Very informative and well researched! I could not agree more that if we want to live long and live well, we should not wait to take care of ourselves. Not until we are 50, nor until we are 35. And it makes my mind spin when I see the number of obese people in the streets. I don't mean to judge anyone, but I am wondering if the people that live unhealthily or are obese (at any age) are aware of the risks and potential damage they are incurring? Anyways, thanks for a great post.
I think we all think we are bullet proof in our 30s and 40s but just like our pensions its when we should be contributing the most for the accrued value in later years.
This is good stuff. The preventive approach is what I came to know about from Peter Attia's book Outlive. He calls is the centenarian marathon and it starts today by taking a walk instead of waiting till 50 to get a stent and what not. Keep up sir!
I never had a doctor express the slightest concern about heart disease when I was I my 30s and 40s. It’s always been something I’ve had to bring up. Most people will not be proactive so doctors really need to take the initiative during annual physicals, much more aggressively imo.
It is less that people end up having a heart attack in their 30s and 40s but more that the risk factors you have in your 30s, 40s and 50s will dictate your cardiovascular health in your 60s, 70s and 80s. We always need to get on top of risk factor control early.
Paddy, I agree time exposure is huge and the majority of Americans are exposed to the most important independent risk factor for CVD for decades without knowing it, hyperinsulinemia. We have had data on insulin for decades…..N Engl J Med 1996; 334:952-958....so why the continued focus on glucose metrics. So why haven’t we become insulin centric? Insulin matters even with low apoB, with >3 fold increased risk. When you put high insulin with high APOB, risk is massively amplified.
In the lower insulin group, apob losses relevance but the study is old and we dont know what the OR for high apoB would be if insulin levels <5 (instead of <12 in the study), which is ideal.
Current consensus is that ApoB is the important INDEPENDENT causal vector. So that's the question that I believe needs resolving - independent, or mainly a great indicator that hyperinsulinemia is busting your chops, for decades, well before A1c rises.
I think the answer is it's both. As you point out from the NEJM paper. I just see people too frequently fall on side or the other apoB V Insulin. I think it would be very foolish of us to think that atherosclerosis was a function of only one variable. The key is to manage all risk factors with apob and Insulin being right at the top of the list. I have seen many many patients with serum insulin's of <5 with multi vessel coronary disease. It's no guarantee of 0 risk.
Yes, but you cannot deny that in mainstream medical practices, insulin is largely ignored and many patients suffer because it is not emphasized and is a major root cause of lipids interacting in a inflammatory/metabolic mayhem
appreciated the caution about the risk evaluation tools; the results need to be seen as a point for more query and not a hard stop e.g I'm good. Thanks
This post contains information I had not seen or even heard of before. I am stunned. Thanks for this.
That is why most people make this mistake. Glad you found it useful.
Very informative and well researched! I could not agree more that if we want to live long and live well, we should not wait to take care of ourselves. Not until we are 50, nor until we are 35. And it makes my mind spin when I see the number of obese people in the streets. I don't mean to judge anyone, but I am wondering if the people that live unhealthily or are obese (at any age) are aware of the risks and potential damage they are incurring? Anyways, thanks for a great post.
I think we all think we are bullet proof in our 30s and 40s but just like our pensions its when we should be contributing the most for the accrued value in later years.
This is good stuff. The preventive approach is what I came to know about from Peter Attia's book Outlive. He calls is the centenarian marathon and it starts today by taking a walk instead of waiting till 50 to get a stent and what not. Keep up sir!
Glad you are finding the content useful. If you want to be a kick ass 90 year old you cant settle for being an average 50 year old.
I never had a doctor express the slightest concern about heart disease when I was I my 30s and 40s. It’s always been something I’ve had to bring up. Most people will not be proactive so doctors really need to take the initiative during annual physicals, much more aggressively imo.
It is less that people end up having a heart attack in their 30s and 40s but more that the risk factors you have in your 30s, 40s and 50s will dictate your cardiovascular health in your 60s, 70s and 80s. We always need to get on top of risk factor control early.
Paddy, I agree time exposure is huge and the majority of Americans are exposed to the most important independent risk factor for CVD for decades without knowing it, hyperinsulinemia. We have had data on insulin for decades…..N Engl J Med 1996; 334:952-958....so why the continued focus on glucose metrics. So why haven’t we become insulin centric? Insulin matters even with low apoB, with >3 fold increased risk. When you put high insulin with high APOB, risk is massively amplified.
In the lower insulin group, apob losses relevance but the study is old and we dont know what the OR for high apoB would be if insulin levels <5 (instead of <12 in the study), which is ideal.
Current consensus is that ApoB is the important INDEPENDENT causal vector. So that's the question that I believe needs resolving - independent, or mainly a great indicator that hyperinsulinemia is busting your chops, for decades, well before A1c rises.
I think the answer is it's both. As you point out from the NEJM paper. I just see people too frequently fall on side or the other apoB V Insulin. I think it would be very foolish of us to think that atherosclerosis was a function of only one variable. The key is to manage all risk factors with apob and Insulin being right at the top of the list. I have seen many many patients with serum insulin's of <5 with multi vessel coronary disease. It's no guarantee of 0 risk.
Yes, but you cannot deny that in mainstream medical practices, insulin is largely ignored and many patients suffer because it is not emphasized and is a major root cause of lipids interacting in a inflammatory/metabolic mayhem
appreciated the caution about the risk evaluation tools; the results need to be seen as a point for more query and not a hard stop e.g I'm good. Thanks
The key is to use lifetime risk calculators.