Hacker News Reader

Comment by boothead | Hacker News Reader

I think this is a bit unkind:

> dismissed in a pseudo-intellectual manner by people who know a lot (just not about the subject at hand).

I'm the one who's potentially sick here, and this (perhaps wrongly) smacks of appeal to authority. What I absolutely don't want to do is disregard medical opinion, but neither am I inclined to abdicate all responsibility for my own health and well being.

> The genetic data currently supports very little role for inflammation in important diseases like coronary artery disease, whereas there is crystalline evidence supporting the connection between LDL-cholesterol levels and mortality

I'd be very interested in learning more about this, do you have anything you could recommend? I'm fully aware that the majority of what I read on the internet is likely to be along the lines of "don't sweat it, eat natural and you'll be fine" and I'd very much appreciate some exposure to the opposite point of view too.

View on HN

>> The genetic data currently supports very little role for inflammation in important diseases like coronary artery disease, whereas there is crystalline evidence supporting the connection between LDL-cholesterol levels and mortality

> I'd be very interested in learning more about this, do you have anything you could recommend?

I'll let the OP chime in if I'm wrong but I believe s/he is referring to the numerous genetic association studies[1] that have implicated LDL biology in coronary artery disease. Look at ref. 2 for a publicly-accessible review. The article details the genes that have been associated with coronary artery disease, none of which appear important for inflammation.

1. https://en.wikipedia.org/wiki/Genome-wide_association_study

2. http://circ.ahajournals.org/content/128/10/1131.full

In talking about pseudo-intellectual dismissals, I am appealing to the prior news.YC discussions about middlebrow dismissals, which would have been better wording. Sorry about that. How is what I mean different from an appeal to authority? Mostly it has to do with the type of evidence selected by statin "opponents", which tends to be of lower quality.

As for studies that I find instructive, here are a few:

People with loss of function mutations in PCSK9 have lower LDL-cholesterol. These people have an even lower risk of ischemic heart disease than you would expect based on the degree of LDL-cholesterol lowering. [1]

Mendelian randomization demonstrates that genetic scores for LDL cholesterol associate with reduced risk of myocardial infarction (suggesting causality, since cholesterol doesn't reverse-cause a genotype).[2]

IMPROVE-IT showed that a non-statin medication (ezetemibe) added to a statin regimen further reduced the risk of second heart attacks after suffering a first heart attack. This is probably the clearest experimental evidence to date that suggest it's not only statins that reduce cardiovascular risk, but LDL-cholesterol reducing agents more generally that lead to reduced risk of heart attack. [3]

This is a very contemporary summary of genetic and clinical trial data; there is a wealth of older data that I won't get into.

1 = http://www.nejm.org/doi/full/10.1056/NEJMoa054013

2 = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419820/

3 = http://www.nejm.org/doi/full/10.1056/NEJMoa1410489

[T]his (perhaps wrongly) smacks of appeal to authority.

Don't dismiss appeals to authority so easily. As it happens, not giving extra weight to experts in proportion to their track record is a provably suboptimal strategy in an adversarial setting (see e.g. [1]). So, in this sense, deferring to trained medical opinion might in fact be the most responsible thing to do.

Note however the bounds in [1] also (indirectly) imply you are better off with a diverse ensemble of expert advice. So if you can afford it, always get a second (or third) reputable medical opinion. And weigh their advice accordingly.

[1] http://www.mit.edu/~9.520/spring08/Classes/online_learning_2...

This is correct. I reference one of the Mendelian randomization studies in my comment [1].

1 = https://news.ycombinator.com/item?id=10739687

You might want to read the book Why Zebras don't get Ulcers by Robert Sapolsky. It's about stress, all aspects of it. So it's not about inflammation, although inflammation means stress and in that regard it is covered - you might find it interesting.

Be prepared for lots of chemical terms, but don't let that hold you off - there's enough interesting stuff to read. It has lots of interesting information.

https://en.wikipedia.org/wiki/Why_Zebras_Don't_Get_Ulcers

Reply on news.ycombinator.com