8 ms·

Heart attacks aren't as fatal as they used to be

83 points by lr0 1y ago

oncallthrow 1y ago
The article should really have a picture of a cath lab at the top, not an AED. Advances in catheterization technology are the key factor in reducing heart attack deaths, not AEDs
- deadbabe 1y ago
  Explain
  - AnimalMuppet 1y ago
    There is a procedure called a "catheterization" (hence "cath lab"). I have two stents in my heart. They went in with a catheter through an artery in my wrist. They found the places in my heart where the arteries were 80% to 90% blocked, and placed stents there. They said I was five years from a heart attack. This was an outpatient procedure. I went home that night. The worst part of it, for me, was that they put a serious tourniquet on my wrist, because once they took the catheter out, I had an open artery. My wrist felt like I lost a bar fight. It ached for a month. This is so much better than having a heart attack. How did they know I needed this? I talked to a cardiologist. He told me that, as you age, your athletic performance drops slowly, over decades. That's normal. What's abnormal is when you suddenly can't do something you were able to do a month ago. So I paid attention when I realized, hey, a month ago I didn't get this winded playing ultimate frisbee. A month ago I recovered faster when I was winded. So I told that to my GP. He ordered a cardiac stress test for me. This basically is hooking you up to an EKG, putting you on a treadmill, running the treadmill faster and harder until you drop, and watching what your EKG does. If the shape stays the same except faster, you're good. If the shape changes, that's part of your heart not getting enough blood under load. My shape changed. So they ordered the catheterization for me. So cath labs are about preventing the heart attack, not keeping you from dying once you have one. Not dying is good. But not having it at all is better. I think that may have been the GP's point.
    - khuey 1y ago
      > So cath labs are about preventing the heart attack, not keeping you from dying once you have one. Cath labs *are* (also) about keeping you from dying once you have one. Inserting a stent into someone with an active MI can restore blood flow and minimize tissue damage.
    - duskwuff 1y ago
      Catheterization is the mode of access to the heart, not the entire procedure. Stenting is one procedure that can be carried out that way, but there are other procedures which can be performed that way as well, such as imaging, cardiac ablation, pacemaker or defibrillator installation, or valve replacement.
    - dogmatism 1y ago
      If someone told you you were "five years from a heart attack" they lied that's not how it works in a stable person (ie, not actually having a heart attack) stents help symptoms (a little better than medicines, but even that is debatable -- see Orbita trial). Medicines and lifestyle changes prevent heart attacks -- see Courage and Ischemia trials cath labs are in fact about keeping you from dying once you have a heart attack. The other stents for stable disease like you had are nice -- you feel better faster with fewer medicines that without, but not main thing source: not going to appeal to authority. See trials mentioned above, or ACC guidelines on management of CAD
  - pfannkuchen 1y ago
    Which part needs to be explained? I think I understood the comment and I’m not in the industry. AED is an initialism for the electrical shock device you can use to (maybe) reboot the heart’s OS when it locks up. Catheters are some kind of tube that gets implanted to bypass a non-functional part of the heart. Catheter procedures improving caused the change, not AEDs (apparently), so it’s somewhat misleading to show an AED instead of something about catheters.
  - roryirvine 1y ago
    PCI (Percutaneous Coronary Intervention, performed in a catheterization laboratory) has become the usual first-line treatment for acute heart attacks. It's much more effective than previous treatments (essentially clot-busting drugs, blood thinners, and bedrest), particularly since Drug-Eluting Stents arrived in the early 2000s.
- FireBeyond 1y ago
