The reason “when” behaves the way it does is cumulative exposure. Nobody builds atherosclerosis from the LDL or the blood pressure they’re carrying today.
They build it from cholesterol-years and blood pressure-years, the area under the curve stacking quietly while everything still feels fine.
We count pack-years without blinking. We should be counting these the same way.
Which means a borderline reading isn’t a passing grade. It’s the meter running.
I learned that one the hard way and ended up with a stent at age 44. I evidently didn’t win the gene lottery. Most people don’t.
So how do we get people, and honestly some clinicians too, to stop hearing “borderline” as “recheck next year” and start hearing it as “the silent phase is already underway”?
This is a fascinating article. As a 70 year old who left it very late to listen to Paddy Barrets' advice of prevention always trumping cure, i still feel i have benefitted hugely by taking the tests to find out where I stand and then making an aggressive effort to make positive lifestyle changes and any essential drug interventions. Ill let you know every decade...so far so good!
The idea of shifting the focus from how long we live to how long we remain healthy is an important one. The centenarian lesson may not be about finding a secret habit, but about creating enough reserve that disease arrives later, or has less time to take away our independence.
The reason “when” behaves the way it does is cumulative exposure. Nobody builds atherosclerosis from the LDL or the blood pressure they’re carrying today.
They build it from cholesterol-years and blood pressure-years, the area under the curve stacking quietly while everything still feels fine.
We count pack-years without blinking. We should be counting these the same way.
Which means a borderline reading isn’t a passing grade. It’s the meter running.
I learned that one the hard way and ended up with a stent at age 44. I evidently didn’t win the gene lottery. Most people don’t.
So how do we get people, and honestly some clinicians too, to stop hearing “borderline” as “recheck next year” and start hearing it as “the silent phase is already underway”?
This is a fascinating article. As a 70 year old who left it very late to listen to Paddy Barrets' advice of prevention always trumping cure, i still feel i have benefitted hugely by taking the tests to find out where I stand and then making an aggressive effort to make positive lifestyle changes and any essential drug interventions. Ill let you know every decade...so far so good!
Such an important message here: we don't get to pick our genes, but we certainly get to choose our lifestyle.
Perfect takeaway!
The idea of shifting the focus from how long we live to how long we remain healthy is an important one. The centenarian lesson may not be about finding a secret habit, but about creating enough reserve that disease arrives later, or has less time to take away our independence.
Pragmatically, if chasing longevity, for Cvd, I guess the advice is start statins very early and target low apob, e.g. <60mg/dl?
Of course, Along with healthy active lifestyle, good diet, weight control, no smoking, and good blood pressure etc