15 ms·

Show HN: Four numbers can predict your lifetime risk of a heart attack

202 points by brandonb 12y ago

spindritf 12y ago
Slick. I liked the additional prompts when entering information. The graph animation was slow in my Firefox 33.
- brandonb 12y ago
  Thanks for the report! I'll work on Firefox speed--it's sort of an all-around problem with the Firefox experience.
gear54rus 12y ago
And none of these numbers can be expressed with proper measurement units most of the world uses... Instead we have lbs feet and inches.
- brandonb 12y ago
  Hey! Which units would you prefer? For height/weight, I'd assume meters and kg? When you get your cholesterol measurements, do use mg/dL, mmol/L, or something else? What about blood pressure?
  - gear54rus 12y ago
    Hello, Ideally, there should be an ability to switch. Regarding height and weigh - its metric meters and kilograms. Not sure about others. Thanks.
    - smeyer 12y ago
      It's pretty amusing that you're complaining about the units (and wanting non-American units is fair) but don't actually know what units you want.
      - gear54rus 12y ago
        Well I certainly know one of two bits of information this app can use to make its guess but I still can't use it because.. well.. you know. Defeats the purpose altogether.
      - readerrrr 12y ago
        And making the units even more alien doesn't help when you have to look them up and after an exhausting search find out they are imperial/metric and have to convert further.
  - intruder 12y ago
    cm and kg
  - equoid 12y ago
    I live in the UK, I think of my height in feet and inches and my weight in Kilograms. Blood pressure is in mmHg while cholesterol is in mmol/L.
  - anigbrowl 12y ago
    Obviously metric, since that's what most of the world uses abd you're cutting yourself from a large chunk of your potential audience. The cholesterol measures are already metric.
    - vacri 12y ago
      The site is going to be limited to the US anyway. The data is calculated from a US population for US lifestyles. And the racial information is US-centric. Does 'Asian' mean Korean, Indian, or Palestinian? Is an African African-American? Even if they're Moroccan? The medical term for that genotype is 'negro', but that word has far too much baggage to be used with a primarily US audience.
  - wazoox 12y ago
    Meters and kilos. My blood analysis data is in g/L (but the conversion is easy).
- gordaco 12y ago
  I came here to say exactly the same. Maybe you could add a radio button, or better, try to get geographical information from the IP and display the units accordingly (but don't forget about the other two countries that still use the imperial system, the USA aren't yet alone ;) ). In any case I'm glad that I'm at relatively low risk despite being overweight (but a little less each day). I guess that low blood pressure and zero smoking are that good. My caffeine intake is also zero (Ok, I think that cocoa powder has some, so not literal zero). I wonder if that has any effect on my risk, maybe something indirect through blood pressure.
  - rflrob 12y ago
    If you're officially "overweight", and not any category of obese (at least by BMI), you might be better off not trying to lose any more. There seems to be a growing consensus that the best all-causes mortality rate is actually for people in the overweight category [1]. Yes, correlation and causation and all relevant caveats apply. Personally, and IANAMD, I think as long as the weight is not causing noticeable quality of life drops, you're better off not stressing about it, and just trying to live life comfortably. Eat well and exercise, but if your body doesn't want to give up that extra reserve, don't force it. [1] http://www.ncbi.nlm.nih.gov/pubmed/23280227 http://www.ncbi.nlm.nih.gov/pubmed/23280227 --- n.b. I haven't actually read the article, but I'm assuming the abstract isn't lying when it says "overweight was associated with significantly lower all-cause mortality".
    - PeterWhittaker 12y ago
      It considers me to have a high BMI - yet my body fat is relatively low. I was lighter and fatter until I started working out; now I am heavier and slimmer. My clothes are generally looser, except my shirts and jackets, which are snugger around the chest. Considering that, overall, my doctor believes I had a low risk of cardiovascular disease before I started exercising regularly, and now believes my risk to be lower, I take the risk numbers with a grain of salt - and a dab of butter. Speaking of fat, as others have noted, total cholesterol may be meaningless. If I told you my total, you'd likely call an ambulance. But my triglycerides are low and my HDL/tri and HDL/total ratios are so good they are silly. Based on everything my doctor knows - and she's scientifically minded, curious, and thorough, traits unusual in family doctors AFAICT - my risk of cardiovascular disease is in the low single digits. Yet this test tells me my best case is mid 30s and my current close to 50. Yeah, uh huh, I'm going to take medical advice from an app prepared by someone who lived an anecdote. (No disrespect intended. Our personal experiences tend to not be transferable, no matter how much we learn about our case, because we learn about our case - not about all cases, with a dash of probability and a hint of objectivity.)
- benihana 12y ago
  Unfortunately, until we figure out an easy way to convert between unit systems, our only recourse is to complain on hacker news.
  - gambiting 12y ago
    Yeah you can convert between units. But as soon as I saw imperial units I just closed the site. If you want to publish something on the Internet you have to take into account that users will be way too lazy to convert. And I don't want to support imperial measurements in any way or form so I would rather not use a site or a service that uses them.
  - highstep 12y ago
    This worked well to convert mmol/l to mg/dl: http://www.soc-bdr.org/rds/authors/unit_tables_conversions_and_genetic_dictionaries/conversion_glucose_mg_dl_to_mmol_l/index_en.html http://www.soc-bdr.org/rds/authors/unit_tables_conversions_a...
    - Someone 12y ago