  Critical care paramedic here. The answer is "both". AEDs are a key factor in ensuring patient survival until we can get them to the cath lab and get them ballooned. "High quality compressions, early access to defibrillation". For every minute you do not have an effective pulse, your chance of survival goes down about 10%. Airway management takes a distant back seat. Most meds we give are only mildly, or questionably effective. But being able to defibrillate a dysrhythmia early is the key to getting the heart working itself - chest compressions are the best we have, but still. It takes us minutes of compressions to get to a suitable arterial pressure for effective perfusion, but ten seconds or less to lose it. AEDs won't improve volume and arterial flow, but it'll give you a fighting chance of getting to the lab. Compressions alone are not going to do that - they will just preserve tissue.
  - pipes 1y ago
    What are AEDs? Aspirin? Blood thinners? I'm from the UK, so probably a naming difference!
    - deleted 1y ago
      [deleted]
    - Eavolution 1y ago
      AED: Automatic External Defibrillator, a defibrillator that doesn't need a trained operator Aspirin: a blood thinner and painkiller Blood thinners: given to people at risk of a heart attack to thin the blood and reduce the chance of blood flow being obstructed
    - 5555624 1y ago
      AED - Automated External Defibrillator. They're portable device defibrillator which can deliver an electric shock. As I understand it, it detects an abnormal heart rhythm and shocks the rhythm back to normal. Note that there are some situations where they will not work. (For example, Pulseless Electrical Activity or PEA is "non-shockable.")
      - 1y ago
paulpauper 1y ago
Yeah cancer is the big killer nowadays. Survival rates for stage 4 cancer still poor after many decades of research. Worse yet, in many instances there are no obvious risk factors, such as people in their 30s or 40s who get colon cancer and were not eligible for screening .
- yieldcrv 1y ago
  that’s to be expected, after we do the adequate screening for one older population and mitigate many of the advanced versions of that, then the previously edge case becomes more prevalent amongst all cases there is still a limited resource for the screening at this point, so that’s a friction to expanding screening
  - zahlman 1y ago
    It's not just a question of scaling up the screening effort. Doctors are also concerned with potential harms caused by false positives.
    - greedo 1y ago
      What false positive would come out of a colonoscopy? You are visually looking for masses, and removing suspect polyps that are sent in for evaluation. The major potential harm of a colonoscopy is a bowel perforation. Serious complications occur roughly 0.3% of the time.
      - Someone 1y ago
        > Serious complications occur roughly 0.3% of the time. https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html https://www.cancer.org/cancer/types/colon-rectal-cancer/abou..., “the lifetime risk of developing colorectal cancer is about 1 in 24 for men and 1 in 26 for women.” So, it’s a 4% lifetime risk versus a 0.3% per colonoscopy risk. The outcomes for the two risks also are different, but I would think that for many healthy people (e.g. those under 40 years old), the risk of doing such a check are greater than that of not taking it. Reading https://en.wikipedia.org/wiki/Colorectal_cancer#Screening https://en.wikipedia.org/wiki/Colorectal_cancer#Screening, that’s one of the reasons frequent colonoscopies aren’t advised.
jvanderbot 1y ago
My father didn't die of a heart attack, he died of an aneurysm. However, he had a massive "widow maker" heart attack and had to be revived from arrest in the ER, more than once. He had a heart beat, unconscious, for a few days, before the blood thinners caused the aneurysm, I'm told. So, is this a heart attack? Is this "less deadly?" No, it's a proximal classification. Maybe their cardiac care center has a metric to hit.
- VeninVidiaVicii 1y ago
  Anecdotally I worked in the emergency department and ICU for 2.5 years as a scribe and translator in undergrad (ending about 7 years ago) and never saw a single person successfully revived. In the sense that everybody who ever got revived to the point that your dad did, in my experience, died.
  - mv 1y ago
    this is why american medical care is so expensive. Family’s and Law make doctors “do everything” even when the doctors know there is 0.01% chance such a person even makes it out of the icu and that’s not saying anything about brain function.
    - golergka 1y ago
      IMO it's still good that it's family's decision. Even if it is an incorrect one.
      - KittenInABox 1y ago
        I think its good, but I also think that we don't have enough education in the US populace about what this means realistically. "Pulling out all the stops" means that your loved ones last time on this earth is either in agony or comatose, neither of which I would tolerate of my dog much less my mother.
        FireBeyond 1y ago
