AnUser
#61
Peter Attia and his podcast with Allan Sniderman comes to mind.
Davin8r
#62
If this hypothetical guy is doing everything you’re doing and has the same genetics and this guy has ApoB of 20-30, his chances of living longer are higher than yours.
1 Like
Davin8r
#63
They take the approach of “any calcium is too much” because the less the better, but nobody considers calcium score of 6 as “advanced” heart disease, not when scores go into the hundreds or over a thousand. Look at the standards. Attia has never said nor implied that he has “advanced atherosclerotic heart disease”. He sees many patients who do.
1 Like
AnUser
#64
Allan Sniderman said a positive CAC, which includes a score of 6, is advanced heart disease, and I don’t think Peter disagreed. If you listen or look at the podcast you will see it.
Davin8r
#65
Then what is a CAC score of 100? 500? 1000? “Really advanced”? “Gosh darn advanced”? The scores are stratified by risk. Calling a 6 “advanced” is way of being dramatic to make a point that anything over 0 is too much, but that’s not how the numbers are classified by the experts.
AnUser
#67
That’s just plain wrong.
I’ll explain before someone comes and tries to correct me, some wordcel probably will try either way who doesn’t understand this topic.
The premise is wrong that we care about 10 year risk, which the ‘low risk’ is based on. Just because it’s in published in PubMed, or Nature, or whatever, doesn’t mean it’s right. It’s misleading.
Neo
#68
@Davin8r @AnUser
I think Peter’s framework takes the person age and hence how much “area under the curve” that person has had the time to be exposed to into account in a very strong way when evaluating the relevance of a CAC score in a person.
He often talks about a 2x2 matrix to think about cac scores (young vs old and high vs low cac score). In that framework he seem to feel that any positive number in a young person is concerning (while a similar small number in an older person would not have a lot of signal and in fact could perhaps even be a positive sign if the person is old enough and number low enough).
1 Like
Neo
#69
For me the range of outcomes of human civilization and our technological development over the next 20-35-50 years is truly massive.
In many of them (where human civilization survives) we’ll learn and develop science and technology and medicine by much more in the next 35 years than we did over the last 35 years, not to mention how much we’ll learn and growth technologically in the next 50 years.
If you divide the probabilities of high and low technological, scientific and medical development trajectories in quartiles of probability, what do you think the state of our world’s medical capabilities could look like in 40-50 years in the top 25% scenario?
1 Like
cl-user
#70
APOB Fetishists!! Excellent. And so true. 
It even fits the first meaning of fetishist as I guess APOB/LDL is a non sexual part of the body 
Fetishist: a person whose sexual desire or gratification is strongly linked to a particular object or activity or a part of the body other than the sexual organs.
[Edit] I just googled LDL Fetishist and I can’t believe the first link Google gives me is this:
So cool and true!
2 Likes
medaura
#71
You can’t do any of that. There’s no bell curve of outcomes (high vs low, top vs bottom 25th percentiles). No such thing. No fortune-cookie casino of life with a normal distribution. Whatever happens in the future will be something no one ever predicted. Science fiction even 30-40 years ago with interstellar travel but no internet or smart phones makes me chuckle.
One thing I do know is no technology will be able to override biology’s master program and if it somehow was able to, which it won’t be, we will become monsters. The only real innovation happens through the turnover of one generation for the subsequent one. This is both in terms of genetics and ideas. My own “immortality” policy is having 4 kids and another on the way. If we didn’t get old and die we’d have no incentive to bring up the next generation and we would stagnate and eat our own through our macro version of “autophagy.”
It would do us all good to read the stoic philosophers than daydream about immortality.
2 Likes
Davin8r
#72
And plenty of protein fetishists, strength training fetishists, low carb fetishists, etc etc. Tee hee. Quite creative and clever.
Davin8r
#73
Ok then, keep your high ApoB and be stoic about aging/dying. Why are you on this forum, exactly?
1 Like
Davin8r
#74
That makes sense; however, the original claim that Attia is somehow biased regarding ApoB because of his “advanced cardiovascular disease” (i.e. CAC of 6) is just ridiculous.
Neo
#75
Why can we not do that?
I’m not talking about normal distributions or knowing what would happen. I’m just asking you what your positive scenarios look like science and knowledge wise.
Do you not feel there is a range of how the world could develop over the next 40-50 years from a scientific stand point?
scta123
#76
It is his claim. He states in in several interviews that he is very aggressive about ASCVD because of his familial and personal history.
Also some of his claims repeated by the “apoB fetishists” are just speculations and no science can allow the extrapolations he is claiming.
But I am not a apoB denier, just saying that that apoB of 20-30 means no ASCVD in just a marketing slogan. It is a complex disease and focusing too much on apoB won’t solve it, it is just one stone in mosaic. But I do think that apoB should be kept low and in low risk individuals no other interventions beyond lifestyle are necessary. If my apoB will ever creep above 80 I will consider medical interventions, but before that with no other risk factors I don’t see any point. It would be completely different if I were a medium or high risk.
2 Likes
medaura
#77
No I don’t think we know what the range is. If we knew exactly what we could accomplish in 50 years in terms of advancing research & knowledge then we would figure out that elusive piece NOW instead of in 50 years. The fact that we haven’t figured it out yet is because it’s hard and we’re butting our heads against an invisible wall. The only things we can reasonably predict within a range have to do with applications of existing knowledge. Let’s say we have made certain discoveries already but it takes X number of years for the market to fully exploit them by developing technologies around them and Y years for the regulatory apparatus to fully adjust. It’s a predictable iterative process that we can think of more in terms of inertia or translational time from pure breakthrough to technology around it.
We’re nowhere near where the escape velocity dreamers need to be to make their dreams come true because the core breakthroughs are lacking not because we’ve yet to fully exploit what we know. The next major breakthrough is completely unpredictable. It can come next year through serendipity. It could come in 50-100 years. It could NEVER come. There’s no stochastic distribution, it’s a fat tails, all or nothing “black swan” scenario.
Now planned obsolescence is strongly hard wired through biology and in the case of humans or higher mammals in general it seems to be done via multiple redundant pathways. So it will take many black swans getting their tails in a row to break it.
I’m also convinced that breaking it won’t be a good thing.
When it comes to medical issues I think there’s a ton of institutional sclerosis that makes things even harder and slower than they otherwise would be. Think how little progress has been made in cancer treatment in 70 years.
Please, please I don’t want any responses to this opinion, it is just an opinion I thoroughly believe in
“COVID-19: 416,893” I believe this figure from the CDC is pure BS.
Hospitals had an incentive to report COVID-19 as the cause of death regardless of confounding factors that were the actual cause of death. Covid-19 made people who were already at death’s door die sooner.
4 Likes
Good luck with that, especially looking like a twenty-year-old.
4 Likes
Davin8r
#80
But nobody is saying that. That’s just another straw man. Anyone who knows anything about ASCVD (including Attia) knows it’s multi-factorial. He doesn’t tell his patients they can be metabolically unfit or have high blood pressure as long as their ApoB is 20.
