4 ms·

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 d

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.
nurettin 1y ago
And transportation, electronic communication, beta blockers, blood diluters...
loloquwowndueo 1y ago
*statins, not satins. Satin is nice though.
- kelseyfrog 1y ago
  Good catch! Love it when the misspelling is also a word :D

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.

nurettin 1y ago

And transportation, electronic communication, beta blockers, blood diluters...

loloquwowndueo 1y ago

*statins, not satins. Satin is nice though.

kelseyfrog 1y ago
Good catch! Love it when the misspelling is also a word :D