aaron695 1y ago
[dead]
kelseyfrog 1y ago
No doubt a decrease of smoking, availability of satins, cpr/defibrillators, and stents has led to a massive increase in prevention and survival. However, the diagnostic and treatment side has improved considerably in that time too. Troponin assays became widely available in the late 1990s/early 2000s, and dual antiplatelet therapy (aspirin + clopidogrel) around 2000s. These are part of the standard toolkit for detecting and treating MIs that simply didn't exist when I was young and are part of the story of making MIs catastrophic events to a more survivable disease. The article isn't wrong per se, but I do want to point out that it isn't comprehensive when it comes to listing the reasons. There are interesting advances that it left out.
- tuatoru 1y ago
  Your point generalises. For instance, homicide rates have fallen in large part because many wounds that used to be fatal are now survived. Breast cancer death rates also are down because of better diagnosis and treatment.
- smeeger 1y ago
  [flagged]
  - jodrellblank 1y ago
    “New analysis shows statins have "minimal" benefits” - Maryanne Demasi, PhD - https://blog.maryannedemasi.com/p/new-analysis-shows-statins-have-minimal-benefits https://blog.maryannedemasi.com/p/new-analysis-shows-statins... “We carried out a systematic review and meta-analysis of 21 statin trials involving 143,532 participants, using similar criteria to the CTT, and found no consistent relationship between lowering LDL-C with statins and death, heart attack or stroke.” - published in JAMA behind paywall, apparently But you’re still wrong because she says “Statins are very effective at lowering LDL-C” which is literally something even if that doesn’t translate to less death.
    - llm_nerd 1y ago
      Statin uses translate into less death, without any medical question or doubt. That particular systematic review is notorious for being utterly nonsensical. It's also notable that Maryanne Demasi is of...uh...of dubious professional credibility. Some of her papers have signs of scientific misconduct, including image duplication (yet with new labeling and analysis, indicating willful misconduct rather than simple error) and so on. She has various other questionable claims -- like mobile phones causing brain cancer -- and notably is a low carb advocate, which is something I will touch upon later. "Our analysis showed that trial participants taking a statin for an average of 4.4 years, showed a 29% RRR in heart attacks, but the ARR was only 1.3%." Over a 4.4 year average study length, there was already a 29% reduction of heart attack events over the control -- the relative risk. This analysis argues that since only some small subset actual had heart attacks -- again, during the short study period that averaged 4.4 years -- the "absolute" risk was low and therefore, negligible. "Minimal". There are two enormous problems with this- 1) Most people given statins already have years to decades of CVD progress. Yet even still statins gave them that much of a relative risk reduction. That is an enormous relative risk reduction, clear evidence of the benefits. If you're a 30 year old with high LDL and are looking at the absolute risk reduction of a 55 year old who finally was prescribed statins, note that the possible benefit to you is much, much larger. It's like saying that someone who started brushing their teeth at 40 years old still has a pretty nasty set of chompers so therefore there is no benefit to brushing your teeth. 2) This is an incredibly small window to study the absolute risk. 3) The benefits of lower arterial plaque is much, much greater than just the worst outcomes of heart attack or stroke. Again, Demasi et al are grifting off of the keto/low carb world, and she is a frequent speaker to this group. The low carb world often has a high saturated fat diet that sees their LDL massively rise, and there's a really desperate need to hope that LDL isn't bad for you. Dave Feldman recently has funded a lot of research on some subset of that group -- a group they call lean mass hyperresponders (LMHR), which are basically fit and active, healthy weight low-carb adherents -- and the premise was that in this subset LDL served a different purpose and wasn't bad. Only their most recent checkpoint was the CAC score of their participants rose disturbingly. https://www.youtube.com/watch?v=A2hvausg9dg https://www.youtube.com/watch?v=A2hvausg9dg https://www.youtube.com/watch?v=vRRD8nXEyGM https://www.youtube.com/watch?v=vRRD8nXEyGM Better than statins would be changing habits and diets to control cholesterol. But the evidence that lower LDL = a better healthspan and lifespan is absolutely overwhelming. And for some people statins have bad side effects. But anyone believing they do nothing is massively misinformed.
