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Cardiologist here, can confirm. We’ve long been seeing these promising trends, in the US, Europe, and elsewhere. I would say the greatest reason for this are 1- advances in percutaneous interventions (which is as much about having new tools to fix acute MIs, such as more effective stents, as much as logistically making these tools + the skilled physicians to operate them widely available in any place at any time), 2- relatively cheap & highly effective cardiac medications, & 3- the hugely successful anti-smoking campaign. Diet/exercise changes of course may be some contributors but they’re clearly not being widely followed. Here’s the original article in JACC fyi— https://www.jacc.org/doi/10.1016/S0735-1097%2823%2901585-1

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My dad died from a heart attack in 1992. His arteries were blocked. He had very high cholesterol and statins were unavailable until the mid 90s. I was found to have the same issue and it was so high I was told it had be familial. A couple of doctors told me eating healthy and exercising could help keep it down but others said, no not really, it's not a little high, it's massively high, I need intervention, so I have been on statins for several years and they have kept my cholesterol levels in the normal range. I am grateful and I do hope that if the second set of doctors are right that the first set learn about this.

I have familial hyperlipidemia, and my mother and brother both had heart attacks when they were 45.

Do you know omega-3 fatty acids promote something called reverse cholesterol transport?

https://pubmed.ncbi.nlm.nih.gov/28984832/

I couldn’t take statins because of the side effects. I went on a fish only, no plant oil diet, and my LDL is now 200 and my HDL for the first time my life rose above 35 to 52. To me, the key was getting the omega-3 level way higher than the omega six level and totally eliminating short chain poly unsaturated fatty acids.

Note that I went on this diet, because I actually know my genetics. I don’t recommend anyone do the same thing without knowing what I know.

Diet works and it’s sad people can’t commit to it. And I’m afraid for a lot of people it won’t be the vegetarian diet that is normally prescribed.

Remember as well cholesterol is not the only contributors her heart disease. Oxidative stress plays a large role in damaging, or oxidizing, the LDL to cause the plaques.

https://www.frontiersin.org/articles/10.3389/fphar.2020.6137....

Oxidative stress can be caused by external forces, but also by the lack in proper nutrients, like zinc and B6 and riboflavin, deficiency in those supplements are all linked to greater incidence of heart disease.

I am in my mid-50s and I’ve had no issues so far.

I keep hearing seed oils are a problem and lead to obesity, but we're addicted to them for cooking, mouth feel, etc.

What do you use as a substitute for vegetable oils in your cooking?

The only oil I use, and use it sparingly, is olive oil. Olive oil is a fruit oil.

You don’t need oil to cook. Your diet will look a lot different, but you certainly don’t need oil to cook.

That makes sense why I hear olive and avocado as sensible alternatives.

If I could advise my younger self, I would say: “Learn how to cook” (for real). It turns out olive oil is all you need, and even not much of that. I discovered that most of my use of oil was simply covering for my lack of ability.

It’s instructive to remember that two hundred years ago, palm oil/vegetable oil/canola oil/avocado oil/almond oil/etc didn’t exist, nonstick pans didn’t exist, and somehow people could still cook amazing food.

Canola is made from rapeseed, which is toxic before processing. (And mostly not toxic after processing. ) The oil it produces used to be used only for greasing engine parts.

there’s no evidence that seed oils lead to obesity, it’s just a fitness fad

It is not that they lead to obesity on their own, but over consumption of them might and the effect they have on the body (inflammation) might have other secondary effects (insulin resistance, higher cholesterol, fatigue).

To say it is "just a fitness fad" is dismissing a ton of good research:

https://openheart.bmj.com/content/5/2/e000898

Meta comment: parent and GP are an interesting contrast between the "settled science" drum-beat dismissiveness narrative and the science/study-based curiosity counter-narrative.

Here's to hoping that with the death of the dollar, the "settled science" practitioners lose their bullhorns.

Not sure if typo but LDL of 200 is still very high.

It is turning out that Cholesterol/HDL ratio is more important and now mine is below 5 always. I do not care about my totals or my LDL.

HDL is an antioxidant and this why HDL rules over all:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607861/#:~:tex....

Familial hypercholesterolemia (FH) is an inherited defect in how the body recycles LDL (bad) cholesterol. As a result, LDL levels in the blood remain very high – in severe cases, levels can reach above 190 milligrams per deciliter (mg/dL) of blood.