      That table is for glucose only. It would be the same for cholesterol if and only if a glucose molecule weighs the same as a cholesterol molecule (is it even possible to do that conversion, given that there are at least two different kinds of cholesterol, with different atomic masses?)
- jmulho 12y ago
  And none of this website can be expressed with a proper language most of the world uses... Instead we have English.
brandonb 12y ago
Hey HN! This project was inspired by a personal experience I had--I put my numbers into a spreadsheet provided by the American Heart Association and found I had a 50% lifetime risk of a heart attack. Yikes! I've gone to regular check-ups all my life and always been a little outside of the cholesterol guidelines, but I never knew how seriously to take that. I didn't know you could translate those numbers into percentage chance of getting a heart attack, whether I was "high" or "low," or how much I could improve by making lifestyle changes. I figured there must be other people out there who are similarly ignorant about their own health, so I built this. (Please don't take this as a substitute for going to the doctor; there are all sorts of things your doctor can tell you that a web page can't. This is just for education!) Please let me know if you have questions!
- vqc 12y ago
  Is there anything like this that uses ABSI or some other BMI alternative?
  - lost_my_pwd 12y ago
    This. I am constantly being tagged as overweight and high risk because of my BMI (5'10" and 175-180lbs but I am very active and the weight is from muscle rather than fat).
    - brandonb 12y ago
      I haven't seen one yet, but I highly recommend knowing your cholesterol numbers since those will give a much more accurate result--both BMI and ABSI are very coarse-grained measures of what's likely to be happening inside your arteries.
      - JeremyNT 12y ago
        So now I'm curious; I'd always thought obesity was itself a risk factor, but your calculator does not consider it. Is the "problem" with obesity only its impact on blood pressure and cholesterol? Or does obesity also increase risk in other ways in addition to worsening those factors?
kbenson 12y ago
These numbers seem slightly off, or the way they are presented is a bit confusing: "Your lifetime risk of heart disease is 56% as of today. You can reduce that to 38% if you ... That would make your risk about 34% lower. Not too shabby!"
- jxf 12y ago
  It's measuring percent, not percentage points. 38% is ~34% less than 56%, but about 18 percentage points. If your risk was lowered from 2% to 1%, that's a 50% reduction, but a 1 percentage point reduction.
  - kbenson 12y ago
    I see what you are saying. I stand by the second part of my statement though. Presenting a percentage you can lower a percentage can (and just did) lead to some confusion.
vishnugupta 12y ago
All I can say is big thank you :-)
hockeybias 12y ago
'Know Your Five' would include whether or not you have diabetes...
ibarrajo 12y ago
I don't know if you submitted your app to the Million Hearts challenge, but it would have made a nice fit. http://www.health2con.com/devchallenge/one-in-a-million-hearts-challenge/ http://www.health2con.com/devchallenge/one-in-a-million-hear... Are you using the Archimedes Indigo back end? https://archimedesmodel.com/indigo-api https://archimedesmodel.com/indigo-api
- brandonb 12y ago
  Ah, I wish I had seen that challenge before submissions closed! The risk models for heart disease are simple enough that I just implemented them in Javascript based on the Framingham papers, although I did talk with one of the risk modelers at Archimedes to understand which models to use.
whiddershins 12y ago
Based on following the research, I don't believe all these risk factors have been established scientifically. What i've gleaned over the years: Total cholesterol: probably doesn't matter much HDL: matters Blood Pressure: I don't know Smoking: matters
- DennisP 12y ago
  Also triglycerides matters, and triglyceride/HDL ratio matters a lot.
- brandonb 12y ago
  If you're curious about the risk modeling research literature, here's a good example of models built for 30-year risk prediction: http://circ.ahajournals.org/content/119/24/3078.abstract http://circ.ahajournals.org/content/119/24/3078.abstract The models tend to be close to equivalent in their inputs: either total or LDL cholesterol (small-particle LDL is the one that drives atherosclerosis, but if the model includes HDL cholesterol, then it doesn't make a big difference in accuracy whether the other variable is total or LDL cholesterol), HDL cholesterol (seems to cause a protective effect, although randomized trials of HDL-boosting drugs haven't shown improvements, so may not be causal), blood pressure, and smoking. People also sometimes include newer biomarkers like triglycerides or hs-CRP, but they don't consistently show accuracy gains (LDL, triglycerides, and hs-CRP are highly correlated, so each one individually is a good predictor but having all three doesn't necessarily give you a more accurate model). There's still a lot of active research to find out which of these variables are causal and which are merely associated with heart disease. For example, LDL-lowering drugs like statins do reduce the risk of heart attacks in randomized trials.
SloopJon 12y ago
The current risk in the graph doesn't update when I change a value and click Calculate My Risk again; e.g., if I calculate with blood pressure blank then recalculate with it set to 130. I'm using Firefox 33 and Chrome 38-ish for Mac.
stefantalpalaru 12y ago
There's an interesting controversy around the lipid hypothesis: http://en.wikipedia.org/wiki/Lipid_hypothesis#Minority_disagreement http://en.wikipedia.org/wiki/Lipid_hypothesis#Minority_disag...
- protonfish 12y ago
  I would like to believe that before a major push from government and health organizations to encourage people to eat less fat, there was strong evidence that reducing dietary fat and cholesterol correlated with significant health improvement. I would like to believe it, but I can't seem to find that strong evidence anywhere.
  - StacyC 12y ago
