Less OT than it was

Investment Analysis Clubs Macro Economic Trends and Risks
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So, not wishing to piggyback too much on Wendy’s thread as these examples are of ASCVD in general rather than Aortic Stenosis specifically but a small selection of the Attia posts/poscasts on the subject…

(Couldda been me?)

(I recall the lecturer in one pathology lecture back in the early 1970s asking for the commonest early symptom of coronary artery disease…it was sudden cardiac death!)

(I had to concentrate extra hard on this…a complicated topic and a strong French Canadian accent)

I’ve probably linked to all of these in the past but sometimes a message has to be delivered multiple times before it’s heard (thank gawd, else husband and I would’ve had a short lived careers)

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“I think we should advise people to measure Lp(a); that would be a gigantic step.” —Benoît Arsenault

I’m a bit confused on this. I thought Lp(a) was a genetic risk and there were no current methods to modify or reduce your Lp(a). So what would be the point of measuring Lp(a) over time? I asked my cardiologist to do this measure last year and I’m in the riskier area of Lp(a) - but I see no value in regular measuring.

JimA

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One of the research articles I read agreed with this and said that measuring once in a lifetime is enough.

There are experimental therapies being tested. Some of these are RNA-antisense molecules which would be very expensive and also need to be injected. Some doctors prescribe off-label drugs that are FDA approved for other conditions and may reduce Lp(a) by about 1/3.

https://www.goodrx.com/conditions/high-cholesterol/elevated-lipoprotein-a-treatment

Wendy

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There is no value in regular screening. It’s a one time only thing and the result is binary…you either have it or you don’t. Pretty much like finding out about many other genetically determined diseases.

The rationale behind measuring it (although it’s not modifiable …yet…and even if you know that you actually have some degree of disease) is because IF you’re one of the unlucky ones, you are then aware that, IF you’re interested in future health and well-being (or, longevity per Peter Attia’s take) you cannot afford to sit on the fence when it comes to acting on orher, more modifiable risk, factors. For instance aggressive management of LDL-C (no room for cholesterol denialism or statin phobia etc)

Also, if you find out belatedly that you fall into this category … as I did…it’s still very worthwhile to know. Even at 72, I’m a “future investor” in my longevity 401k but, even more important, I have a daughter and a granddaughter. Fortunately, this genetic predisposition has stopped with me. My daughter’s tested Lp(a) is low.

All this insight…and more…was new to me when I decided to take out a temporary subscription to the Attia podcasts (for an entirely different subject) in early 2020. It didn’t take me long to catch on to the value sufficiently to convert my temporary membership to annual…and to continue to renew it.

PS…in the intervening years I’ve dropped very broad hints in the context of becoming proactive in ones health and well-being (especially with regard to ASCVD…and its consequences beyond coronary artery disease) I’m not sure how to do it, but I’d be willing to wager that, if I checked back over the past couple of years or so, >90% of the fairly limited number of thread starts I’ve made have been to these tidbits from Peter Attia’s longevity site.

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One of the problems with this approach is that you run into the difficulty of deciding if lowering Lp(a) actually has a meaningful effect on the reason for lowering it. That is, does the exercise actually reduce the incidence of cardiovascular events…stokes, symptomatic coronary artery disease etc??

Not as nitpicking as it might look. Whenever discussion of lipid profiles or “high cholesterol” takes place, it’s rarely very long before someone pipes up with an argument from the cholesterol denialism camp…oftentimes repeated tired old arguments that’ve been around for ages but that actually had some degree of merit decades ago (before statins) Back in Days of Yore, it was actually true that most of the drugs or remedies that appeared to successfully lower total cholesterol had no result on actually preventing symptomatic disease. Which has spawned a whole cottage industry in cholesterol denialism which is still going pretty strong (parallels with the anti vaccine movement in many ways)

Seeing as this measurable end result is a long time in the making …but for a few mercifully rare examples of monogenic FH…it’s obviously going to take a while before the results of lowering Lp(a) can be considered valid prevention strategy.

Because I like reward for effort as much as anyone, I actually asked my cardiologist a question about assessing the results of this aggressive LDL-C reduction on my last visit. Since these super low levels are intended to not just halt the advance of atherosclerotic plaque build up, but actually reverse what’s already formed…like, say would a repeat CT Angiogram demonstrate a reversal. Seems it’s a common question (his wife…who’s in a similar situation to me but at a younger age…asked just that. Apparently, the Gold Standard for whether it works or not is no cardiovascular “events”. Not very satisfactory (like, what if today is the day before you have an event?) but a truthful answer, I expect. Sometimes you have to trust the process rather than (mistakenly) feel like the radiation exposure is worthwhile.

Trusting the process…

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The importance of taking charge of one’s own health
I found this headline not intentionally misleading but misleading nonetheless. There is much more to “taking charge of one’s own health” than thinking there is something wrong and going to a doctor. That is just the first step. A step my father didn’t do and less than a year later he died of cancer.

John Doe did request lab tests on his own accord. So far the headline is accurate but from then on it’s medicine as usually practiced. From the article:

After a coronary artery calcium (CAC) scan raised further red flags, John saw a cardiologist, who ordered a computed tomography angiogram (CTA) that confirmed the grim reality: severe stenosis (narrowing) of the LAD.

