Cardiovascular disease is the leading cause of death for both men and women in the U.S. The instant-death “widowmaker” heart attack doesn’t cost much but heart failure, survivable heart attacks and stroke add up to major Macroeconomic costs. That doesn’t count the cost of chronic illness and dementia caused by vascular problems.
I love big data. There are always exceptions but they are rare.
More than 99% of people who experienced a heart attack, heart failure, or stroke had at least one of four major cardiovascular risk factors — high blood pressure, cholesterol, or fasting glucose, as well as tobacco use — above ideal healthy levels beforehand. These are preventable risk factors.
This was a huge study with medical data from more than 9 million adults in South Korea and almost 7,000 adults in the United States.
Study participants were followed for up to 20 years, allowing scientists to see multiple measurements for blood pressure, cholesterol, glucose, and smoking exposure before a participant had their first cardiovascular issue.
Thanks @WendyBG . This is an interesting article, but a little bit misleading …… as is oftentimes the case when big data are being reported on. Not necessarily the interpretation, mind, but the wording in the press release, the commentary by any of the authors who’re quoted (and they always are), and the way that said press release is presented for the readership of the media source. “Health and Science Writers” do tend to act more like glorified stenographers than their title implies as similar articles on the same press release show…
See, the “Nearly everyone has at least one risk factor…….” in the headline doesn’t qualify the statement in the context of the general population sufficiently to be able to apply it appropriately to individual risk assessment. This “nearly everyone” are/were folk whose biomedical data are in a large database for one reason or another, right?
I’ve spent a bit of time over the last couple of days (since the press release hit the list serves) trying to find the primary document, the better to understand how the raw data presented itself before the headlines were thought up……fundamental stuff like age of inclusion in these databases. As in, at what age did these easily measurable biomarkers get measured…..and possibly ignored (we know that happens, right??) Best I could come up with is this (behind a paywall, unfortunately)…
At the risk of adding more confusion into the mix….along with observations to be ignored….far more than 1% of MACE (Major Adverse Cardiovascular Events) happen as a first sign of ASCVD. As any past or present student in the biomedical sciences who’s stayed awake during pathology lectures on the topic will attest (it seems to be a common trick question among pathologists when emphasizing the early onset of cardiovascular disease….the"first sign” for a good many is still Sudden Cardiac Death)
In a nutshell: Don’t feel too complacent if you pass the test with the few “risk factors” cited in this article. If, however, you don’t …. gawd help you!
From my perspective, the research shows that there are only a few factors which are highly correlated with the majority of CVD… and that these factors are modifiable.
That gives each person a short checklist to investigate. If any are out of the safe zone there are inexpensive, effective ways for most people to ACT and bring them back into the safe zone.
Of course you are right that the"first sign” for a good many is still Sudden Cardiac Death.
That’s the point!!!
If they knew about these few significant factors in advance (hopefully, during early adulthood or middle age at the latest) they would have time to course-correct.
The most significant factor is high blood pressure, which doesn’t have symptoms in many cases and which affects minorities disproportionally. Measuring blood pressure is free – the local pharmacy has a blood pressure machine that anyone can use.
Let’s say that you are a 35 year old black woman who happens to learn about this study. You happen to see this blood pressure machine in a pharmacy and decide to spend a minute measuring your blood pressure. You learn that your blood pressure is 135/90 which is high for that age. Given the information in the study you now know that this could develop into fatal CVD over time so you make an appointment with your doctor to get medication.
That is the life-saving value of this study.
The rare exceptions – like your Lp(a) and my calcified aortic valve – are not and should not be the focus of population-scale studies. The point is to save most lives that could easily be saved. That would have Macroeconomic impact.
Thing is here … and it’s something that even the articles on the study mention … is that the modifiable risk factors cited…
BP over 120/80
TC over 200 mg/dL
FBG over 100mg/dL
Smoking….both current and former.
…have been correlated with cardiovascular disease for decades. Well before I, for instance, started posting on TMF andspecifically the H&N board, and one thing I can tell you (and you probably won’t be surprised because the same has happened on this board and far more recently) is that, when individuals could rightly apply any one or more of those very well recognised modifiable risk factors to themselves, the denialism comes out. Whether it’s a lowering of guidelines for “healthy” blood pressure or Total Cholesterol…..you can’t ignore that there are those who squawk the Big Pharma gambit along with those who seem to approve the notion. Which suggests to me that on an individual basis, yet another study telling us what we already know isn’t going to do much to motivate the 35 year old…black, white, either gender. Especially if those particular modifiable risk factors don’t apply…..yet.