    I would like to believe it, but I can't seem to find that strong evidence anywhere. That’s because it doesn’t exist, of course. We have been tragically misled for about 30 years. This is N=2 but my wife and I switched to a low-carb/high-fat diet last summer and we are both at our ideal weight, higher energy than we have had in many years, and feeling absolutely fantastic. I think this is where the current metabolic science is taking us.
    - bitJericho 12y ago
      Same here, no idea if it's good for my heart or not but I've got lots of energy.
    - adventured 12y ago
      Tragically misled might even be an understatement. The US Government is probably going to end up having killed hundreds of thousands of people through dangerously bad dietary guidelines and the impact they have across the culture over a generation. Their recommendation for consuming 5-12 servings of breads, cereals, pasta, 'whole grains' per day is like telling people they need to drink more soda.
  - wffurr 12y ago
    The original evidence was about red meat consumption, but it was changed to dietary fat after an outcry from the beef lobby. Further, the harm in red meat consumption may be related to the use of preventative antibiotics in livestock and their diet in CAFO factories.
cbr 12y ago
If you don't enter height or weight into "debug my life" it says: "Your current BMI is 23, which is in the healthy range" instead of "you didn't give us what we need to calculate your BMI".
- brandonb 12y ago
  Ah, thanks! Will fix.
cdjk 12y ago
The sensitivity analysis being displayed automatically is a nice feature, as it immediately shows the effects of changes. That's a clever bit of UI that most similar apps don't have.
kolev 12y ago
Total cholesterol, really (which goes up with HDL, which has no upper limit)? And no triglycerides?
- jmhain 12y ago
  I closed the page immediately upon seeing total cholesterol. Being on a ketogenic diet, it'd probably tell me I'm at risk because the diet increases both HDL and big LDL particles (the harmless kind). Total cholesterol is meaningless.
  - kolev 12y ago
    In fact, there was some study (can't find the link) showing that people with moderately higher LDL lived longer than people with LDL that's in norm. I'm also on a ketogenic diet and my HDL is over 100, triglycerides below 70, and LDL is a bit high, but total cholesterol is way high due to high HDL. It's totally unscientific to use LDL given it includes HDL and the higher the HDL, the better with no set up limit (unlike many markers). HDL/triglycerides is the only meaningful ratio in the standard lipid profile. Also, there's some truth in doing subfractioning of LDL, which almost nobody does as it's expensive and not part of official lipid profile testing as far as I know. Edit: Grammar.
    - jmhain 12y ago
      > It's totally unscientific to use LDL given it includes HDL I agree that total LDL is not a good indicator unless you do subfractioning, but I think you meant total cholesterol here, as LDL does not include HDL (that wouldn't even make sense!).
      - kolev 12y ago
        Yes, I made a mistake, but you got my point. As you may have in-norm LDL and very HDL and then your TC will be in the danger zone, which doesn't make any sense.
sitkack 12y ago
What a great way to get detailed demographic data of the HN crowd!
- j_lev 12y ago
  I was thinking the exact opposite after having plugged in all sorts of crazy numbers to see how they affect the results (incidentally the highest total cholesterol it accepts is 400, way too low for anyone who regularly cooks with coconut oil IMHO).
  - sitkack 12y ago
    The initial height/weight/sex/race/ip address/browser is a pretty good combo and most likely the legit values.
dabernathy89 12y ago
Interesting that family history isn't included. I'd have thought that was a pretty important factor.
hippich 12y ago
How does BMI affect numbers when I do weight lifting? I.e. I assume I have more muscles than average Joe?
- ugh123 12y ago
  BMI has never been fully trusted. Partly for the reason you bring up. http://en.wikipedia.org/wiki/Body_mass_index#Limitations_and_shortcomings http://en.wikipedia.org/wiki/Body_mass_index#Limitations_and...
platz 12y ago
There was also that thing in the news about some effects of smoking being mitigated if one quit by about age ~32. Still I wonder (as someone who previously smoked) how there couldn't be some kind of damage after several years of smoking
artmageddon 12y ago
Does age play any part into one's risk?
- brandonb 12y ago
  It does when calculating your 10-year-risk, but not for lifetime risk. I'd like to add a feature to show you both 10-year and lifetime risks, but for now, the NIH has a 10-year-risk calculator: http://cvdrisk.nhlbi.nih.gov/ http://cvdrisk.nhlbi.nih.gov/ For most people, the 10-year-risk becomes important in your 50's, 60's, and 70's and is used to guide treatment for e.g., statin therapy or anti-hypertensive medication. If you're 30, your 10-year-risk is generally very low even if you treat your body terribly. :) So part of the motivation for showing the lifetime risk is to get people thinking about how to optimize their health for their life, since by the time your 10-year-risk is significant it's often too late to change your habits for diet/exercise.
saryant 12y ago
Minor bug: the heart icon gets clipped if the risk factor comes out to 12% in the latest version of Chrome. http://imgur.com/l27HcXA http://imgur.com/l27HcXA
- silencio 12y ago
  Actually, it's clipped _and_ it's overlapping with 'current risk'. I also see the same on the other end of the chart with blood pressure: http://imgur.com/jaJHErm http://imgur.com/jaJHErm (I'm also unclear as to why '90' systolic blood pressure is at an unexpected end of the graph, but...)
mapcars 12y ago
Just wonder, do people know about kilograms, meters, international system of units?
recusancy 12y ago
Shouldn't alcohol intake be a major factor as well along with smoking?
cperciva 12y ago
Please add support for SI units (mmol/L) for cholesterol. Some of us live in more enlightened countries...
- brandonb 12y ago
  Working on it!
mathattack 12y ago
Great app - thank you for sharing. Unfortunately the answer to this seems similar to most health advice sent my way, "Lose some weight!"
