Since heart disease is the biggest killer of men and women in the U.S. this calculator has Macro impact.
It predicts the probability of cardiovascular disease, ASCVD (Atherosclerotic Cardiovascular Disease) and heart failure. Use the PREVENT equations for adults* ages 30–79 without known CVD.
Do not use the PREVENT equations for adults with known CVD, evidence of severe subclinical CVD (e.g., left ventricular ejection fraction <40%, coronary artery calcium ≥300), positive genetic testing for a variant known to be pathogenic or for an inherited cardiovascular condition, end-stage kidney disease, or limited life expectancy (<1 year).
It’s clear from the questions that cholesterol, high blood pressure, smoking and kidney disease have a big impact.
Apparently, even with a total cholesterol reading of 156, hdl of 80, systolic reading of 114, and efgr of ‘greater than 60’, I still have a cvd risk of 9.2% within the next ten years. The only way I can significantly improved my odds is have a sex change operation.
What I tend to do with these calculators that have age as a strong influencer of of end result is to do a bit of a backsolve. Much like, say, a rough and ready calculator for $$$bucks necessary for a comfortable retirement……or Peter Attia’s Centenarian Decathlon principles.
With the ASCVD calculators….both the standard and the MESA (with CAC score as a refinement) and now this one ….I use age 40 as a comparison for risk score since that’s just about my age when statins were first introduced. I plug in the most recent bloodwork values prior to my starting lipid lowering therapy and look at the result. This calculator is, in its way, much more relevant with its 30 year risk assessment than others because, as I’ve mentioned very frequently, ASCVD and its consequences is a disease state for most that’s a looong time in the making. A 40 year old needs to actually think about what they want for themselves at 70 (cardiovascular health, $$$bucks, or functional fitness) like it or not.
You know something……I do believe that, even with the refinements of this calculator and the obviously compounded nature of risk over a 30 year period, any PCP looking at my “mildly elevated LDL-C and total cholesterol “ against everything else would still have been as mistakenly reassuring.
Not necessarily. The “female advantage”, such as it is, only lasts until menopause. Then the brakes come off. I have no idea what my lipid profile was before that but, seeing as my post menopausal Usual Suspects raised no Red Flags until my CAC scan, I bet I would’ve fallen well under the radar.
One reason why women fare so badly with cardiovascular issues. Even the folk who ought to know better oftentimes believe the wrong things.
In looking for something online that might clarify this change in risk status for pre and post menopausal women, I stumbled across this article from one of my go-to sites (and where I read about a near-70 year old with a lipid profile similar to mine ……..and a zero CAC score, which was not similar to mine when I took the plunge)
Not much that about women specifically, but plenty about looking beyond the Usual Suspects used in most any risk calculator…
Prevention of Coronary Heart Disease: The Importance of Imaging and Advanced Biomarkers – The Skeptical Cardiologist https://share.google/DriCTUY3vKvxTbI8e
PS….with regard to the moniker “advanced biomarkers”, I fancy this might be a bit off putting for someone who doesn’t know whether to be interested or not as it smacks a bit of biohacking or something extra special that only the “health obsessed” go for. Nope……just rational use of tests that don’t even require any extra blood to be drawn. Might as well do a proper job rather than half-arsing it.
I don’t think it’s behind the usual paywall. I knew I’d find something here as he’s had at least one podcast with a noted researcher on the subject which, unfortunately, is. As usual, there’s probably enough to hear before the cutoff to give a heads-up on the reality of this anomaly.
Yep. Me too. They should have Lipoprotein(a) levels in there as part of the calculation. It’s ridiculous that they don’t. 20% of the population has an elevated Lp(a) level and it isn’t even screened for, until it is too late.
On the Lp(a) screening, it’s far more frequently tested for in European centers apparently. The Netherlands does almost universal screening in infants, I think. Just a once in a lifetime test. You’re predisposed or not.
Fortunately my daughter’s levels were low when she requested a test. Just as well since, she was screened after dh’s open heart surgery (due to a congenital aortopathy that was a revelation for him) and is now a card carrying member of the UCHEALTH “Big Aorta” Club.