In my particular case…..it was an insurance company underwriter 20 years ago who probably did most to raise my awareness of the fact that I had a “slightly elevated TC” after a physical for a new life insurance policy in my mid 50s (and didn’t need the coverage I’d had after selling my practice) It was somewhere around 230 or so mg/dL. Subsequent follow up with my PCP showed that came from an LDL-C of around 125-135, an HDL of around 80 mg/dL, triglycerides about the same…..even an hs-CRP of something like .8!
Much the same since so, given that even that dodgy LDL-C didn’t raise my supposed 10 year risk for MACE to the%that suggested any intervention, and my sooper-dooper Righteous Lifestyle choices appeared to mitigate what elevated LDL-C does … or would be assumed to do in overweight, sedentary, smoking individuals….I ended up being a victim of The Curse of the Healthy Lifestyle. The sort of thing that leads to supervised neglect by health care providers who really ought to know better….and think a bit more when puzzle pieces don’t quite fit. I fancy this study and doubtless others like it will just serve to increase the laziness when dealing with folk who making the effort to stay healthy.
Well, considering that elevated Lp(a) affects only about 20% of the population, and I don’t see any major changes to folk altering the steady rise in the major cause of 3 of the 4 modifiable risk factors (primarily obesity and the metabolic syndrome that’s downstream), I don’t see a massive impact.
My intervention cardiologist….who is very excited about the medical management possibilities in the pipeline….agreed with me that he’s not likely to be out of demand for stent placement etc, given that overall Bad Habits of the general population.
Additionally…..and this is one reason that I tried to find the primary document and where the real details of the study are going to be…..I was interested in the inclusion criteria used to cull the numbers from these databases. Manifestly, it doesn’t appear that it was a database of absolutely everyone who’s ever had regular physicals etc over the past 20 years or more. The US numbers are just too low for that.
I suspect that, in the data mining, the study authors had age cut offs and included folk who had high BP, TC, FBG and who smoked (parameters known to correlate with cardiovascular disease) from the get go. So, not so much finding anything new or surprising …. but, rather, confirming what’s already known . Not in itself a bad thing….seeing as there are folk bound and determined to deny the undeniable….. but it misses the opportunity to point out that, on a population wide basis these modifiable risk factors don’t travel alone. The elevated BP, lipids and fasting glucose are oftentimes biomarkers for underlying pathology….to the extent that, by the time they actually are elevated (not just discovered to be elevated) the biological detritus has been hitting the fan for any underlying damage to be non reversible.
I hope my reasoning isn’t so tortuous that it obscures the point that, smoking excepted (that’s a dumb habit no one has an excuse to have started) the other 3 risk factors form part of the metabolic consequences of overweight/obesity and sedentary behavior….and how to effect behavior change before anyone is so far away from healthy homeostasis they need to take themselves to their doctor for a prescription.
I think you know this. LPa, the alpha protein, is literally sticky in the arteries. It is a leading cause of plaque formation. It might be the main cause of plaque formation.
Still unable to find access to the full document but the Science Direct offers a decent enough access to some of the relevant snippets that the press release driven articles miss.
From just this limited access, it seems to me that my take on the banner headlines that’ve sloshing around the internet (that they’ve gone so far along the hyperbole route as to be misleading) is a reasonable one. The figure of note is the actual numbers of cardiac events that were studied retroactively was only just over 1000 in the US population cohort, and that the percentages bandied about in the media outlets were confined to this relatively small number of cases. The database came from the MESA study…..a longstanding study of cardiovascular disease with heaps of descriptions available online, including a “refined” risk calculator that still only gives a 10 year projection, mind.
So, here’s a brief Wiki-description of the MESA study. I was familiar with its existence since it’s mentioned frequently on many of the cardiology related sites/podcasts I’ve followed since before my realisation that they were talking about me…
The MESA App-Estimating Your Risk of Cardiovascular Disease With And Without Coronary Calcium Score – The Skeptical Cardiologist https://share.google/CQ0GyukBlhxN492xj
Heaps of articles here explaining the nuts and bolts of a refined approach for assessing early onset, subclinical ASCVD
P.S. (edit) I think the use of the MESA study….and its detailed examination/specialized testing of study participants recruited for investigation….explains the relatively small numbers (just under 7000) vs the numbers for the Korean arm.
PPS …..the article that prompted me to reassure myself that my PCPs were correct in their reassurances on my “mildly elevated” LDL-C. Oh well….
Now here’s an interesting (for me) offshoot of my dive down this MESA rabbit hole. Not so much a study with an outcome of interest, but more an example of how studies are conceived, develop, and change. Not something one routinely reads about…