- brandonb 12y ago
  Unfortunately it's hard but true. I'm on a diet too and it's hard to keep it up. But the benefits of losing weight are pretty clear--it basically improves all four of your numbers except for smoking. :) Feel free to email me if you have thoughts on what you've tried so far, and what you'd like to see ideally. Address is in my profile.
Dewie 12y ago
So if I have relatively more muscle mass compared to my height, that means that I am at a higher chance for getting a heart attack? Well, that could be the case for all I know.
kstenerud 12y ago
Cool, but it doesn't take into account your drinking habits. 1-2 drinks per day reduces the chances of coronary heart disease by up to 40%.
- killerdhmo 12y ago
  [citation needed]
- readerrrr 12y ago
  [research results needed] Even if true, drinkings bring your other risk factors so high( >Σ40%) that you are better of staying abstinent.
  - kstenerud 12y ago
    http://pubs.niaaa.nih.gov/publications/arh23-1/15-24.pdf http://pubs.niaaa.nih.gov/publications/arh23-1/15-24.pdf
    - deleted 12y ago
      [deleted]
rip747 12y ago
This has got to be off. "I had a 50% lifetime risk of a heart attack. Yikes!" not for nothing, but I entered in my numbers and got 68% and I smoke about a pack of day. If that's the case, then I'm not quitting any time soon.
- lgas 12y ago
  You know higher numbers are worse, right?
dr_ 12y ago
Interesting, but not exactly new. This has been promoted in various ways in the past (http://www.cvriskcalculator.com/ http://www.cvriskcalculator.com/ - which is updated with recent BP management data as well)
in_sur_ance 12y ago
Nice try, insurance company.
vikp 12y ago
This is great, brandonb, and I love to see people making tools that raise awareness. If anyone is looking for this in iOS app form, I made something a few months ago: https://itunes.apple.com/us/app/heartgram-physicians-cvd-risk/id885312924?mt=8 https://itunes.apple.com/us/app/heartgram-physicians-cvd-ris... .
nazgulnarsil 12y ago
TC is less predictive than HDL:Triglyceride ratio by a significant margin. people with "high" TC of 200-220 and a good HDL:Trig ratio outlive those with "excellent" TC levels. There are cases where BP matters less as well. For example the cochrane review on sodium consumption indicated that while lowering sodium intake aggressively did successfully lower BP, it resulted in worse mortality.
- brandonb 12y ago
  Have a citation for a risk model that uses triglycerides? "Predicting the Thirty-year Risk of Cardiovascular Disease: The Framingham Heart Study" (http://circ.ahajournals.org/content/119/24/3078.abstract http://circ.ahajournals.org/content/119/24/3078.abstract) reported that triglycerides were not statistically significant when added to a model that already contains total and HDL cholesterol: "Standard CVD risk factors (male sex, age, SBP, antihypertensive treatment, total and HDL cholesterol, smoking and diabetes) were highly significant (0.01 level) in the multivariable model. DBP and triglycerides were not statistically significant and inclusion of LDL in place of total cholesterol did not improve model performance."
  - nazgulnarsil 12y ago
    Interesting, thanks for the citation I hadn't seen it before. It does look like pretty solid evidence, so I'm less sure of the triglyceride hypothesis than I was before. A couple cites of interest: http://cpr.sagepub.com/content/3/2/213.short http://cpr.sagepub.com/content/3/2/213.short http://www.ahjonline.com/article/0002-8703(86)90296-6/abstract http://www.ahjonline.com/article/0002-8703(86)90296-6/abstra... http://circ.ahajournals.org/content/85/1/37.short http://circ.ahajournals.org/content/85/1/37.short http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664115/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664115/ There is significant overlap in the explanatory power of these variables because they are not independent. So it is possible that "high" cholesterol has covariance with triglyceride:HDL ratio in the majority of the population sample (seems likely). In that case we should see people with "high" TC still have better mortality outcomes. Which we do see: http://www.ncbi.nlm.nih.gov/pubmed/11502313 http://www.ncbi.nlm.nih.gov/pubmed/11502313 But like I said, the Framingham study does seem like reasonable evidence. I'll look over the entire thing later. There is also this interesting development, but I don't know enough to speak intelligently about it: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2006.01616.x/full http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2006.... It is interesting to note that apo-b levels VERY closely track HDL:Trig ratio.
DanBC 12y ago
So far there are only two links to published research in this thread. That's suboptimal when discussing something where the science is moving.
pragone 12y ago
One critical factor missing is immediately family history of early cardiac disease, such as a parent or sibling having a heart attack before age 45
jmulho 12y ago
How might I increase my HDL (good cholesterol)?
HamSession 12y ago
Right now QRISK2 is considered the most accurate when it comes to predicting morbidity and mortality of cardiovascular events. This calculator is great, but missing one important factor if either of your first degree parents had a heart attack before 60 then you are at greater risk. This mostly ties into things like homocystine levels, hrcp, and LDL particle size, but its a good ballpark for the genetic variation. My advice get genetically screened if you are worried and make changes. If you carry alterations on the 9p21 chromosome chances are you are at higher risk. If so you can simply eat more fruit and vegetables this has been shown in multiple studies to dramatically lower rates independent of other factors.
markdown 12y ago
> Your risk of heart disease is 25% But the graph shows 26%
lacker 12y ago
This seems pretty neat. Are you considering turning this into a startup, then? X for Y pitch of "machine learning for personal health"? I say go for it. :D
arc_of_descent 12y ago
A good metric would be the hours spent per week in doing cardio exercises.
loqqus 12y ago
Great domain name.