Were it not for his own proactive steps, his atherosclerosis – for which he has now undergone stenting surgery and is currently on a treatment regimen…

What is missing are the necessary lifestyle changes one has to make to avoid further maladies, where possible. I had read a Canadian article about fitness and health that led me to do a home stress test after getting strong chest pains. When the test brought back the pain I headed to the cardiology clinic in the middle of the night. They told me I had arrived just in time. For the next 15 years or so, like John Doe, I got good conventional medical treatment. I don’t consider this taking charge of one’s own health. Once retired from the rat race I read more about health and started to improve my lifestyle. My cardiologist retired and when I got some pains I asked him for referrals. I did not like the first doctor so I went to the next one. After a stress test he suggested an angiogram. I requested a cost estimate and asked who would perform the procedure. Told it was the cardiologist who suggested it raised red flags so I went for a second opinion. This third doctor said it was not urgent but that it was the approved or conventional procedure. This is where the patient needs to take his health in his own hands! The standards are more pills and more procedures! The non-conventional is a change in lifestyle to remove the causes of the disease. By losing over 50 pounds I was able to stop taking some eight medications (under medical supervision by the third doctor) that were supposedly for life. That is taking charge of one’s own health in my opinion.

My father and my best friend died of cancer of the stomach. Both cases were harrowing not just for them but for the families and friends. That’s when I decided I wanted to die healthy. Some medical advances are fabulous but not everything in medicine is kosher.

The difficulty with medicine as with economics is that it deals with complex systems and, unlike physics, reductionism does not work, you cannot take complex systems apart to find out what makes them tick. Much of medical research is about correlation and not necessarily about causation. Medicine is hard!

Doctors Peter Attia, Steven Gundry, and Robert Atkins have one thing in common. One day they looked in the mirror and found that they were obese. They asked themselves, if I’m following the advice I give my patients, why am I so fat? They reached the obvious conclusion, “My advice does not work!” which set them on the right path. Good medicine might be science but it’s much more complicated than what doctors are taught in medical schools.

Just like doctors Attia, Gundry, and Atkins, we all need to take charge of our own health which goes way beyond visiting a good doctor. The doctor is just one aspect of the process. One example, I was given Prednisone to treat ulcerative colitis which I was told was incurable. Every once in a while I would stop taking it to see if it was still necessary. Eventually it was no longer need. The chronic incurable condition turned out to be curable. In time I got rid of all prescribed medications. That is to take charge of our own health!

Why are doctors stuck in a rut? In addition to not getting enough training in nutrition, in a lawyer infested society they can be sued for malpractice if they don’t follow the conventional rules.

The Captain

Reductionism in medicine:

  • If you eat fat it will clog your arteries just like fat clogs drains.
  • Ergo, polyunsaturated fats are healthier than saturated fats, lard, tallow, and butter.
  • Yet, plant based margerine is healthier than butter.
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Indeed, there is certainly more to being proactive and taking care of ones own health than the care that you appear to have received. The point of the article, however (and this is a common theme in Attia’s articles on the subject of ASCVD) is that his John Doe example illustrates that for some folk like “John”, Wendy, me and others with various of the genetic predictions, the healthy lifestyles that you apparently embraced after you had discernable problems had been in place well before.

What were you doing in your 40s that might’ve been categorized as a “generally healthy lifestyle”? Or rather before your 40s, given that John Doe’s level of disease was already well established and, as it turned out, actually symptomatic.

You’ve suggested in other threads that your requirement for stent placement wasn’t due to occlusion of coronary arteries by atherosclerotic plaque (like John’s)…i.e. what most folk would call coronary artery disease…but rather a stress related syndrome that mimicked the symptoms?? If this is the case, adopting new, healthier lifestyle choices …even a bit belatedly…most certainly altered the course of whatever direction your metabolic syndrome etc had you going in but reversing the level of disease experienced by John Doe, me and Wendy would absolutely not be possible with diet alone and it’s a bit disingenuous (says she, euphamistically) to imply that such a situation happened to you.

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You have the timelines wrong.

  • Stress 1985. Bolivar devaluation, Apple distributor not importing, change business from hardware sales to developing Desktop Help for Mac. Stress so bad I could taste it.
  • Stent 1997. Boating in Grenada. Making good money in the stock market. Some of the best times in my life.
  • Change to better lifestyle much later, maybe around 2005 or later.

At no point did I address your various cases. My issue is with the article’s headline. To repeat what I was talking about:

Your imagination is running wild! :slightly_smiling_face:

The Captain

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According to the article, John Doe was already a triathlete and had a healthy diet. He had a genetic condition that is not normally screened for. That was that part he took charge on.

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Yes.

The Captain

image

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Yes indeed…and there was no implication whatsoever in the article that he failed to continue with those healthy lifestyle choices after receiving a late-in-the-disease diagnosis and “exogenous” interventions (surgical and medical management)

If lifestyle choices are already “healthy”, there is relatively little physiological value to further minor tweaks if you’ve been gifted with a suboptimal genetic hand.

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So, as I mentioned upstream, John Doe’s issues with ASCVD certainly began before his 40s given the timescale in departure from healthy homeostasis to the clinical manifestations of disease and I got to thinking when that might actually be. Early adulthood? Adolescence?? Childhood??? More to the point, how did it all begin. Certainly not the fat clogged internal plumbing per Denny’s reductio ad absurdum example of misunderstanding upstream.

I recalled pathology lectures back in Days of Yore and the assertions of the lecturer that most of us in the lecture theatre (medical and dental students in our early 20s) probably had the beginnings of ASCVD like the examples he was showing us taken post mortem from young victims of road traffic accidents, suicides and random unexplained deaths. These were all images of slices through vessel walls and not a clogged pipe in sight!! I wish I’d listened up a bit more.

Anyways, since Peter Attia’s whole focus in the context of longevity is in attempting to attack issues at their earliest sign (in this thread context ASCVD…although “cancer” is another frequently discussed topic and
in the context of the first cell) and I had an idea that I’d read more than a handful of his articles along these lines, I thought I’d do an Attia trawl first. I found this…which I hadn’t actually read but do recognise some of the names he mentions from his podcasts…

I can see why the clogged plumbing analogy is popular. I’m struggling with it…and I’ve been struggling for way more than 15 minutes.