exhilaration 1y ago
I would just like to recommend this excellent Radiolab episode about saving lives during heart attacks: https://radiolab.org/podcast/how-to-save-a-life https://radiolab.org/podcast/how-to-save-a-life
thro230-0 1y ago
Also as result of long covid, more young healthy people get hearth attack. They have better chance to survive hearth attack, than older people. It improves survival stats!
- southernplaces7 1y ago
  I as a relatively young man also hate it when my hearth is attacked. One can't even be secure before their own fireplace, in their own home any more. Hearth= area in home where fire is kept, usually for cooking. Heart= that sometimes unfortunate little knot of pumping muscle under your rib cage.
- dogmatism 1y ago
  no, healthy young people have more heart attacks with acute covid. And die (or at least did in 2020-2021 time frame) Long covid isn't really associated with increased heart attack rates
- AbstractH24 1y ago
  But was the “Long Covid” caused by SARS-CoV-1 or decreased physical activity as a result of life fully coming to a stop for a few weeks/month and not fully resuming for years (and for some people never has)?
rectang 1y ago
> A sudden cardiac death is the disease equivalent of homicide or a car crash death. It meant someone’s father or husband, wife or mother, was suddenly ripped away without warning. Now ever increasing numbers of people avoid an abrupt death and live long enough that misery and terrible quality of life extend for decades. Hooray for all of those who emphasize preventing death above all else, whether they are motivated by extracting medical fees during life's long slow twilight, or by more pure considerations.
- mr_toad 1y ago
  Most people who recover from a heart attack will not suffer a terrible quality of life. Depending on the severity and the treatment many will live quite normal lives for decades, and die from something completely unrelated.
  - dogmatism 1y ago
    This is true. In fact if you have a heart attack and are treated relatively quickly, with no major injury and decreased function of the heart muscle, and continue to have regular follow up care and address risk factors, your mortality risk normalizes to those without history of a heart attack (but with CAD) and should have no functional limitations
  - rectang 1y ago
    The point stands — it’s not that the heart attack leaves you infirm, but that surviving it lets you live long enough to die of Alzheimer’s or cancer or depression. Causes of abrupt death are being winnowed down, which the author regards with horror. I hope that they never experience the prolonged agony to which modern medicine has consigned so many, and that they are never forced by suffering to change their mind.
catchcatchcatch 1y ago
[dead]
dreamcompiler 1y ago
CAC tests are not without risk. Every CAC test is a CAT scan which means X-ray radiation. It is certainly the case that for a great many people the benefits of a CAC test outweigh the risks, but talk to your doctor before you rush out and get one. I wish it were possible to do a CAC test using MRI (and thus without ionizing radiation) but to the best of my knowledge it's not.
Razengan 1y ago
Wish it was the case for some of my family :(
randcraw 1y ago
"[…] people who undergo CPR outside of a hospital setting survive only 10 percent of the time. Within a hospital setting, CPR survival rates are only a bit higher — about 17 percent." https://www.discovermagazine.com/health/contrary-to-popular-belief-cpr-is-not-as-successful-as-many-think https://www.discovermagazine.com/health/contrary-to-popular-... So it seems CPR has contributed little to the survivability of heart attacks.
- FireBeyond 1y ago
  This varies hugely around the country. The Utstein criteria are only a subset of cardiac arrests, but while in NY you might have 11% chance of survival, Detroit, 8%... Rochester County, MN, King, Pierce and Thurston Counties in WA regularly battle each other for highest survival rates in the country, from high 30s, often in the 40s, even 49% survival. -- paramedic in Washington
AbstractH24 1y ago
> 2.1 percent doesn’t sound high — it’s a little higher than the chance of pulling an ace of spades from a card deck — but when it comes to major adverse cardiovascular events, 2.1 percent is approximately 100 percent higher than I’d like. That says something about the excesses of American medicine

