[cthalupa]

Sure, but the primary point of the discussion for the article we're all discussing is around ASCVD, so switching to all-cause mortality is kind of moving the goalposts.

People at risk for ASCVD should also realistically just be doing both. It shouldn't be an either/or.

[ltbarcly3]

My response was pointing out you weren't actually responding to me, you were making some other point. My point was fully on topic within the context of the sub-thread.

All of this is fine, having your response take the shape of a rebuttal was silly.

[cthalupa]

I mean, I literally agreed with you on the all-cause mortality as the very first thing I said. I would not call that a rebuttal. I was just attempting to refocus the discussion back on where the context had been before you suddenly changed it.

Let's trace the context:

The very first comment is talking about lowering inflammation in relation to this article. This is within the context of ASCVD

The next comment is saying to exercise. This is in answer to someone asking about inflammation in context of ASCVD.

The next comment is saying this is harder than taking a pill. Still in context of ASCVD.

Then you comment saying it's not that hard in comparison to getting a statin. Which, again, is treating for ASCVD.

The next comment is talking specifically about how walking will not be enough to impact your cholesterol. Again, ASCVD.

Then you switch the goalposts to talking about all-cause mortality when the entire rest of the conversation has been about ASCVD.

Then I reply saying yeah sure exercise impacts a whole lot more causes of mortality but again reiterate that suggesting it as a solution in a conversation about ASCVD does not make much sense. The people in this situation are worried about ASCVD in specific - their remedial actions should focus on ASCVD. Your commentary also further restricts things by talking about if you previously weren't exercising at all, but plenty of people that DO exercise regularly and walk 30 minutes a day are still at risk for ASCVD because exercise does very little to reduce cholesterol without additional lifestyle modifications around diet, and even then, it is unlikely to get you to modern treatment targets.

Who is the person here who went against all the prior context? Not me.

----

But if you're going to say I'm rebutting your points, I suppose I might as well actually do that.

First, we can just talk about lifestyle changes in general - we know they don't work for most people. Not in the sense that if someone adheres to them they don't function, but that most people don't adhere to them. People aren't awesome about adhering to medications either, but they're a lot better than they are about overhauling their diet and exercise regimen. Countless studies here, very obvious evidence when looking at drugs like GLP-1s and the impact they're having on weight loss vs. lifestyle changes, etc. I can dig up studies here if you really want, but I do feel like this should be pretty self-evident.

Next, let's look at your strange claim about how statins are only easy for a low % of people in the US, despite the fact that over 1/3rd of the adults in the US take statins. Atorvastatin is literally the most prescribed drug in America.

https://www.sciencedirect.com/science/article/pii/S131901642...

> After 2013, the number of individuals who used statins increased 149% from 37 million in 2012–2013 period to 92 million users in 2018–2019.

92m statin users in the US as of 2019, almost exclusively used in adults. 260ish million adults in the US as of 2022. If a third of all adults are using them, it can't be that hard, either.

How many adult Americans get the CDC recommended 150 minutes a week of moderate aerobic activity, less than the 210 you are saying is easier than statins? 46%. I suspect that number drops if you increase the amount of aerobic activity by more than a third, but there's not data on that specific number of 30 minutes a day that I can find. And the CDC, for all cause mortality, says you really should add in some resistance training as well, which brings the number down to 23%. And the sort of people doing this regularly also tend to be people that are more health conscious, have better diets, etc., too, which means they were already less likely to need statins. For people that don't live that lifestyle, they've not lived it for a reason - and changing to someone that does live that lifestyle is a significant shift.

https://www.cdc.gov/nchs/products/databriefs/db443.htm

I'm not saying exercising is that hard - I hit 5 hours a week most weeks, and more some weeks. I also spent a decade or so with an LDL sitting in the 70-110 range, which we know means I was depositing plaque, despite that being in range to just barely out of range on most lab reports. So I take a combo therapy to get mine down to <40 to hopefully get some regression and to stabilize what won't regress. Anecdotally, I can tell you what's easier between the two for me to do - taking the pills. They show up on my doorstep, I spend 5 minutes each Sunday putting them in pill organizers, and 30 seconds each morning taking them. Bloodwork related to the ASCVD stuff? Once a year. Insurance covers it all, but even if it didn't, I can get a 90 day supply of 20mg Rosuvastatin for $8 and ezetimibe for $9 from CostPlus and similar prices from goodrx, and a lipid panel from jasonhealth is $10 (though I think they have a draw fee which is probably $25ish). But this stuff is all generic and so cheap you don't need great insurance to cover it - none of this requires a preauth. You're really unlikely to be fighting your insurance on any of this even with a pretty mediocre plan.

So your entire argument that a lifestyle change of walking for 30 minutes a day every day is significantly easier (or even not-so-significantly) vs. a couple of hours a year of doctors visits and labwork and then popping one or two pills daily is just pretty fundamentally flawed - it doesn't match the numbers even in the absolute and even less when you consider the success rate of lifestyle changes. The picture you paint of the ability to get on a statin as difficult even among those with "gold plated insurance" doesn't make sense. The only thing that does is that yes, going from no exercise to regular exercise will lower all-cause mortality. But the whole conversation had been about ASCVD until that point, and even the rest of your comments in both cases were discussing statins, which are again, almost entirely focused on ASCVD.