5 Steps to prevent Heart Disease

Tuesday, May 15, 2018

My response to Dave's bullet points on my answer to his challenge not meeting his criteria.


He submitted the study, “Coronary Heart Disease Risks Associated with High Levels of HDL Cholesterol”
So let’s compare the study to each item in the challenge:

“normal, non-treated”

Yes! I’m happy to be looking at neither a drug nor genetic study.
Good. Also patients started out without CAD.

“(1)High HDL”

Yes! This study specifically stratifies for HDL groupings.
Good.

“(2)Low Triglycerides”

Alas, no — the study doesn’t stratify for low triglycerides.
TG were low at 76 in one subgroup
Challenge did not ask for stratified data. 
While the mean average of triglycerides gets lower with each step higher in HDL, this isn’t the same as categorically excluding higher triglyceride participants from that group. In fact, there certainly were some given the high standard deviation reported. Thus, a few higher risk individuals that would’ve been singled out by this original rule of the challenge could tip the scales.
I used the last column subgroup.  It met the criteria of the challenge.

(3)”High LDL”

No as well. This wasn’t stratified either.
Again not stratification not requested in the challenge.  
HDLc very high at greater than 90
Yet despite High HDLc and Low TG these people where not protected from LDLc 105 as they developed CAD.
Dave does not keep up with latest articles in 2017 and 2018.  LDLc is high at 105 if risk factors make it so. 

Again

“HIGH RATES OF CARDIOVASCULAR DISEASE”

This one was somewhat odd as Brian seemed very insistent that *any* amount of CAD was a high rate. He pointed out the participants were selected for this study for not having it, yet some developed it on follow up — even in the group with the highest HDL. I definitely felt any reasonable person wouldn’t interpret “any” heart disease as the same as “high” heart disease.
I asked what he’d consider an “average” rate of CAD, leaving it to him to define. Thus, “low” would certainly be below average. Eventually, I offered up:
I’ve already said I’d be happy to accept a reasonable source. Here — the first link under googling, “chd rate by age” is http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_449846.pdf …


This is Dave's graph that he found for me. 
The rate of the 50 year old age group had a 6% incidence. 
The group in my trial had the lowest CAD rate of 8%
This is a 33% increase which I think is a high rate of CAD.

I

 Ironically, even in spite of the higher alcoholism, the last two columns shown in the study were still under the average when compared to the heart.org data. So even if TG and LDL had been stratified, the existing rates would still be lower than the mean.
Thus, no — we don’t have high rates of CVD shown. This was actually already alluded to quite a bit from the study’s own graph:
I think a posed a cogent argument above

I also took the time to match our twitter comments. People can read them and decide if I misrepresented Dave or that I was intellectually dishonest. ​

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