83 points by lr0 1y ago

The article should really have a picture of a cath lab at the top, not an AED. Advances in catheterization technology are the key factor in reducing heart attack deaths, not AEDs

deadbabe 1y ago
Explain
- AnimalMuppet 1y ago
  There is a procedure called a "catheterization" (hence "cath lab"). I have two stents in my heart. They went in with a catheter through an artery in my wrist. They found the places in my heart where the arteries were 80% to 90% blocked, and placed stents there. They said I was five years from a heart attack. This was an outpatient procedure. I went home that night. The worst part of it, for me, was that they put a serious tourniquet on my wrist, because once they took the catheter out, I had an open artery. My wrist felt like I lost a bar fight. It ached for a month. This is so much better than having a heart attack. How did they know I needed this? I talked to a cardiologist. He told me that, as you age, your athletic performance drops slowly, over decades. That's normal. What's abnormal is when you suddenly can't do something you were able to do a month ago. So I paid attention when I realized, hey, a month ago I didn't get this winded playing ultimate frisbee. A month ago I recovered faster when I was winded. So I told that to my GP. He ordered a cardiac stress test for me. This basically is hooking you up to an EKG, putting you on a treadmill, running the treadmill faster and harder until you drop, and watching what your EKG does. If the shape stays the same except faster, you're good. If the shape changes, that's part of your heart not getting enough blood under load. My shape changed. So they ordered the catheterization for me. So cath labs are about preventing the heart attack, not keeping you from dying once you have one. Not dying is good. But not having it at all is better. I think that may have been the GP's point.
  - khuey 1y ago
    > So cath labs are about preventing the heart attack, not keeping you from dying once you have one. Cath labs *are* (also) about keeping you from dying once you have one. Inserting a stent into someone with an active MI can restore blood flow and minimize tissue damage.
  - duskwuff 1y ago
    Catheterization is the mode of access to the heart, not the entire procedure. Stenting is one procedure that can be carried out that way, but there are other procedures which can be performed that way as well, such as imaging, cardiac ablation, pacemaker or defibrillator installation, or valve replacement.
  - dogmatism 1y ago
    If someone told you you were "five years from a heart attack" they lied that's not how it works in a stable person (ie, not actually having a heart attack) stents help symptoms (a little better than medicines, but even that is debatable -- see Orbita trial). Medicines and lifestyle changes prevent heart attacks -- see Courage and Ischemia trials cath labs are in fact about keeping you from dying once you have a heart attack. The other stents for stable disease like you had are nice -- you feel better faster with fewer medicines that without, but not main thing source: not going to appeal to authority. See trials mentioned above, or ACC guidelines on management of CAD
- pfannkuchen 1y ago
  Which part needs to be explained? I think I understood the comment and I’m not in the industry. AED is an initialism for the electrical shock device you can use to (maybe) reboot the heart’s OS when it locks up. Catheters are some kind of tube that gets implanted to bypass a non-functional part of the heart. Catheter procedures improving caused the change, not AEDs (apparently), so it’s somewhat misleading to show an AED instead of something about catheters.
- roryirvine 1y ago
  PCI (Percutaneous Coronary Intervention, performed in a catheterization laboratory) has become the usual first-line treatment for acute heart attacks. It's much more effective than previous treatments (essentially clot-busting drugs, blood thinners, and bedrest), particularly since Drug-Eluting Stents arrived in the early 2000s.
FireBeyond 1y ago
Critical care paramedic here. The answer is "both". AEDs are a key factor in ensuring patient survival until we can get them to the cath lab and get them ballooned. "High quality compressions, early access to defibrillation". For every minute you do not have an effective pulse, your chance of survival goes down about 10%. Airway management takes a distant back seat. Most meds we give are only mildly, or questionably effective. But being able to defibrillate a dysrhythmia early is the key to getting the heart working itself - chest compressions are the best we have, but still. It takes us minutes of compressions to get to a suitable arterial pressure for effective perfusion, but ten seconds or less to lose it. AEDs won't improve volume and arterial flow, but it'll give you a fighting chance of getting to the lab. Compressions alone are not going to do that - they will just preserve tissue.
- pipes 1y ago
  What are AEDs? Aspirin? Blood thinners? I'm from the UK, so probably a naming difference!
  - deleted 1y ago
    [deleted]
  - Eavolution 1y ago
    AED: Automatic External Defibrillator, a defibrillator that doesn't need a trained operator Aspirin: a blood thinner and painkiller Blood thinners: given to people at risk of a heart attack to thin the blood and reduce the chance of blood flow being obstructed
  - 5555624 1y ago
    AED - Automated External Defibrillator. They're portable device defibrillator which can deliver an electric shock. As I understand it, it detects an abnormal heart rhythm and shocks the rhythm back to normal. Note that there are some situations where they will not work. (For example, Pulseless Electrical Activity or PEA is "non-shockable.")
    - 1y ago