It sounds like 200 is still trouble. Was it even higher before?

Yes, it was 290 but my HDL was also 30. I just focus on the HDL now. And the doctors no longer bug me about being on a statin.

What do you mean by “eliminating short chain poly unsaturated fatty acids”? Omega-3 is also a poly unsaturated fatty acid, isn’t it?

Omega 3 is a long chain fatty acid.

Return short, chain fatty acids into long chain fatty acids by four enzymes FADS1, FADS2, EVOL1, and EVOL2.

https://www.mdpi.com/nutrients/nutrients-06-01993/article_de...

I have polymorphisms in FADS1 and FADS2 that slow down the rate of this pathway. By the way, I have Inuit (SAMI) Heritage.

Your family history and extremely elevated LDLs are scary. Diet and exercise are not enough to prevent poor outcomes in familial hypercholesterolemia. The rough estimate we quote patients is that the risk of a heart attack in males with FH is ~50% by age ~50 without medical treatment. This is 20 times (not 20%, but 20 TIMES) the normal risk at that age.

I will not give medical advice over the internet, but if I were you, I would not want to be messing around with anything short of the standards of care given those odds. Statin therapy is a core part of that standard.

Statin adverse effects do exist, but they are found to be quite rare (1-2% prevalence) when assessed for through well designed placebo-controlled trials. Additionally, there are newer statins with fewer adverse effects you could consider. Assuming you truly have FH and truly are statin intolerant (or remain at elevated LDLs despite maximally tolerated statin therapy), PCSK9 inhibitors can be considered. In the US, you would likely qualify for one if these through a good insurance plan, assuming the above criteria are met.

If you want to see my charts, feel free to email me. I’ve corrected my cholesterol in a more functional way than a Staten could have. And when I tried to statin and not only lower my cholesterol, but it lowered my HDL as well, which is bad. It also gave me myopathy add myopathy.

I’m not screwing around, I know my genetics, and I know how reverse cholesterol transport works. I also know keeping oxidative stress at a minimum is probably more important than the level of cholesterol. I actually moved to a location with extremely low air pollution for that very factor. You can’t look at LDL only to understand the risk of heart disease.

I had very good doctors and if they thought I was at risk, they would be telling me what to do because that’s what they always do. But now they say there’s no need for statins and they’re not concerned about my heart disease risk anymore.

Followingdao@proton.me

Take k2.

Sorry to hear about your dad. How old was he? I assume he was Indian given your username. South Asian ancestry is a risk enhancer for heart disease, unfortunately. Being Indian myself, I have so many stories of relatives (esp male) dying of MIs and sudden cardiac deaths at ages 40-50s. I didn’t even consider this unusual till after growing up and esp after caring for ppl of other backgrounds.

There’s no clear/satisfactory answer as to why South Asian patients have so much more heart disease, but the evidence does suggest we should be adopting more aggressive targets of risk parameters for them (A1c, LDL, BP, weight, etc.), and the clinical guidelines likely will reflect this in the future.

Thank you. My dad was 43. Yes he was Indian and I believe you are right about enhanced risk.

> Diet/exercise changes of course may be some contributors but they’re clearly not being widely followed

Diet advices actually have been followed, particularly the demonization of dietary fat and its replacement with sugar, and that may be the cause for the increase in T2D and obesity.

Who's out there saying "cut fat and replace it with sugar"?

Customers, who still demand tasty products in spite of the food industry cutting back on fat.

Ancel Keyes at the McGovern committee in the 1970. Yudkin disagreed, and was a victim of a smear campaign by Keyes.

They are said "cut fat". Replace with sugar was never said - but it was the obvious replacement so that is what was used.

> Diet/exercise changes of course may be some contributors but they’re clearly not being widely followed.

Over the past two decades, the number of gyms and fitness centers saw exponential growth to the point where they became ubiquitous, and some workout programs became widely recognized memes. Working out is now socially acceptable, and in some places social pressure tilted to the targeted against those who do not exercise.

Even though diet/exercise changes may not be widely followed, don't you agree that they have been widely adopted?

In the UK, the _average_ time spent watching TV/streaming content is about 40 hours per week. This in combination with generally sedentary lifestyle that relative wealth allows. Unfortunately gyms and fitness centres, as good as they are, I'm not sure can counter this trend.