202 points by brandonb 12y ago

spindritf 12y ago

Slick. I liked the additional prompts when entering information. The graph animation was slow in my Firefox 33.

brandonb 12y ago
Thanks for the report! I'll work on Firefox speed--it's sort of an all-around problem with the Firefox experience.

gear54rus 12y ago

And none of these numbers can be expressed with proper measurement units most of the world uses... Instead we have lbs feet and inches.

brandonb 12y ago
Hey! Which units would you prefer? For height/weight, I'd assume meters and kg? When you get your cholesterol measurements, do use mg/dL, mmol/L, or something else? What about blood pressure?
- gear54rus 12y ago
  Hello, Ideally, there should be an ability to switch. Regarding height and weigh - its metric meters and kilograms. Not sure about others. Thanks.
  - smeyer 12y ago
    It's pretty amusing that you're complaining about the units (and wanting non-American units is fair) but don't actually know what units you want.
    - gear54rus 12y ago
      Well I certainly know one of two bits of information this app can use to make its guess but I still can't use it because.. well.. you know. Defeats the purpose altogether.
    - readerrrr 12y ago
      And making the units even more alien doesn't help when you have to look them up and after an exhausting search find out they are imperial/metric and have to convert further.
- intruder 12y ago
  cm and kg
- equoid 12y ago
  I live in the UK, I think of my height in feet and inches and my weight in Kilograms. Blood pressure is in mmHg while cholesterol is in mmol/L.
- anigbrowl 12y ago
  Obviously metric, since that's what most of the world uses abd you're cutting yourself from a large chunk of your potential audience. The cholesterol measures are already metric.
  - vacri 12y ago
    The site is going to be limited to the US anyway. The data is calculated from a US population for US lifestyles. And the racial information is US-centric. Does 'Asian' mean Korean, Indian, or Palestinian? Is an African African-American? Even if they're Moroccan? The medical term for that genotype is 'negro', but that word has far too much baggage to be used with a primarily US audience.
- wazoox 12y ago
  Meters and kilos. My blood analysis data is in g/L (but the conversion is easy).
gordaco 12y ago
I came here to say exactly the same. Maybe you could add a radio button, or better, try to get geographical information from the IP and display the units accordingly (but don't forget about the other two countries that still use the imperial system, the USA aren't yet alone ;) ). In any case I'm glad that I'm at relatively low risk despite being overweight (but a little less each day). I guess that low blood pressure and zero smoking are that good. My caffeine intake is also zero (Ok, I think that cocoa powder has some, so not literal zero). I wonder if that has any effect on my risk, maybe something indirect through blood pressure.
- rflrob 12y ago
  If you're officially "overweight", and not any category of obese (at least by BMI), you might be better off not trying to lose any more. There seems to be a growing consensus that the best all-causes mortality rate is actually for people in the overweight category [1]. Yes, correlation and causation and all relevant caveats apply. Personally, and IANAMD, I think as long as the weight is not causing noticeable quality of life drops, you're better off not stressing about it, and just trying to live life comfortably. Eat well and exercise, but if your body doesn't want to give up that extra reserve, don't force it. [1] http://www.ncbi.nlm.nih.gov/pubmed/23280227 http://www.ncbi.nlm.nih.gov/pubmed/23280227 --- n.b. I haven't actually read the article, but I'm assuming the abstract isn't lying when it says "overweight was associated with significantly lower all-cause mortality".
  - PeterWhittaker 12y ago
    It considers me to have a high BMI - yet my body fat is relatively low. I was lighter and fatter until I started working out; now I am heavier and slimmer. My clothes are generally looser, except my shirts and jackets, which are snugger around the chest. Considering that, overall, my doctor believes I had a low risk of cardiovascular disease before I started exercising regularly, and now believes my risk to be lower, I take the risk numbers with a grain of salt - and a dab of butter. Speaking of fat, as others have noted, total cholesterol may be meaningless. If I told you my total, you'd likely call an ambulance. But my triglycerides are low and my HDL/tri and HDL/total ratios are so good they are silly. Based on everything my doctor knows - and she's scientifically minded, curious, and thorough, traits unusual in family doctors AFAICT - my risk of cardiovascular disease is in the low single digits. Yet this test tells me my best case is mid 30s and my current close to 50. Yeah, uh huh, I'm going to take medical advice from an app prepared by someone who lived an anecdote. (No disrespect intended. Our personal experiences tend to not be transferable, no matter how much we learn about our case, because we learn about our case - not about all cases, with a dash of probability and a hint of objectivity.)
benihana 12y ago
Unfortunately, until we figure out an easy way to convert between unit systems, our only recourse is to complain on hacker news.
- gambiting 12y ago
  Yeah you can convert between units. But as soon as I saw imperial units I just closed the site. If you want to publish something on the Internet you have to take into account that users will be way too lazy to convert. And I don't want to support imperial measurements in any way or form so I would rather not use a site or a service that uses them.
- highstep 12y ago
  This worked well to convert mmol/l to mg/dl: http://www.soc-bdr.org/rds/authors/unit_tables_conversions_and_genetic_dictionaries/conversion_glucose_mg_dl_to_mmol_l/index_en.html http://www.soc-bdr.org/rds/authors/unit_tables_conversions_a...
  - Someone 12y ago
    That table is for glucose only. It would be the same for cholesterol if and only if a glucose molecule weighs the same as a cholesterol molecule (is it even possible to do that conversion, given that there are at least two different kinds of cholesterol, with different atomic masses?)
jmulho 12y ago
And none of this website can be expressed with a proper language most of the world uses... Instead we have English.

