comprehensive panel of my own volition with Quest Labs and was pleasantly surprised by the entire process. It was super easy to schedule, affordable, and their online platform is surprisingly sleek.

by hmontazeri

0 subcomment

Triglyceride-to-HDL Ratio (TG/HDL)
Interpretation: • < 2.0: Insulin sensitive • 2.0–3.9: Moderate insulin resistance risk • ≥ 4.0: High likelihood of insulin resistance
Your ratio = 5.0 → Suggests likely insulin resistance.

by Padriac

0 subcomment

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

by hshdhdhehd

0 subcomment

It is a long read and I want to make time for it. Quick search check and calc (for calcify etc.) and diet appear alot in the article which is not surprising based on other things I have watched on the subject.

by reidrac

3 subcomments

There are some points on this post that confuse me.
> In early 2023 during a routine skin check at my dermatologist [...]
Are routine skin checks a thing?
> [...] I’ve spoken with several of the world’s leading cardiologists and lipidologists [...]
How come?

by k__

2 subcomments

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

by dtgriscom

1 subcomments

> 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.

by goblin89

1 subcomments

It seems to be nearly impossible for me to advocate for myself at a place like a hospital.
It might be easier to do this for someone else, but it seems narcissistic to assume I of all the patients is so special. If there’s nobody to advocate for me, clearly I’m not!
Let’s say I try it anyway. I tend to be a slow rational thinker in real-time situations, especially under pressure. If I try to advocate for myself and ask questions, I would need to have time to consider the responses (did I even get the information I requested, what are the implications) and maybe do some research in order to make an informed choice as to whether to proceed or not, or whether to ask further questions. However, if I actually request time and have people wait for me, I enter a high-pressure mode in which I can’t think well. The clock is ticking, the stakes are high.
Even if it’s a simple routine case, I am entrusting myself to people who have the power to kill me. If it’s anything beyond routine, killing or harming me may not even be consequential to them (mistakes happen). It is a very particular type of situation.
The natural thing for me to believe is that all of these people are professionals. If I have reasons to supervise them, it automatically implies I believe they are either unprofessional or malicious, in which case I really should not be there in the first place. The arrangement is that I am not supposed to know better than them. If I try to supervise them, that implies I think I do. At worst it would be disrespectful or offensive and would make them hostile on a personal level (which is always at play between humans, regardless of the protocol), at best it would make me look like a crackpot not to be taken seriously anyway. Besides, if I already assume they make mistakes or are unprofessional, their answers can be false anyway.
On the other hand, I am aware that many, many mistakes are made in hospitals daily, so I know they are not such infallible professionals.
As a result, this makes me very reluctant to go to a hospital or a clinic for any reason. It’s probably bad.
Anyone has advice for overcoming this? Maybe training to think quickly and finding ways out in high-stakes situations like this? Tricking yourself into a mode where you feel natural advocating for yourself and act in a way that makes people treat you seriously without being offensive to them (considering the power they have over you)? Learning to not care what people think in a healthy way? (Please don’t suggest LLMs.)

by armada651

0 subcomment

I honestly think we should live more for the now than the far future. Rather than focusing on how to optimally extend my lifespan I'd rather focus on living the life where I'd be satisfied if I dropped dead the next day.
Like the article says this is only one of the many causes you could possibly work to prevent and if you die of something else then all that effort was for naught. Whereas if you put all your effort into living a worthwhile life then it doesn't matter what you die of or when.
I understand this man has kids he wants to live long for and that makes optimizing for living a long life worthwhile to him. But I don't think that a long life should be the goal in and of itself, it should be to live a worthwhile life.

by jokoon

1 subcomments

yeah, always the usual: eat better and do physical activity
unfortunately, depression cripples my motivation to do physical activity
I still do some, but it's never enough

by bambax

2 subcomments

> 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?

by dawnerd

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

by tschellenbach

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

by everdrive

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What if heart disease saves me from dementia? I'm not just being contrarian. I think about this a lot of the time. I'm already 40. I'm being healthy now, but whatever damage has already been done is baked in. (plus whatever is in my genetics) A quick death at 65-70 might be much more preferable to a slow terrible decade-long decline.

by puttycat

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I cannot judge the science in most of the article since I'm not a medical doctor.
But since I have a PhD in computer science in a relevant subdomain, I can certainly judge the part where he recommends the following:
> What should you do with your test results? Throw them into ChatGPT, of course!
Do not count on anything coming out of ChatGPT for medical advice. Period.

by grvdrm

1 subcomments

My first thought after reading: where does a guy like Peter Attia fit into the mix? Is he motivated and communicating in legitimate ways? Just a promotion machine at this point? Somewhere in between?
I love the idea of knowing biomarkers but have trouble with what I might do with them. Yes there are specific actions, but then what? A lifetime of SaaS to monitor?
Planning to ask my doctor for expanded tests in upcoming physical - definitely exploring everything I can.
But, doing basics too. Lot of exercise. Weights. Good diet. Get min 7 hours of sleep if possible. Try not to be a maniac filled with stress.

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by stdclass

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

by pstuart

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

by mmaunder

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

by ETH_start

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All of this advice seems really good. The only one I am reluctant to follow is getting a CT or CTA scan.
For reference, radiation levels:
Chest X-ray: ~0.1 mSv (millisieverts)
Head CT: ~2 mSv
Chest CT: ~7 mSv
Abdomen–pelvis CT: ~10 mSv
CTA (angiography): often 10–20 mSv
Are there non X-ray diagnostic imaging scans that can detect arterial plaque?

by aktuel

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This is all very interesting, but far too detailed and technical for 99% of people. The TLDR should include an easy to understand summary without jargon like "VO2" and "a set of HIIT at Zone 4".

by floundy

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

by tamimio

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

by reducesuffering

2 subcomments

"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.

by deadbabe

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

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by lisbbb

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Love the chart at the bottom--it really puts on display media bias and lack of integrity and using fear to push idiotic policies which area really just a way to put everyone in the pocket of government and keep them there permanently with zero real improvement to public health. Fear get eyeballs. the Covid mass hysteria proves that, too.
As far as heart disease goes, yes, it's the big killer and it's time people started waking up from the media haze, but to do that, you have to admit you were wrong, and for many, that is far too tall a hill to climb.

by catchcatchcatch

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by stefantalpalaru

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by camel_gopher

4 subcomments

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

by righthand

1 subcomments

Really surprised at the last few paragraphs! Read with caution this is not Real medical advice!
This was a good read until they recommended using ChatGPT instead of working with your doctor. Also they have some delusion about the actual cost of using ChatGPT.
> Pretty incredible. Also free.
Not free at all. Not a good idea to feed a private corporation your health data!

by loeg

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Wall of text, jeez. This reads as neurotic.
The big levers anyone can do (but most don't) are:
1. Exercise regularly (anything aerobic)
2. Minimize your saturated fat / cholesterol intake
That's a better tl;dr than the useless one presented in the article.

by lbrito

3 subcomments

I don't like this kind of content. The author might have a personal motivation for it, but for the general public, it's just more mental load.
We are all going to die one day.
When I was younger, I would fret over this kind of article. Great, one more thing I have to worry about. Now I just mostly ignore it. It's impossible otherwise. If I dedicate hours and days and months to all the heart best practices, what about when the liver, esophagus, kidney, bladder, brain articles come out?
We all know the good practices. Don't be a dumbass. Don't drink too much, exercise and so on. Besides that, I'm very much going to be reactive, as the article cautions against. I just don't have time or mental energy to do otherwise.