Funny but most of my streaming happens as I'm cycling at home

Does gym correlate with being fat later in life?

I’ve seen it a lot: A sports jock at 20-25, gets a manager job and becomes quite unhealthy at 40, much more in US than in, say, France, where gyms arrived much later and there hasn’t been a culture of muscle size in high school/uni until very recently.

I would assume the opposite. Childhood obesity probably correlates very strongly to obesity in adulthood. What you are observing is probably just an overall trend in society and not specific to jocks.

Athlete turned overweight is so common. They keep up their diet as they grow older but not their exercise. Opposed to someone who have the same diet their whole life and only occasionally exercised, they'd just maintain their weight.

Many sport create bad eating habits. Wrestling is the worst where kids are taught to cut a lot of weight in a short time (by dehydration), but even in other sports the coach will often give out diet advice that is at best good for the year but not good for long term health. (and at worst it isn't even good advice for the current year - coaches are not nutritionists)

ime Gym or high intensity physical activity correlates with getting fat when you stop unless you put a lot of effort into eating less. When I stopped all sports and powerlifting during covid lockdowns I certainly gained a few pounds because my appetite was still at around 3500 kcal/day despite my physical activity not being at that level anymore.

75% of Americans are overweight or obese

Gyms aren't that popular, most people going to gyms aren't doing enough

Not only are they not doing enough they don't know what they're doing. Worse, the fitness industry is not science based and the barrier to entry to be a personal trainer is pathetically low.

I was a certified trainer under NASM years ago. It was fairly intensive, but largely nonsense.

This is a huge bummer.

If one wants to get in shape they almost need to make fitness a hobby.

> If one wants to get in shape they almost need to make fitness a hobby.

"In shape" is the normal state of a human being. If you want to get in shape you just need to disconnect from the high calorie food supply and eat normal, plus do a bit of walking.

For some reason we have come to believe that everyone is born fat and only lose weight through costly and time consuming interventions.

Most people expect more from being in shape than just not being fat. I expect to look good without my shirt on and have at least some endurance.

For that you probably need at least 3h of decent training per week. After you add changing, showers, etc, it's a commitment of 5-6h a week. Quite a hobby. I certainly consider it a hobby.

Well you can consider eating healthy a hobby, it sure takes more than just quick visit to McDonald or any similar junkfood joint, and it costs more too so there is another skewed justification for why not do anything and have more miserable life.

I think you are not getting the point - being fit was the default since humans mutated from our predecessors, till very very recently. I mean I can't believe I have to explain this to anybody, especially here.

Also, you have incorrect world view on what it means 'being fit' that may be very effectively hindering your motivation to get better. Its definitely not about looks, if somebody is selling it as such they are doing a great disservice. Some people have genes that make their bodies look very different from ripped bodybuilders with 4% body fat, yet if they are very fit can achieve pretty amazing things.

Don't look for external validation, if you are happy in your own body (which being fit brings pretty much guaranteed, some mental disorders notwithstanding) then its all good and you can focus on other amazing things in life, while being happier, living better and longer and so on. Everything is connected.

As a generalisation, get fit in the gym, lose weight in the kitchen.

Whilst it is possible to lose weight by eating a similar diet and increasing exercise you just end up someone who is fitter but still eating what will almost certainly be a poor diet.

Most people are overweight because they have a poor or terrible diet, not because they don't do enough exercise. (Although to be fit or healthy you need to tackle both.)

(Again this is a generalisation. There are many reasons why people are overweight. I am, and I'm changing my diet and the amount of exercise I do to sort this out.)

You can't outrun a bad diet. Exercise is ~5% of weight loss. Diet is ~95%.

You can almost outrun (or out-sport) a bad diet when you’re 16. The problem is those bad diet habits stick with you then when you’re 35 or 40 or 45 and can’t outrun it you see screwed.

That argument is solely about weight loss but there are many other reasons like cardiovascular fitness (keeping in theme with the article), or overall fitness level that lead to to better outcomes.

This is not true if you have the genetics for hyperlipidemia.

Genetics matter, we’re not all the same. These generalizations are OK but they won’t mean they will work for you.

Yes but you can strengthen your heart to a degree. Even most anti-cardio lifters eased up a little. I still won't run but I do tabata every other workout.