brandonb 12y ago

Hey HN! This project was inspired by a personal experience I had--I put my numbers into a spreadsheet provided by the American Heart Association and found I had a 50% lifetime risk of a heart attack. Yikes! I've gone to regular check-ups all my life and always been a little outside of the cholesterol guidelines, but I never knew how seriously to take that. I didn't know you could translate those numbers into percentage chance of getting a heart attack, whether I was "high" or "low," or how much I could improve by making lifestyle changes. I figured there must be other people out there who are similarly ignorant about their own health, so I built this. (Please don't take this as a substitute for going to the doctor; there are all sorts of things your doctor can tell you that a web page can't. This is just for education!) Please let me know if you have questions!

vqc 12y ago
Is there anything like this that uses ABSI or some other BMI alternative?
- lost_my_pwd 12y ago
  This. I am constantly being tagged as overweight and high risk because of my BMI (5'10" and 175-180lbs but I am very active and the weight is from muscle rather than fat).
  - brandonb 12y ago
    I haven't seen one yet, but I highly recommend knowing your cholesterol numbers since those will give a much more accurate result--both BMI and ABSI are very coarse-grained measures of what's likely to be happening inside your arteries.
    - JeremyNT 12y ago
      So now I'm curious; I'd always thought obesity was itself a risk factor, but your calculator does not consider it. Is the "problem" with obesity only its impact on blood pressure and cholesterol? Or does obesity also increase risk in other ways in addition to worsening those factors?

kbenson 12y ago

These numbers seem slightly off, or the way they are presented is a bit confusing: "Your lifetime risk of heart disease is 56% as of today. You can reduce that to 38% if you ... That would make your risk about 34% lower. Not too shabby!"

jxf 12y ago
It's measuring percent, not percentage points. 38% is ~34% less than 56%, but about 18 percentage points. If your risk was lowered from 2% to 1%, that's a 50% reduction, but a 1 percentage point reduction.
- kbenson 12y ago
  I see what you are saying. I stand by the second part of my statement though. Presenting a percentage you can lower a percentage can (and just did) lead to some confusion.

vishnugupta 12y ago

All I can say is big thank you :-)

hockeybias 12y ago

'Know Your Five' would include whether or not you have diabetes...

ibarrajo 12y ago

I don't know if you submitted your app to the Million Hearts challenge, but it would have made a nice fit. http://www.health2con.com/devchallenge/one-in-a-million-hearts-challenge/ http://www.health2con.com/devchallenge/one-in-a-million-hear... Are you using the Archimedes Indigo back end? https://archimedesmodel.com/indigo-api https://archimedesmodel.com/indigo-api

brandonb 12y ago
Ah, I wish I had seen that challenge before submissions closed! The risk models for heart disease are simple enough that I just implemented them in Javascript based on the Framingham papers, although I did talk with one of the risk modelers at Archimedes to understand which models to use.

whiddershins 12y ago

Based on following the research, I don't believe all these risk factors have been established scientifically. What i've gleaned over the years: Total cholesterol: probably doesn't matter much HDL: matters Blood Pressure: I don't know Smoking: matters

DennisP 12y ago
Also triglycerides matters, and triglyceride/HDL ratio matters a lot.
brandonb 12y ago
If you're curious about the risk modeling research literature, here's a good example of models built for 30-year risk prediction: http://circ.ahajournals.org/content/119/24/3078.abstract http://circ.ahajournals.org/content/119/24/3078.abstract The models tend to be close to equivalent in their inputs: either total or LDL cholesterol (small-particle LDL is the one that drives atherosclerosis, but if the model includes HDL cholesterol, then it doesn't make a big difference in accuracy whether the other variable is total or LDL cholesterol), HDL cholesterol (seems to cause a protective effect, although randomized trials of HDL-boosting drugs haven't shown improvements, so may not be causal), blood pressure, and smoking. People also sometimes include newer biomarkers like triglycerides or hs-CRP, but they don't consistently show accuracy gains (LDL, triglycerides, and hs-CRP are highly correlated, so each one individually is a good predictor but having all three doesn't necessarily give you a more accurate model). There's still a lot of active research to find out which of these variables are causal and which are merely associated with heart disease. For example, LDL-lowering drugs like statins do reduce the risk of heart attacks in randomized trials.

SloopJon 12y ago

The current risk in the graph doesn't update when I change a value and click Calculate My Risk again; e.g., if I calculate with blood pressure blank then recalculate with it set to 130. I'm using Firefox 33 and Chrome 38-ish for Mac.

stefantalpalaru 12y ago

There's an interesting controversy around the lipid hypothesis: http://en.wikipedia.org/wiki/Lipid_hypothesis#Minority_disagreement http://en.wikipedia.org/wiki/Lipid_hypothesis#Minority_disag...

