100% rock hard facts about cardiovascular disease prevention/delayment

Factual Questions
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Inspired by this thread but I’m only interested in CVD.

I know there are a lot of pharmacological interventions to prevent/delay CVD, but isn’t much of that inconclusive, exaggerated or only working on preventing non-fatal heart attacks?

Even lifelong hypertension treatment, according to this study, only adds a few months to QALY (2-11). It isn’t like you get an extra 30 years of disability free and death free life by treating it. I saw another study which I’m having trouble finding right now which said smoking cessation is 5-8x more effective at preventing CVD than treating hypertension. So yeah treating hypertension or lowering LDL or triglycerides is important, but compared to say exercise or not smoking they seem like less important goals.

So I really am confused about pharmacological interventions to prevent and treat CVD (antihypertensives, cholesterol drugs, aspirin, fish oil, niacin, etc). Are the metrics themselves important, or are lifestyle changes more important? I’m under the impression the latter matters more.

With aspirin for example, the results may not be as conclusive as presented.

I assume exercise, smoking, ‘healthy’ diet (whatever that is since healthy diets always contradict each other) are all important.

What about stress reduction or high quality sleep? Are those strongly correlated with reduced risk of CVD, heart attack, stroke, atherosclerosis, etc?

Aside from exercise, not smoking, healthy diet, low stress, high quality sleep and (to a degree) pharmacological interventions to improve CVD metrics what else is there that is consistently proven to be effective?

Good oral hygiene? Treating sleep apnea? Strong social connections? Moderate alcohol consumption?

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I’m sure others will come along that feel differently, but here’s my dos centavos.

Contrary to popular belief, medicine isn’t an exact science. The biggest problem with doing medical science is that people are not standard.

Most people tolerate aspirin well as a pain reliever, yet it gives my sister hives.

So you do the best you can… are their studies linking gum disease to heart disease? You bet.

Is good oral hygiene a good idea no matter what the CVD implications? No doubt.

You can find all the studies you want just by googling for “oral hygiene and heart disease” or “sleep and heart disease” or “heart disease and social connections” or “alcohol and heart disease.” It’s all out there.

But it all gets filed under “interesting” for me. I’m going to take care of my teeth and gums regardless of the CVD implications and I don’t need studies to tell me that I feel great after a good night’s sleep and less so when I have a restless night. I like hanging out with friends because it is fun and if I live longer because of it, that’s cool, but I would still do it for the fun even if there were no CVD involvement.

As always, YMMV.

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The short answer to your title question is that there is no 100% rock hard facts other than things like “never smoke” or “have good genes,” and the like.

For your individual questions about the data available for individual approaches, I recommend browsing through the Cochrane reviews for as straightforward a literature summary as you can find anywhere else.

Here is one on statins to give you an idea.

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That one on statins was good, but doesn’t make me want to take them. For every 100 high risk people you treat you prevent about 2 cardiovascular events over 4-5 years. That isn’t very impressive, 98% of people will not be in that group.

How does that compare to smoking cessation or exercise, how many cardiovascular events per 100 people are avoided in intervention groups?

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Eating lot of fruits and vegetables as well as a bunch of fiber is helpful. Alcohol will actually help to repair artherosclerosis, but if you take too much it quickly becomes harmful, so one drink a day, maybe two for men. I also saw sugar and processed meats mentioned as risk factors. For sure you want to avoid getting diabetes, as that increases your risk by a factor two to three.

Despite years of advice to avoid it, there is no (or at least insufficient) evidence that saturated fats are bad for cardiovascular outcomes. Taking omega 3 supplements doesn’t seem to help, although I seem to remember that eating fish and other foods that naturally have them does. It’s clear that trans fats are bad, so avoid those, although it’s less clear if naturally occurring ones are also bad.

Also, be young, female, non-obese, exercise and don’t have a family history of cardiovascular disease.

If you want to know your risk, you need to have your blood checked for your triglyceride level as well as several flavors of cholesterol. HDL is no longer just good and LDL just bad, there are various subtypes, big, small…

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The thing is, any one of the things mentioned in the OP isn’t going to extend your life very much. But taken as part of a generally healthy lifestyle, you’re increasing your odds of having a long, healthy life. I mentioned once to my endocrinologist that taking that one last piece of cake isn’t going to kill me. He responded that together, the cake and the pizza and the ice cream and the cigarette and the lack of exercise could indeed kill me . . . or worse, maim me. And yes, I can have an occasional piece of cake, but only if I’m doing other things right.

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It depends. My goal isn’t so much life extension as extending my health span. I really don’t care much about an extra 2-3 years in my 80s, but I have seen some people end up almost crippled in their 50s and I want to avoid having to spend 20-30 years in chronic pain (CVD is a major cause of disability). however those people had a mix of terrible lifestyles, careers that were terrible on their joints and bad genetics.

I have seen studies like this, which claim that a healthy lifestyle in your 70s provides the same % of living another decade as a shitty lifestyle in your 60s.

There is also the fact that each one is not equal in its impact.

“The effect of each individual factor on life expectancy is relatively high,” said Martin-Diener.

http://psychcentral.com/news/2014/07/09/healthy-lifestyle-can-add-10-years-to-life-expectancy/72262.html

Which is similar to the statins issue. If it takes 100 high risk people treated with statins for 5 years to prevent 2 CVD events (and I didn’t see any mention if those were fatal or non-fatal CVD events), combined with the side effects of statins I don’t know how appealing that route is to avoid CVD. Like I said, I found a study I’m having trouble digging up showing smoking cessation is 5-8x more potent at avoiding CVD than treating hypertension. The study above shows smoking cessation is 4x more potent than either unhealthy diet, sedentary life or alcohol abuse individually.

I’d like to find the most rock solid, effective interventions. So far smoking cessation is all I can find and I already have that going for me. Exercise & diet are important, but apparently not as important as not smoking.

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Is it possible to have your arteries checked for calcifications? This would be helpful input for deciding how radical to be regarding medicine use and changing habits.

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