paulpauper 1y ago

Yeah cancer is the big killer nowadays. Survival rates for stage 4 cancer still poor after many decades of research. Worse yet, in many instances there are no obvious risk factors, such as people in their 30s or 40s who get colon cancer and were not eligible for screening .

yieldcrv 1y ago
that’s to be expected, after we do the adequate screening for one older population and mitigate many of the advanced versions of that, then the previously edge case becomes more prevalent amongst all cases there is still a limited resource for the screening at this point, so that’s a friction to expanding screening
- zahlman 1y ago
  It's not just a question of scaling up the screening effort. Doctors are also concerned with potential harms caused by false positives.
  - greedo 1y ago
    What false positive would come out of a colonoscopy? You are visually looking for masses, and removing suspect polyps that are sent in for evaluation. The major potential harm of a colonoscopy is a bowel perforation. Serious complications occur roughly 0.3% of the time.
    - Someone 1y ago
      > Serious complications occur roughly 0.3% of the time. https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html https://www.cancer.org/cancer/types/colon-rectal-cancer/abou..., “the lifetime risk of developing colorectal cancer is about 1 in 24 for men and 1 in 26 for women.” So, it’s a 4% lifetime risk versus a 0.3% per colonoscopy risk. The outcomes for the two risks also are different, but I would think that for many healthy people (e.g. those under 40 years old), the risk of doing such a check are greater than that of not taking it. Reading https://en.wikipedia.org/wiki/Colorectal_cancer#Screening https://en.wikipedia.org/wiki/Colorectal_cancer#Screening, that’s one of the reasons frequent colonoscopies aren’t advised.

jvanderbot 1y ago

My father didn't die of a heart attack, he died of an aneurysm. However, he had a massive "widow maker" heart attack and had to be revived from arrest in the ER, more than once. He had a heart beat, unconscious, for a few days, before the blood thinners caused the aneurysm, I'm told. So, is this a heart attack? Is this "less deadly?" No, it's a proximal classification. Maybe their cardiac care center has a metric to hit.

VeninVidiaVicii 1y ago
Anecdotally I worked in the emergency department and ICU for 2.5 years as a scribe and translator in undergrad (ending about 7 years ago) and never saw a single person successfully revived. In the sense that everybody who ever got revived to the point that your dad did, in my experience, died.
- mv 1y ago
  this is why american medical care is so expensive. Family’s and Law make doctors “do everything” even when the doctors know there is 0.01% chance such a person even makes it out of the icu and that’s not saying anything about brain function.
  - golergka 1y ago
    IMO it's still good that it's family's decision. Even if it is an incorrect one.
    - KittenInABox 1y ago
      I think its good, but I also think that we don't have enough education in the US populace about what this means realistically. "Pulling out all the stops" means that your loved ones last time on this earth is either in agony or comatose, neither of which I would tolerate of my dog much less my mother.
      - FireBeyond 1y ago

aaron695 1y ago

[dead]