protonfish 12y ago
I would like to believe that before a major push from government and health organizations to encourage people to eat less fat, there was strong evidence that reducing dietary fat and cholesterol correlated with significant health improvement. I would like to believe it, but I can't seem to find that strong evidence anywhere.
- StacyC 12y ago
  I would like to believe it, but I can't seem to find that strong evidence anywhere. That’s because it doesn’t exist, of course. We have been tragically misled for about 30 years. This is N=2 but my wife and I switched to a low-carb/high-fat diet last summer and we are both at our ideal weight, higher energy than we have had in many years, and feeling absolutely fantastic. I think this is where the current metabolic science is taking us.
  - bitJericho 12y ago
    Same here, no idea if it's good for my heart or not but I've got lots of energy.
  - adventured 12y ago
    Tragically misled might even be an understatement. The US Government is probably going to end up having killed hundreds of thousands of people through dangerously bad dietary guidelines and the impact they have across the culture over a generation. Their recommendation for consuming 5-12 servings of breads, cereals, pasta, 'whole grains' per day is like telling people they need to drink more soda.
- wffurr 12y ago
  The original evidence was about red meat consumption, but it was changed to dietary fat after an outcry from the beef lobby. Further, the harm in red meat consumption may be related to the use of preventative antibiotics in livestock and their diet in CAFO factories.

cbr 12y ago

If you don't enter height or weight into "debug my life" it says: "Your current BMI is 23, which is in the healthy range" instead of "you didn't give us what we need to calculate your BMI".

brandonb 12y ago
Ah, thanks! Will fix.

cdjk 12y ago

The sensitivity analysis being displayed automatically is a nice feature, as it immediately shows the effects of changes. That's a clever bit of UI that most similar apps don't have.

kolev 12y ago

Total cholesterol, really (which goes up with HDL, which has no upper limit)? And no triglycerides?

jmhain 12y ago
I closed the page immediately upon seeing total cholesterol. Being on a ketogenic diet, it'd probably tell me I'm at risk because the diet increases both HDL and big LDL particles (the harmless kind). Total cholesterol is meaningless.
- kolev 12y ago
  In fact, there was some study (can't find the link) showing that people with moderately higher LDL lived longer than people with LDL that's in norm. I'm also on a ketogenic diet and my HDL is over 100, triglycerides below 70, and LDL is a bit high, but total cholesterol is way high due to high HDL. It's totally unscientific to use LDL given it includes HDL and the higher the HDL, the better with no set up limit (unlike many markers). HDL/triglycerides is the only meaningful ratio in the standard lipid profile. Also, there's some truth in doing subfractioning of LDL, which almost nobody does as it's expensive and not part of official lipid profile testing as far as I know. Edit: Grammar.
  - jmhain 12y ago
    > It's totally unscientific to use LDL given it includes HDL I agree that total LDL is not a good indicator unless you do subfractioning, but I think you meant total cholesterol here, as LDL does not include HDL (that wouldn't even make sense!).
    - kolev 12y ago
      Yes, I made a mistake, but you got my point. As you may have in-norm LDL and very HDL and then your TC will be in the danger zone, which doesn't make any sense.

sitkack 12y ago

What a great way to get detailed demographic data of the HN crowd!

j_lev 12y ago
I was thinking the exact opposite after having plugged in all sorts of crazy numbers to see how they affect the results (incidentally the highest total cholesterol it accepts is 400, way too low for anyone who regularly cooks with coconut oil IMHO).
- sitkack 12y ago
  The initial height/weight/sex/race/ip address/browser is a pretty good combo and most likely the legit values.

dabernathy89 12y ago

Interesting that family history isn't included. I'd have thought that was a pretty important factor.

hippich 12y ago

How does BMI affect numbers when I do weight lifting? I.e. I assume I have more muscles than average Joe?

ugh123 12y ago
BMI has never been fully trusted. Partly for the reason you bring up. http://en.wikipedia.org/wiki/Body_mass_index#Limitations_and_shortcomings http://en.wikipedia.org/wiki/Body_mass_index#Limitations_and...

platz 12y ago

There was also that thing in the news about some effects of smoking being mitigated if one quit by about age ~32. Still I wonder (as someone who previously smoked) how there couldn't be some kind of damage after several years of smoking

artmageddon 12y ago

Does age play any part into one's risk?

brandonb 12y ago
It does when calculating your 10-year-risk, but not for lifetime risk. I'd like to add a feature to show you both 10-year and lifetime risks, but for now, the NIH has a 10-year-risk calculator: http://cvdrisk.nhlbi.nih.gov/ http://cvdrisk.nhlbi.nih.gov/ For most people, the 10-year-risk becomes important in your 50's, 60's, and 70's and is used to guide treatment for e.g., statin therapy or anti-hypertensive medication. If you're 30, your 10-year-risk is generally very low even if you treat your body terribly. :) So part of the motivation for showing the lifetime risk is to get people thinking about how to optimize their health for their life, since by the time your 10-year-risk is significant it's often too late to change your habits for diet/exercise.

saryant 12y ago

Minor bug: the heart icon gets clipped if the risk factor comes out to 12% in the latest version of Chrome. http://imgur.com/l27HcXA http://imgur.com/l27HcXA

silencio 12y ago
Actually, it's clipped _and_ it's overlapping with 'current risk'. I also see the same on the other end of the chart with blood pressure: http://imgur.com/jaJHErm http://imgur.com/jaJHErm (I'm also unclear as to why '90' systolic blood pressure is at an unexpected end of the graph, but...)

mapcars 12y ago

Just wonder, do people know about kilograms, meters, international system of units?

recusancy 12y ago

Shouldn't alcohol intake be a major factor as well along with smoking?

cperciva 12y ago

Please add support for SI units (mmol/L) for cholesterol. Some of us live in more enlightened countries...

brandonb 12y ago
Working on it!

mathattack 12y ago

Great app - thank you for sharing. Unfortunately the answer to this seems similar to most health advice sent my way, "Lose some weight!"

brandonb 12y ago
Unfortunately it's hard but true. I'm on a diet too and it's hard to keep it up. But the benefits of losing weight are pretty clear--it basically improves all four of your numbers except for smoking. :) Feel free to email me if you have thoughts on what you've tried so far, and what you'd like to see ideally. Address is in my profile.

