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 dragonbytes
Joined: 12/25/2014
Msg: 25
IMO, really interesting health linkPage 2 of 2    (1, 2)

Another reason why some nations will rank higher for some diseases than others, is that they are better at recognizing that that disease is present. Or, their medical people or insurance companies pay off on that disease, and not on others, so their doctors will SAY that's what killed them more often.


What incentive do doctors have for lying about the actual cause of death? Health insurance stops paying after you are dead. They don't pay more retroactively depending on cause of death.


And then there's the complication that results from people living longer in some places than in others. Someone who lives to 95, is more likely to be said to have died from complications arising from dementia, than someone who dies at 55.


True for those countries like Somalia or Chad where one is more likely to die from Diarrhoeal diseases, Influenza & Pneumonia, War or Malaria.

You would take into consideration their very low life expectancy and not look at Alzheimers/Dementia as having any meaning for those countries as people aren't going to live that long.

One should compare Japan, which has the longest life expectancy and compare it to the USA.

When you do that, you see that Alzheimers/Dementia is ranked as the number #2 killer in the USA but at #18 in Japan, and then you really have to wonder why. Why despite living longer than people in the USA does Japan have a much lower rate of Alzheimers/Dementia?
 Skyr
Joined: 3/30/2008
Msg: 26
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IMO, really interesting health link
Posted: 6/19/2015 2:14:22 AM

Then you agree that your statement "some people are also genetically predisposed to higher CRP levels (but not increased cardiovascular risk) is meaningless and to draw any conclusion from that would be a "conclusion by secondary extrapolation" ??


It's getting convoluted.

But basically- both hs-CRP and lipid profiles are risk markers for cardiovascular disease at a "population" level. The hs-CRP is not particularly specific or sensitive, and has less utility in calculating ones cardiovascular risk, compared to the lipid profile.

Secondary extrapolation would be to conclude a "treatment" will be effective at preventing "cardiovascular events" by treating a secondary variable (hs-CRP or lipid profile); nothing at all to do with whether a risk marker is higher or lower in certain subgroups.


So then a doctor would say, see, the higher than normal inflammation didn't cause a cardiac event.


It's a risk marker, just like lipids. Whether it is causal is up for debate. Do atheromas cause inflammation, or does inflammation cause atheromas?

Likewise, a link between serum lipids and cardiovascular disease does not prove causality. What makes us think it is part of the pathophysiology is the mechanism of lipid transport, and the fact that atheromatous plaques are full of cholesterol and fatty acids.


So let's just ignore your chronic inflammation because it's hard to figure out the cause and likely won't cause a future cardiovascular event? Obviously (I hope it obvious), I wasn't talking about a one time spike in CRP.


Neither was I. The hs-CRP is measured when one is well and without obvious cause for inflammation (eg surgery/injury), so we make the assumption it is related to endothelial inflammation. But the inflammatory process is fairly ubiquitous.


BTW, I don't argue against statins, I would keep in mind they can have negative side effects for some people. I don't see the point of statins for those age 90 or above.


The studies do not generally cover this age group. Treatments are individualised. It would be hard to justify initiating a statin as primary prevention on a 90yr from a nursing home. But an independent, active 90yr old who had a small heart attack 10yrs ago, and has been doing fine on statins since....would you stop?
 dragonbytes
Joined: 12/25/2014
Msg: 27
IMO, really interesting health link
Posted: 6/19/2015 2:26:45 PM

The studies do not generally cover this age group. Treatments are individualised. It would be hard to justify initiating a statin as primary prevention on a 90yr from a nursing home. But an independent, active 90yr old who had a small heart attack 10yrs ago, and has been doing fine on statins since....would you stop?


I think I would leave it up to the patient. Maybe the expense is a problem. Data on statins suggest there is NO benefit over 80 on lifespan, so I am not sure what the benefit is.

And there is this interesting data.


Participants with low serum total cholesterol seem to have a lower survival rate than participants with an elevated cholesterol level, irrespective of concomitant diseases or health status.


http://www.ncbi.nlm.nih.gov/pubmed/20470020

Perhaps people over 80 should switch to coconut oil to raise their total cholesterol numbers? I am not sure if there is a drug to raise total cholesterol.
 Skyr
Joined: 3/30/2008
Msg: 28
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IMO, really interesting health link
Posted: 6/19/2015 6:00:16 PM

I think I would leave it up to the patient. Maybe the expense is a problem. Data on statins suggest there is NO benefit over 80 on lifespan, so I am not sure what the benefit is.


It is always up to the patient.

There is a paucity of data in people aged over 80, but like anything, studies still have to be applied to the individual (what is their life expectancy and co-morbidities?). No evidence of benefit is not the same as evidence of no benefit.


http://www.ncbi.nlm.nih.gov/pubmed/20470020

Perhaps people over 80 should switch to coconut oil to raise their total cholesterol numbers? I am not sure if there is a drug to raise total cholesterol.


It does not give a breakdown of the lipid profile- TC:HDL ratio for instance.

Nor does a cohort study prove cause and effect.

Your coconut oil example is what is meant by treating a secondary variable, rather than the primary one. What is the evidence for a diet which increases total cholesterol on cardiovascular risk in the elderly?
 dragonbytes
Joined: 12/25/2014
Msg: 29
IMO, really interesting health link
Posted: 6/20/2015 8:12:33 AM

There is a paucity of data in people aged over 80, but like anything, studies still have to be applied to the individual (what is their life expectancy and co-morbidities?). No evidence of benefit is not the same as evidence of no benefit.


I guess no evidence of harm isn't the same as say, no harm?

About the coconut oil for those over 80, I found out total cholesterol (TC) lower than 180 was a risk marker for early death in those over 80, and was being jocular about adding coconut oil to the diet to raise TC.

About your original question, I concluded that first I would look first at TC and if TC was at 180 or lower I would take the 90 old off of statins as they likely do more harm that good. If TC was 220 or higher I would leave him on statins. In between I think it's a judgement call and it wouldn't matter.
 Skyr
Joined: 3/30/2008
Msg: 30
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IMO, really interesting health link
Posted: 6/20/2015 2:44:02 PM

About your original question, I concluded that first I would look first at TC and if TC was at 180 or lower I would take the 90 old off of statins as they likely do more harm that good. If TC was 220 or higher I would leave him on statins. In between I think it's a judgement call and it wouldn't matter.


I wouldn't be checking cholesterol in a 90yr old to begin with.

The cohort study you mention is talking about primary prevention, not secondary. The most well known randomised controlled trial on statins in the elderly (The PROSPER trial), only goes up to age 82, but it did show a mortality and cardiovascular benefit (for secondary prevention).
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