kelseyfrog 1y ago

No doubt a decrease of smoking, availability of satins, cpr/defibrillators, and stents has led to a massive increase in prevention and survival. However, the diagnostic and treatment side has improved considerably in that time too. Troponin assays became widely available in the late 1990s/early 2000s, and dual antiplatelet therapy (aspirin + clopidogrel) around 2000s. These are part of the standard toolkit for detecting and treating MIs that simply didn't exist when I was young and are part of the story of making MIs catastrophic events to a more survivable disease. The article isn't wrong per se, but I do want to point out that it isn't comprehensive when it comes to listing the reasons. There are interesting advances that it left out.

tuatoru 1y ago
Your point generalises. For instance, homicide rates have fallen in large part because many wounds that used to be fatal are now survived. Breast cancer death rates also are down because of better diagnosis and treatment.
smeeger 1y ago
[flagged]
- jodrellblank 1y ago
  “New analysis shows statins have "minimal" benefits” - Maryanne Demasi, PhD - https://blog.maryannedemasi.com/p/new-analysis-shows-statins-have-minimal-benefits https://blog.maryannedemasi.com/p/new-analysis-shows-statins... “We carried out a systematic review and meta-analysis of 21 statin trials involving 143,532 participants, using similar criteria to the CTT, and found no consistent relationship between lowering LDL-C with statins and death, heart attack or stroke.” - published in JAMA behind paywall, apparently But you’re still wrong because she says “Statins are very effective at lowering LDL-C” which is literally something even if that doesn’t translate to less death.
  - llm_nerd 1y ago
    Statin uses translate into less death, without any medical question or doubt. That particular systematic review is notorious for being utterly nonsensical. It's also notable that Maryanne Demasi is of...uh...of dubious professional credibility. Some of her papers have signs of scientific misconduct, including image duplication (yet with new labeling and analysis, indicating willful misconduct rather than simple error) and so on. She has various other questionable claims -- like mobile phones causing brain cancer -- and notably is a low carb advocate, which is something I will touch upon later. "Our analysis showed that trial participants taking a statin for an average of 4.4 years, showed a 29% RRR in heart attacks, but the ARR was only 1.3%." Over a 4.4 year average study length, there was already a 29% reduction of heart attack events over the control -- the relative risk. This analysis argues that since only some small subset actual had heart attacks -- again, during the short study period that averaged 4.4 years -- the "absolute" risk was low and therefore, negligible. "Minimal". There are two enormous problems with this- 1) Most people given statins already have years to decades of CVD progress. Yet even still statins gave them that much of a relative risk reduction. That is an enormous relative risk reduction, clear evidence of the benefits. If you're a 30 year old with high LDL and are looking at the absolute risk reduction of a 55 year old who finally was prescribed statins, note that the possible benefit to you is much, much larger. It's like saying that someone who started brushing their teeth at 40 years old still has a pretty nasty set of chompers so therefore there is no benefit to brushing your teeth. 2) This is an incredibly small window to study the absolute risk. 3) The benefits of lower arterial plaque is much, much greater than just the worst outcomes of heart attack or stroke. Again, Demasi et al are grifting off of the keto/low carb world, and she is a frequent speaker to this group. The low carb world often has a high saturated fat diet that sees their LDL massively rise, and there's a really desperate need to hope that LDL isn't bad for you. Dave Feldman recently has funded a lot of research on some subset of that group -- a group they call lean mass hyperresponders (LMHR), which are basically fit and active, healthy weight low-carb adherents -- and the premise was that in this subset LDL served a different purpose and wasn't bad. Only their most recent checkpoint was the CAC score of their participants rose disturbingly. https://www.youtube.com/watch?v=A2hvausg9dg https://www.youtube.com/watch?v=A2hvausg9dg https://www.youtube.com/watch?v=vRRD8nXEyGM https://www.youtube.com/watch?v=vRRD8nXEyGM Better than statins would be changing habits and diets to control cholesterol. But the evidence that lower LDL = a better healthspan and lifespan is absolutely overwhelming. And for some people statins have bad side effects. But anyone believing they do nothing is massively misinformed.

