#1521

Because rapamycin raises LDL and other lipids, people who are taking rapamycin now want to make the case that low LDL is not important, despite the facts. There may in fact be a “sweet spot” for low LDL. But, studies showing that extremely low LDL levels increase all-cause mortality do not take into account all of the confounding variables. I am not an advocate of extremely low LDL levels, but I certainly think we should keep it in the normal range.

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#1522

A recent article in the very prestigious journal JAMA by cardiologists at the University of California and editors of JAMA Internal Med. They discuss in detail the indications, benefits, and risks of statin usage in primary prevention.

In summary, when it comes to primary prevention of the low risk patient and the life time use of statins, the benefit/ risk ratio favors risk. Or, as they conclude, “ time to curb our enthusiasm “.

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#1523

How did it go with the cardiologist?

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#1524

She’s going in for the tests this Friday. The cardiologist was older and experienced. We should know more a few days after the tests are done. Hoping for the best.

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#1525

Which test was recommended?

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#1526

“Low risk patient”, let’s ignore compounded effects and ASCVD, CAC positive incidence rate… Or long term effects. It’s counterintuitive to think in exponential growth.

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#1527

Which there was no evidence for in the article you linked…
And this might be a bit esoteric, but it would be possible to just take statins for 10 or 15 years very early in life to delay the onset of ASCVD just enough. As said by Thomas Dayspring IIRC.

You’re clearly biased against statins. To take rapamycin with a similar risk profile yet go on a holy crusade against statins is strange… Or am I wrong that the risk profile is similar?

#1528

To say that I’m on some kind of crusade means that you don’t actually read what I post, or you don’t understand it. Are the cardiologists from a prestigious medical university writing in JAMA also on a crusade? We’re once again discussing risk stratification, where statins aren’t indicated in the low risk, but very much so in the high risk.

Aging is a chronic disease and is there is no risk stratification. We’re all in the highest risk category. It’s inevitable. So the risk is as high as possible for all of us.

Furthermore, our options to prevent aging are extremely limited, and it could be argued that only rapamycin is proven in a multitude of species. The risks from low dose taken intermittently seem to be quite low.

So the benefit/ risk for rapamycin is very much in favor of benefits. In fact, this is so true, that not using rapamycin is the equivalent of doing something harmful like smoking.

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#1529

What do you mean with low risk?
What about normal risk? What’s that?

#1530

Another based video from Dr. Brad Stanfield, regarding health and diet:

Cardiovascular health is a large determinant of a good diet, and is brought up in detail here.

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#1531

It is so funny that we are still debating the benefits of LDL reduction. Independent risk factors are independent risk factors. More posts than I can possibly read but kudos to AnUser.

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#1532

Actually, that’s not what we’re debating.

#1533

I don’t think I’ve seen you post once about the benefits of statins or LDL reduction. Only skepticism and fence sitting. You only do things like “oh statins are good in high risk patients” or “these ldl lowering supplements are good”. “oh low LDL is so baad”. Only in response.

I think you only feel comfortable with your position because it is the mainstream position. Among doctors. Stop relying on that. They’re wrong. As has happened many times in history. Doctors kill hundreds of thousands every year from medical errors.

Doctors and the medical establishment take very long to be up to date to the latest science, like how LDL is still used instead of apoB in the U.S…

#1534

I certainly never anticipated such an openly anti-doctor sentiment and bias. You unreservedly bashed my entire profession.

Yes, I’m a board certified physician, so sometimes I agree with the mainstream opinions, especially those expressed in recognized and prestigious journals. I don’t apologize for that.

As for doctors killing off hundreds of thousands of patients per year through medical errors, this would mean that we kill 62% of all hospitalized patients. Absurd! The number of medical errors resulting in hospital deaths is closer to 3-4% and we work hard every year to reduce those inadvertent numbers.

In this thread I’ve repeatedly expressed that in the low risk patient, the absolute risk reduction in total mortality is less than 1%. So the person on rapamycin, without other cardiac risk factors, may not need to overreact to an elevated LDL, since their baseline risk is already low.

I take rapamycin for anti aging , so to accuse me of just having mainstream ideas and sentiments is hilarious.

Regardless, I now see why medical organizations discourage doctors like myself from posting on public forums. I will certainly be more careful in the future and will not respond to you under any circumstances.

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#1535
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#1536

Lol, I’m sorry ‘anti-doctor sentiment and bias’? It is a fact that doctors have been wrong many times in history. And I didn’t make up the figure of hundreds of thousands a year: https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us

You’ve linked a counter argument to that claim, I’ll have to look into that, but it’s not central to my argument anyway. I’ve never seen you post about the benefits of statins or LDL reduction, I think you’re comfortable with not accepting conflicting evidence because you hold the mainstream position. And lastly, doctors and the medical establishment often are not up to date with the latest science, like how LDL is used instead of apoB…

#1537

True, but we have to be careful not to overgeneralize, and also look at reasons for why things are. Just because the medical establishment generally is not up to date on the latest science (is that even possible given the thousands of studies across many areas of medicine covered by GPs, etc.), doesn’t mean that any given doctor is not. And we have to give doctors here credit - they’ve spent many years in medical school learning the deep biological and medical systems that we will never know. And the doctors here are at the forefront of medicine, so go especially easy on them. As I say here always, you can go “hard” on the science, but go soft on the people.

Also - you have to look at the incentives in the US medical system to understand why medicine is practiced the way it is. Medicine is a fee for service structure - people in medicine get paid for doing services, so the natural default given this is to focus on high value, high impact services and the most urgent problems - such as fixing a big problem (like cancer, heart disease, broken bones, etc.). And not preventing them.

Then you have the legal system overlayed on this, which penalizes doctors for stepping outside the purvue of “proven medicine” - so doctors are frequently punished for being too leading edge. Far better from a legal standpoint to be conservative and wait for many double blind, placebo-controlled clinical trials before adopting something… thus the reason for few rapamycin prescribing doctors.

And of course you have the Insurance company structure layered over all of this too - so a cheaper test like LDL will be favored (and covered in insurance) far longer than necessary over APOB which may be a unique and more expensive test…

So - I encourage people to not think doctors specifically are a big problem in the entire sickcare system… they respond to incentives and punishments and systemic structures like all human beings.

So please - treat everyone with respect, especially the doctors here who are here as they are the leading edge that can help move the system forward towards preventative care, and away from just sick care.

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#1538
#1539

Thank you for posting this. It’s thoughtful & useful.

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#1540

I appreciate your input. I’m sorry you’ve had a bad experience here, but I do want to hear what you say.

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