Dewie 12y ago

So if I have relatively more muscle mass compared to my height, that means that I am at a higher chance for getting a heart attack? Well, that could be the case for all I know.

kstenerud 12y ago

Cool, but it doesn't take into account your drinking habits. 1-2 drinks per day reduces the chances of coronary heart disease by up to 40%.

killerdhmo 12y ago
[citation needed]
readerrrr 12y ago
[research results needed] Even if true, drinkings bring your other risk factors so high( >Σ40%) that you are better of staying abstinent.
- kstenerud 12y ago
  http://pubs.niaaa.nih.gov/publications/arh23-1/15-24.pdf http://pubs.niaaa.nih.gov/publications/arh23-1/15-24.pdf
  - deleted 12y ago
    [deleted]

rip747 12y ago

This has got to be off. "I had a 50% lifetime risk of a heart attack. Yikes!" not for nothing, but I entered in my numbers and got 68% and I smoke about a pack of day. If that's the case, then I'm not quitting any time soon.

lgas 12y ago
You know higher numbers are worse, right?

dr_ 12y ago

Interesting, but not exactly new. This has been promoted in various ways in the past (http://www.cvriskcalculator.com/ http://www.cvriskcalculator.com/ - which is updated with recent BP management data as well)

in_sur_ance 12y ago

Nice try, insurance company.

vikp 12y ago

This is great, brandonb, and I love to see people making tools that raise awareness. If anyone is looking for this in iOS app form, I made something a few months ago: https://itunes.apple.com/us/app/heartgram-physicians-cvd-risk/id885312924?mt=8 https://itunes.apple.com/us/app/heartgram-physicians-cvd-ris... .

nazgulnarsil 12y ago

TC is less predictive than HDL:Triglyceride ratio by a significant margin. people with "high" TC of 200-220 and a good HDL:Trig ratio outlive those with "excellent" TC levels. There are cases where BP matters less as well. For example the cochrane review on sodium consumption indicated that while lowering sodium intake aggressively did successfully lower BP, it resulted in worse mortality.

brandonb 12y ago
Have a citation for a risk model that uses triglycerides? "Predicting the Thirty-year Risk of Cardiovascular Disease: The Framingham Heart Study" (http://circ.ahajournals.org/content/119/24/3078.abstract http://circ.ahajournals.org/content/119/24/3078.abstract) reported that triglycerides were not statistically significant when added to a model that already contains total and HDL cholesterol: "Standard CVD risk factors (male sex, age, SBP, antihypertensive treatment, total and HDL cholesterol, smoking and diabetes) were highly significant (0.01 level) in the multivariable model. DBP and triglycerides were not statistically significant and inclusion of LDL in place of total cholesterol did not improve model performance."
- nazgulnarsil 12y ago
  Interesting, thanks for the citation I hadn't seen it before. It does look like pretty solid evidence, so I'm less sure of the triglyceride hypothesis than I was before. A couple cites of interest: http://cpr.sagepub.com/content/3/2/213.short http://cpr.sagepub.com/content/3/2/213.short http://www.ahjonline.com/article/0002-8703(86)90296-6/abstract http://www.ahjonline.com/article/0002-8703(86)90296-6/abstra... http://circ.ahajournals.org/content/85/1/37.short http://circ.ahajournals.org/content/85/1/37.short http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664115/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664115/ There is significant overlap in the explanatory power of these variables because they are not independent. So it is possible that "high" cholesterol has covariance with triglyceride:HDL ratio in the majority of the population sample (seems likely). In that case we should see people with "high" TC still have better mortality outcomes. Which we do see: http://www.ncbi.nlm.nih.gov/pubmed/11502313 http://www.ncbi.nlm.nih.gov/pubmed/11502313 But like I said, the Framingham study does seem like reasonable evidence. I'll look over the entire thing later. There is also this interesting development, but I don't know enough to speak intelligently about it: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2006.01616.x/full http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2006.... It is interesting to note that apo-b levels VERY closely track HDL:Trig ratio.

DanBC 12y ago

So far there are only two links to published research in this thread. That's suboptimal when discussing something where the science is moving.

pragone 12y ago

One critical factor missing is immediately family history of early cardiac disease, such as a parent or sibling having a heart attack before age 45

jmulho 12y ago

How might I increase my HDL (good cholesterol)?

HamSession 12y ago

Right now QRISK2 is considered the most accurate when it comes to predicting morbidity and mortality of cardiovascular events. This calculator is great, but missing one important factor if either of your first degree parents had a heart attack before 60 then you are at greater risk. This mostly ties into things like homocystine levels, hrcp, and LDL particle size, but its a good ballpark for the genetic variation. My advice get genetically screened if you are worried and make changes. If you carry alterations on the 9p21 chromosome chances are you are at higher risk. If so you can simply eat more fruit and vegetables this has been shown in multiple studies to dramatically lower rates independent of other factors.

markdown 12y ago

> Your risk of heart disease is 25% But the graph shows 26%

lacker 12y ago

This seems pretty neat. Are you considering turning this into a startup, then? X for Y pitch of "machine learning for personal health"? I say go for it. :D

arc_of_descent 12y ago

A good metric would be the hours spent per week in doing cardio exercises.

loqqus 12y ago

Great domain name.