心血管健康

[relaxedmeatball]

@adssx

CVD mortality crude rate and it seems that’s it’s not the economics but then… What can it be?

I’m not the guy you asked, but the answer is like HFpEF. From hypertension and terrible metabolic health.

@DeStrider

For some reason though, most medical systems seem to be OK with letting their populations develop CVD in their 70s, having stents and heart operations, or suffer from heart attacks and strokes. This is their ‘Normal’ outcome and why cardiovascular disease is the number 1 global killer of man.

THANK YOU. Well said. This drives me crazy too. For example, in the UK, you can’t get a PCKS9i until you’ve had a heart attack. It boggles my mind. I have familial hypercholestrolemia and UK doctors just sorta shrug their shoulders and say “yeah but you’re young”. And I say “yeah but I’m building plaque right now”. They basically see it like “something had to kill you, so it might as well be this” ignoring the fact that if I have a heart attack, then the NHS would be paying for all sorts of expensive interventions to keep me alive. Total failure of preventative medicine.

We have to abandon this idea that LDL-C of anything higher than 70mg/dl is “normal”. As you said, the “normal” outcome of the status quo is a heart attack at 70-75, heart failure for your last few years and death before 80. That’s nowhere near good enough.

[RapAdmin]

Paywalled paper:

https://www.mayoclinicproceedings.org/article/S0025-6196(25)00075-8/abstract

[relaxedmeatball]

Edit: the graph in the preview doesn’t really show the conclusion. The conclusion is that combination therapy is better than statin monotherapy.

Glad I’ve smashed my own LDL-C to lower than 40 mg/dl. If only I can do the same for Lp(a) soon!

[AnUser]

It looks to me like most of the effect is driven by Lee et al, which looks like a cohort study.

[RapAdmin]

The largest analysis to examine the best way to lower levels of “bad” cholesterol in patients with blocked arteries shows that they should immediately be given a combination of a statin and another drug called ezetimibe, rather than statins alone. This could prevent thousands of deaths a year from heart attacks, strokes and other cardiovascular diseases.

Thousands of lives could be saved by combining two cholesterol-lowering...

[AnUser]

If it was done early it would be millions of deaths every year.

[AnUser]

@relaxedmeatball

I’m not the guy you asked, but the answer is like HFpEF. From hypertension and terrible metabolic health.

The age-standardized change is flat, doesn’t that suggest that there has been no increase?

[DeStrider]

Prof. Banach said, "Cardiovascular disease kills around 20 million people a year worldwide. Based on our previous analysis, we estimate that if combination therapy to reduce LDL-C was included in all treatment guidelines and implemented by doctors everywhere for patients with high cholesterol levels, it would prevent over 330,000 deaths a year among patients who have already suffered a heart attack, and almost 50,000 deaths alone in the U.S.

This is cause enough to advocate for Ezetemibe + statin.

Start everyone on EZ+statin early before they have developed plaque and save 20 million people a year worldwide. This should be a no-brainer, but for some reason it isn’t.

[adssx]

@relaxedmeatball

I’m not the guy you asked, but the answer is like HFpEF. From hypertension and terrible metabolic health.

No increase in CVD deaths in any age group, so why would it be HFpEF? It’s most likely just aging population (more people >70yo => higher share of CVD deaths vs other causes of deaths)

心血管健康

[image] Per ChatGPT: This graph clarifies that within age groups in the US (especially the 70+ years group), the cardiovascular death rate continues to decline steadily, even after 2010. Therefore, the increase in the crude cardiovascular death rate since 2010 cannot be explained by worsening health within specific age groups. Instead, the rising crude death rate is primarily due to demographic shifts—specifically, a larger proportion of the population entering older age categories (70+). This demographic change leads to an overall increase in cardiovascular deaths in the general population, even though each age group’s individual risk is decreasing. QED

[adssx]

The effect on all-cause mortality (OR, 0.81; 95% CI, 0.67 to 0.97; P=.02) is insane! Ezetimibe

[Dexter_Scott]

@relaxedmeatball

Nobody said that either. We’re better than ever at treating some forms of CVD.

You said it. Specifically, “Now, we’ve basically used up the benefits of the improved treatment and the deaths are catching up again.” Though I know you’re going to try and weasel your way out of this.

So a better question is, "what happened in who were turning 40 in 2010 (i.e. those born in 1970).

I don’t find this convincing as an explanation for the sharp reversal in the mortality rate in 2010.

I wouldn’t be looking at what happened in 2010 that suddenly caused a bunch of deaths.

When you see a large change in the mortality rate, you should absolutely look first at the surrounding social or economic or disease factors - unemployment, war, covid, etc.

[relaxedmeatball]

@Dexter_Scott

You said it. Specifically, “Now, we’ve basically used up the benefits of the improved treatment and the deaths are catching up again.” Though I know you’re going to try and weasel your way out of this.

I don’t need to weasel because what I wrote is still true. If you interpret that as “we are getting worse at treating CVD” then that’s entirely a problem with reading comprehension.

@Dexter_Scott

I don’t find this convincing as an explanation for the sharp reversal in the mortality rate in 2010.

I am reporting what the authors of that statistical analysis study (where the graph came from) and the president of the AHA said when he presented those data. He talked about better AMI therapy (reperfusion), better cholesterol management, smoking cessation as contributing to the decreases, and HFpEF, diabetes contributing to the increase. The sex difference narrowing is because in the 1990s and early 2000s massive efforts were put into educating doctors that women have hearts and get heart disease too.

IMO, it seems that people are trying to imagine that one dramatic thing has happened which can explain everything. If you zoom out the Y axis, the changes are much more modest and noisy. That sudden, skyrocketing spike of 2010 is… nothing more than a return to the 2005 numbers. In fact, women are still better off in 2020 than 2005, according to the graph.

Of course you are entitled to your own beliefs, and if you don’t “buy” this version maybe you can submit your alternative hypotheses and data for peer review somewhere.