Comment by carbocation | Hacker News Reader

Comment by carbocation | Hacker News Reader

How to avoid heart disease:

(0) Be female. Don't be born with heart defects. Don't be old. Don't have Marfan or Loeys-Dietz syndromes. (All of the unfair/can't modify factors will get lumped into recommendation #0.)

(1) Don't use tobacco or cocaine, and don't drink too much alcohol.

(2) Don't get exposed to radiation or chemotherapy.

(3) Don't have diabetes.

(4) Don't have high blood pressure.

(5) Have low levels of LDL and triglycerides.

(6) Don't eat too much. This is tightly related to #3 and #4, and reasonably related to #5.

(7) Have extremely low levels of LDL and triglycerides throughout your entire life. Having low LDL throughout your entire life reduces your risk of heart disease, even moreso than you would expect based on the LDL value alone. It seems that lifelong exposure to low LDL is more valuable than just late-life exposure to low LDL. [a]

Most of the genetic variants that we can currently interpret when accounting for risk (as opposed to the innumerable ones which we cannot yet interpret) fall into lipoprotein-related pathways. It will be interesting to learn about ones that do not, yet still confer meaningful cardiovascular risk. I don't think that we have a mechanistic explanation yet for the risk conferred by variants in the 9p21 locus, for example. [b]

I'm reasonably certain that your HDL is not particularly important (except as a poor proxy for your socioeconomic status, perhaps).[c] And omega-3 fatty acids have no visible effect when examined in the rigorous way in which we examine any other new drug. [d]

a = http://www.ncbi.nlm.nih.gov/pubmed/20579540

b = http://circgenetics.ahajournals.org/content/6/2/224.long

c = http://www.ncbi.nlm.nih.gov/pubmed/22607825

d = http://www.nejm.org/doi/full/10.1056/NEJMoa1205409

Well, I'm fucked.

Grandfather was in decent shape at 40 when pretty much all his arteries clogged. He is now 87 with half a single artery left in his heart. He is not what I would call "living" as much as existing.

On the other side, my mother, grandmother, and great grandmother have intense high blood pressure with no understandable reason.

Well, I figure I may have till I'm 50. Though I hope doing biking marathons would train my heart even a bit to help.

To the extent that it is important to you, you can work with your doctor to modify the risk factors that you can and would like to modify. Interestingly, 90% of Americans over 55 will develop high blood pressure; it is the norm [1]. (Not saying you are an American, as I don't know; just saying that I also don't know if this applies to the rest of the world.)

1 = http://www.nhlbi.nih.gov/guidelines/hypertension/speaker2.ht...

Soviet Union represent! Moved to America bout 22 years ago. And of course after all these diseases hit the family. For the record only my father is overweight, and he's the healthiest of them all (not true but at least his heart is alright for now)

Get on a statin even if your LDL levels are within the normal range. They're very safe (safer than aspirin, arguably) and effective.

A sizable contingent disagrees with this statement. For example, Tim Noakes says "never prescribe a statin to a loved one".

Do not follow quack recommendations like this. pw is not a medical doctor and is not licenced to practice medecine. That makes pw a quack.

Instead, seek out professionals who don't just say everything is OK, but who tell you what specific things to do and tell you why you should do those things backed up by research. A competent MD will not be afraid to refer you to the research that they are using to make their recommendations. A real MD does not say (I'm and expert, trust me) but they are willing to point to the studies and the opinions of other experts. Experts will not all agree but usually, when something really works, there will be a majority who do prescribe that course of action.

Do not follow quack recommendations like this. memracon is not a medical doctor and is not licenced to practice medecine. That makes memracom a quack.

Sorry, no, that does not logically follow. You do not need to be a professional to recommend that you use professional advice. It would only be hypocritical if memracon had subsequently made specific recommendations.

Google memory problems statins.

FDA published a warning a month or two ago.

By anecdotal information, don't believe the memory problems will necessarily go away...

I would be very skeptical of statins. An actual MD who disagrees with you: http://www.proteinpower.com/drmike/statins/statins-everyone-...

There's a tremendous body of evidence showing improved cardiovascular outcomes -- ie, reduced heart attacks and strokes; even, in some studies, improved survival -- with statin use. Aside from lowering LDL, they appear to have direct anti-inflammatory effects within the vessels. I've heard anecdotal mention of memory problems with statin use, but have never been convinced I've seen it in any of my patients.

