Absolutely one of your best, Dr. Mandrola, and the clearest explanation I've come across of how risks & benefits are not easy to evaluate in preventive medicine, and why it's important for patients to do their share of the work and think things through. Many thanks.
I enjoyed reading this post and I liked your comment that our ability to control future events is less than we think we are capable of. While I certainly do not want my patients to be blissful because of ignorance, I worry about creating anxiety in them by trying to prevent everything that can go wrong with them in the future.
Dear Mandrola, I'm a resident cardiologist that work in Italy, I really appreciate your articles and your podcasts, you teached me a lot.
In my limited experience I saw that the correct balance between benefits and harms is one of the most difficult thing even because often doctors tend to see only benefits from therapies.
This week I read on Medscape this article "Cost-Effectiveness of Lipid-Lowering Treatments in Young Adults" [https://www.medscape.com/viewarticle/965220]. I must say that I was very surprised. We should give statins to all ASCVD-free young adults that have LDL-C of ≥130 mg / dL? But also authors say "Intensive lifestyle intervention was more costly and less effective than statin therapy". Really? I think this conclusion is quite incredible!
It would be interesting to have a commentary to this study in a future episode of "This week in cardiology".
Thank you for your amazing work of scientific dissemination
I believe RCT' s one since 2000 have shown statins to be of little or no value. However, there is perhaps a set of markers which recommend statin regimen. High calcium score, apoB>100, apo-a >5. Are these the markers you look at instead of LDL-C?
I'm an old guy (81) who's had A-Fib for 20+ years and have survived three attempted ablation procedures. The last of them resulted in perforation of my heart, and was almost fatal. Needless to say, I am averse to any further invasive procedures: However in the intervening years I have become convinced that perhaps a modern pacemaker would be helpful - in that it could potentially reduce the drug loading I currently am subject to. Is there any data available related to outcomes from pacemaker use specifically as an a-fib treatment alternative?
I really enjoy your BLOG though my statistical skills are relatively weak.
Absolutely one of your best, Dr. Mandrola, and the clearest explanation I've come across of how risks & benefits are not easy to evaluate in preventive medicine, and why it's important for patients to do their share of the work and think things through. Many thanks.
I enjoyed reading this post and I liked your comment that our ability to control future events is less than we think we are capable of. While I certainly do not want my patients to be blissful because of ignorance, I worry about creating anxiety in them by trying to prevent everything that can go wrong with them in the future.
Dear Mandrola, I'm a resident cardiologist that work in Italy, I really appreciate your articles and your podcasts, you teached me a lot.
In my limited experience I saw that the correct balance between benefits and harms is one of the most difficult thing even because often doctors tend to see only benefits from therapies.
This week I read on Medscape this article "Cost-Effectiveness of Lipid-Lowering Treatments in Young Adults" [https://www.medscape.com/viewarticle/965220]. I must say that I was very surprised. We should give statins to all ASCVD-free young adults that have LDL-C of ≥130 mg / dL? But also authors say "Intensive lifestyle intervention was more costly and less effective than statin therapy". Really? I think this conclusion is quite incredible!
It would be interesting to have a commentary to this study in a future episode of "This week in cardiology".
Thank you for your amazing work of scientific dissemination
A very balanced and nicely written approach to one of the most confounding problems in medicine.
I believe RCT' s one since 2000 have shown statins to be of little or no value. However, there is perhaps a set of markers which recommend statin regimen. High calcium score, apoB>100, apo-a >5. Are these the markers you look at instead of LDL-C?
thank yu
'
Thank you. So well explained.
Frank R
So true. We want to control our bodies, but the fact is we don't. All we can do is find that balance to improve our odds of staying healthy.
Dr. JOHN,
I'm an old guy (81) who's had A-Fib for 20+ years and have survived three attempted ablation procedures. The last of them resulted in perforation of my heart, and was almost fatal. Needless to say, I am averse to any further invasive procedures: However in the intervening years I have become convinced that perhaps a modern pacemaker would be helpful - in that it could potentially reduce the drug loading I currently am subject to. Is there any data available related to outcomes from pacemaker use specifically as an a-fib treatment alternative?
I really enjoy your BLOG though my statistical skills are relatively weak.
Thanks,
Bob Everett
Agree with every single word.