You can absolutely outrun your fork, even into middle age. You just have to run a lot fucking farther than you think. A mile burns about 100 calories, very conservatively. Do the math, then do the miles. It's not going to be easy but it's unequivocally possible without a Herculean training regimen.

I have gone to gyms since the early 90s.

30 years ago, so many guys had a bench and cheap weights in their basement that they barely used. Now that group just has a gym membership they barely use. Women had home VHS aerobic workouts they barely did instead of a gym membership they barely use. It has really just reflected the change in gym membership prices. My first gym was $75 a month adjusted for inflation and it was nothing special. The nice Golds Gym that was the alternative was $100 a month adjusted for inflation. It is just easier now to pay $15 a month and not use the gym.

I can't imagine we have a more fit population now. Maybe there is 10% more very fit people in the tail but the median is most likely much less fit.

What I notice most is going for an hour walk at sunset on a beautiful spring night in a nice suburban neighborhood, there is absolutely no one outside. Everyone is inside sitting. When I see a kid they are usually riding a motorized scooter to zoom between places to sit.

You also have to factor in that old people now grew up with so much more physical activity than young people now. I can't imagine the knock on effects of what all this sitting by young people will have once they are old.

> Working out is now socially acceptable

When was working out socially unacceptable?

Noticed any change in the past couple of years? There have been reports of increases in heart attacks following Covid infection, especially in younger people.

However data moves pretty slowly. The article linked above for example cuts off in 2020. Whereas most people only got infected in 2022.

https://www.cedars-sinai.org/newsroom/today-young-people-are...

Studies not taking the vaccination status into account are not serious. This study even does not talk about vaccination status.. I am not saying COVID isn't cause heart attacks. But this study is just embarrassing.

It's literally an observational summary of all filed provisional death certificates between between April 1, 2012, and March 31, 2022 limited to those that specifically mention "heart attacks" (AMI - acute myocardial infarctions) [0].

As those death certificates don't mention measles, rubella, flu, or COVID vaccinations, etc. they don't feature in a pure numerical grouping and summary.

If you feel that vaccination status play a part worthy of notice then you are free to pull the data yourself [1] and cross reference those deaths against vaccination status data.

Very few published studies are the be all to end all, they are each at best parts of a greater picture, what this study does highlight is that AMI's trended downwards for almost a decade and then rose as COVID spread.

Clearly there is more work to be down here - as this study signposts.

[0] https://onlinelibrary.wiley.com/doi/10.1002/jmv.28187

[1] https://wonder.cdc.gov/mcd-icd10-provisional.html

> Diet/exercise changes of course may be some contributors but they’re clearly not being widely followed

Human here, can confirm. No source required.

:D Yeah I can’t bring myself to reply to those contesting this part of my statement. Look around you, people. Please observe the teaming masses who cannot stop shoveling shit into their mouths at increasingly alarming rates.

MI = myocardial infarction, percutaneous ~= stents/angioplasty

Stents and Statins mean my wife will see our son graduate college. She'd probably be gone by now. 2 heart attacks in her 20's. Her father died at 40.

Do you have an opinion on GLP1 agonists? It would seem they can pre-empt the metabolic problems that drive CVD.

A lot of GPs I’ve talked to are negative on them as they are expensive and they seem to have the mindset “you should just eat better”. But we know that dietary interventions fail like 97% of the time because long term adherence is almost impossible.

Maybe also improved transfer logistics to the right hospital to get tPA for STEMIs?

e.g. more pre-hospital ecgs so patients go straight to the right hospital?

And with those pre-hospital ecgs, more pre-hospital administration of things like ASA and clopidogrel?

Regarding 3/ weren't most gains expected to be reversed due to vaping (sp one company: Juul)?

Don't forget that the introduction of Smoking laws in most western countries have reduced the 3rd party/passive smoking dramatically. Anecdotally - As kid visiting offices in the 80s I remember nearly every single adult office worker being a smoker and going into office work places thick with smoke. Vaping does not seem to have the same numbers.

Nicotine is not that bad for you. It's the smoke in smoking that is the main health hazard.

You've got it a bit mixed up Nicotine has not been definitely linked to cancer. Cigarette smoking has, however. But nicotine has been linked to heart disease and related cardiovascular illnesses.

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