exhilaration 1y ago

I would just like to recommend this excellent Radiolab episode about saving lives during heart attacks: https://radiolab.org/podcast/how-to-save-a-life https://radiolab.org/podcast/how-to-save-a-life

thro230-0 1y ago

Also as result of long covid, more young healthy people get hearth attack. They have better chance to survive hearth attack, than older people. It improves survival stats!

southernplaces7 1y ago
I as a relatively young man also hate it when my hearth is attacked. One can't even be secure before their own fireplace, in their own home any more. Hearth= area in home where fire is kept, usually for cooking. Heart= that sometimes unfortunate little knot of pumping muscle under your rib cage.
dogmatism 1y ago
no, healthy young people have more heart attacks with acute covid. And die (or at least did in 2020-2021 time frame) Long covid isn't really associated with increased heart attack rates
AbstractH24 1y ago
But was the “Long Covid” caused by SARS-CoV-1 or decreased physical activity as a result of life fully coming to a stop for a few weeks/month and not fully resuming for years (and for some people never has)?

rectang 1y ago

> A sudden cardiac death is the disease equivalent of homicide or a car crash death. It meant someone’s father or husband, wife or mother, was suddenly ripped away without warning. Now ever increasing numbers of people avoid an abrupt death and live long enough that misery and terrible quality of life extend for decades. Hooray for all of those who emphasize preventing death above all else, whether they are motivated by extracting medical fees during life's long slow twilight, or by more pure considerations.

mr_toad 1y ago
Most people who recover from a heart attack will not suffer a terrible quality of life. Depending on the severity and the treatment many will live quite normal lives for decades, and die from something completely unrelated.
- dogmatism 1y ago
  This is true. In fact if you have a heart attack and are treated relatively quickly, with no major injury and decreased function of the heart muscle, and continue to have regular follow up care and address risk factors, your mortality risk normalizes to those without history of a heart attack (but with CAD) and should have no functional limitations
- rectang 1y ago
  The point stands — it’s not that the heart attack leaves you infirm, but that surviving it lets you live long enough to die of Alzheimer’s or cancer or depression. Causes of abrupt death are being winnowed down, which the author regards with horror. I hope that they never experience the prolonged agony to which modern medicine has consigned so many, and that they are never forced by suffering to change their mind.

catchcatchcatch 1y ago

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dreamcompiler 1y ago

CAC tests are not without risk. Every CAC test is a CAT scan which means X-ray radiation. It is certainly the case that for a great many people the benefits of a CAC test outweigh the risks, but talk to your doctor before you rush out and get one. I wish it were possible to do a CAC test using MRI (and thus without ionizing radiation) but to the best of my knowledge it's not.

Razengan 1y ago

Wish it was the case for some of my family :(

randcraw 1y ago

"[…] people who undergo CPR outside of a hospital setting survive only 10 percent of the time. Within a hospital setting, CPR survival rates are only a bit higher — about 17 percent." https://www.discovermagazine.com/health/contrary-to-popular-belief-cpr-is-not-as-successful-as-many-think https://www.discovermagazine.com/health/contrary-to-popular-... So it seems CPR has contributed little to the survivability of heart attacks.

FireBeyond 1y ago
This varies hugely around the country. The Utstein criteria are only a subset of cardiac arrests, but while in NY you might have 11% chance of survival, Detroit, 8%... Rochester County, MN, King, Pierce and Thurston Counties in WA regularly battle each other for highest survival rates in the country, from high 30s, often in the 40s, even 49% survival. -- paramedic in Washington

AbstractH24 1y ago

> 2.1 percent doesn’t sound high — it’s a little higher than the chance of pulling an ace of spades from a card deck — but when it comes to major adverse cardiovascular events, 2.1 percent is approximately 100 percent higher than I’d like. That says something about the excesses of American medicine