This is probably the link I’ve dumped here most frequently …… with the admission that, with a lipid profile similar to the flaneur in the article, I felt reasonably confident (with all the exuberant reassurances from my physicians over the years) that I would have a similar result
I nearly remember the glory days of the discovery that brown fat didn’t disappear totally after infancy in humans. This was back in the early-mid aughts and I first heard of it in a workshop at a fitness conference. It was one of those serendipitous observations (in PET scan follow-ups of chemotherapy treatment for cancer patients, I think) that became a really big thing for a while….with BAT workouts (training strategies that allegedly help to beigify Brown Adipose Tissue), BAT diets, labs and research facilities springing up all over….and conferences to discuss the research earnestly….and even searches to find pharmaceuticals to reproduce the effects of exercise on stimulating this extra expenditure of energy. Of course. If you typed BAT into Google, there’d be page after page of convincing articles and it took a lot of wading through to fathom that, as much as it was a “thing”, it wasn’t quite the Big Thing that the folk who were suddenly invested in the idea hoped for. Not least because, increasing extra energy expenditurein the form of heat has serious consequences for the human body.
One set of researchers at Harvard (Dana-Farber and Beth Israel Deaconess) thought they’d made a discovery of a specific uncoupling protein in mitochondria (the “coloring agent” in brown fat) that aided and abetted this process. I remember this as dh was on faculty at Beth Israel at the time, and the two researchers responsible laid on a lecture for interested faculty and dh got me a ticket. It ended up being canceled as there was a massive snowfall. It looked like research that was really going places and had lots of press releases like this ….
The Spiegelman guy and his Beth Israel buddy gave the uncoupling protein a name ….Irisin….and partnered with a biotechnology company and called themselves Ember Therapeutics (nifty name, right) Unfortunately, no one could reproduce the work and the flame sputtered and died. The imagined irisin levels were apparently an artifact of the assay technique they used (dh had extensive experience with the assay technique in question and predicted it)
My BIL has his lab at BIDMC. He is department chair.
A friend of his made a foray into small inexpensive testing units for third world nations. Ten years earlier I had tried a small investment in such a company. The small cheap technique based attempts in testing do not work. I predicted with experience it would not work again. Although I decided not to say anything. I do not have a PhD. He did do his thing.
Indeed. However, when taking the trouble to visit with a healthcare professional, it’s reasonable for the individual to expect an interaction that looks at their own individual results in a personalised way. Something above and beyond the potentially flawed decision making information that might come from looking at data on an internet website. Without the benefit of understanding the role of more specific testing….or even that it exists.
With all the study and research on the World’s #1 killer, it’s not unreasonable to expect Red Flags/puzzle pieces that don’t fit etc to be followed up on with the addition of simple strategies that’ve been available for l9ng enough to percolate down to even primary care level.
In the context of knowledge base regarding the undeniable role of a dysfunctional lipid profile (“high cholesterol“) in the development of ASCVD, I think it’d be an interesting statistic ….. for anyone interested enough to follow up on it, that is……to compare the relative number of cases of ASCVD development and it’s consequences in outliers such as @Volucris , @WendyBG and myself etc with the folk who HAVE been informed of their risk status repeatedly by their Healthcare providers but have chosen to ignore the information. Buying into the cholesterol denialism and statin phobia tomfoolery that’s so prevalent on social media. Supervised neglect vs personal hubris, I guess.
Yes but a 40 year old often is not on the radar yet. BP might not be high. Cholesterol might not be high. Sugar is not prediabetic perhaps. And if so in any of those catagories creating stress is somewhat counter productive.
Then there is the patient. Advice is given. But if ignored repeatedly? Most ignore. They like their smokes and a drink. That is their business.
Those with DNA matters? When if you are 70 now, then 40 years old was 1995…Good grief Charlie Brown.
I am going to add…
Playing with over exercising and supplements are unknowns. It is very possible detrimental.
There are plenty of folk around who use enough gumption to carve out a meaningful, worthwhile, and consistent training program for themselves along with a rational use of supplements.
Take home message…..follow the ones who’re making an effort (and with a rationale) rather than the ones who aren’t