Cardiovascular disease is a solved problem – Total Health Optimization
Cardiovascular disease is a solved problem – Total Health Optimization
Cardiovascular disease (CVD) is the leading cause of death in the developed world. The progression of cardiovascular disease is fully dependent upon the retention of low-density lipoproteins (LDLs) into the arterial wall, triggering the growth of atherosclerotic plaques. Only certain LDLs, namely those attached to apolipoprotein B (apoB) and apolipoprotein(a) (Lp(a)), tend to become pathologically embedded in the arterial wall in the course of their circulation in the bloodstream. Circulating levels of lipoproteins are largely genetically determined, with minimal influence from lifestyle factors, and modern pharmaceuticals are capable of dramatically reducing LDL levels to those incapable of causing cardiovascular disease in the span of a human lifespan. These pharmacological treatments are safe and well-tolerated, and there is no lower limit at which LDL reduction stops being beneficial. For young adults in relatively good health, aggressive LDL reduction will permanently protect them from developing cardiovascular disease with nearly zero downside. Consequently, cardiovascular disease is effectively a fully solved problem.
Note
quite a bold claim. not an entirely new claim though and there are many others in and outside of the medical profession that are also saying something similar (or at least, saying everyone should be taking statins)
yet, despite the evidence, the idea that it is a solved problem falls short on many definitions and expecations one may have when being told something is solved.
- medicine is very personal and if it is a solved for most, it won't be for all
- affording a subscription for life is not a solved problem
- even with the evidence today, the field itself hasn't moved as fast
- there are still no long term studies (10-20 years). that is a high bar, and we don't have to wait to adopt an approach, but it would be worth waiting a bit to call something solved.
the author takes care to try to contain and focus their definition of "solved problem", but it requires a careful read, unlike the eye catching title.
all that said, it is wonderful that so many preventable deaths may be avoided in our lifetimes. while i hope for increased access to such medicines, i also hope for society to better envision ways to build cities and employment opportunities to encourage lifestyles that also have been shown to prevent heart disease.
Published
Summary
Image