A representative example: http://en.wikipedia.org/wiki/Scandinavian_Simvastatin_Surviv...

And, for good measure, a recent ABCTV documentary on the bad science of cholesterol-heart hypothesis and statins: http://www.youtube.com/watch?v=FTkyS5yV82Q

He is 87 though. And your great grandmother is still alive.

You're gonna do just fine.

a) G.grandmother is 2 years older than grandfather (young mothers in my family)

b) 15-20 years of being completely and utterly crippled, unable to walk (over a few minutes at a time), eat salt at all, lay down, stand, etc... not sure if this is much of a life.

FYI: if you have clogged arteries, your heart is unable to move the water in your blood, thus if you lay down all that water gathers near the lungs and you can't inhale.

And then there is non-alcoholic fatty liver disease (NAFLD).

I am not fat, I've always been thin and my cholesterol is bang on perfect, my blood pressure 120/80 or better. Although I've slacked off the gym for about four years I'm pretty active at work.

Anyway out of the blue I am diagnosed with fatty liver: it hurts, I can feel it. Know how people with fatty liver die? Heart attack or stroke, fatty liver significantly increases the chances of either or both.

My grandfather died at age 52 of a heart attack, his daughter my aunt died of a stroke after multiple heart attacks age 70-ish and her brother my uncle also died of a heart attack at age 52 same as his father. Their brother my uncle had a quadruple bypass in his late 50s.

I'm beginning to wonder if people with a family history of heart disease really have NAFLD.

I have this too but didn't realize it was a risk-factor for anything?

What exactly do you feel and where?

I have a dull ache in my right side, back under shoulder blade and lower right abdomen. It's not painful just an annoying constant ache. Sometimes pins and needles on my back over my shoulder blade.

From what I understand most people with NAFLD feel nothing, some people who develop scarring (cirrhosis) and even cancer don't feel anything. The liver is weird, at least it can regenerate from a lot of abuse.

NAFLD is usually caused by obesity. However, it is also a common finding in those with ApoB defects. People with these defects have a curious phenotype: normal or even fantastic lipid levels but with NAFLD/NASH. Essentially, the defective ApoB doesn't get secreted from the liver so serum cholesterol levels look good, but the liver becomes fatty as it cannot export TG and cholesterol.

Certainly not trying to diagnose your familial disorder over the Internet, but taking a trip to a good lipid clinic might be something worth considering if you wanted to be aggressive in the pursuit of a diagnosis. (Which, again, might not be what I'm talking about above.)

> normal or even fantastic lipid levels

At work a nurse comes in and we can get tested for high cholesterol, high blood pressure, diabetes. I go and each time even up until my NAFLD my numbers practically perfect.

Maybe I do have some ApoB protein trouble. Although I doubt there is a lipid clinic anywhere in Canada for me to go to.

Thanks anyway.

Actually Canada has fantastic lipid clinics. (Disclosure: lipoproteins were the focus of my research and I collaborated with these folks.) Rob Hegele is a big name in lipids and his clinic is in Southwest Ontario, I believe.

I'm in the Maritimes and things are so well at my job so no go for travel, but maybe I'll mention it to my doctor.

Thanks.

Most of those amount to "be lucky", which isn't very helpful advice.

1, 3, 4, 5, 6, and 7 are all modifiable.

Maybe it's how you phrased it. "Be X", "Be Y", etc.

3, 4, 5 and 7 are hard to modify, either by behavior or with medical intervention.

5 and 7 could be achieved by taking a statin (or a PCSK9 inhibitor) lifelong. This has not been clinically trialed–it is only my (and others') extrapolation from the genetic data.

3 and 4 can often be achieved by succeeding at #6, but certainly this is not true for type I diabetics nor for people with MODY or other non-metabolic-syndrome-type diabetes. Dietary discretion is difficult for almost all of us, it is true.

It's useful to know the relative magnitude of risk factors which you can and cannot control.

Well, if it is the male hormones causing trouble for part of (0), technically you could get a sex change after you have children...that would remove the male hormones and give you female hormone supplements.

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