Yeah, the directives are leaking out into the results--just the problem, succinctly.
In a weird way, publishing these things is an entirely new low for disrespecting people over the internet. Back In My day, the author at least put some effort into insulting the audience, now it's just laziness.
> Moderna's goal with this trial was to show their tailored vaccine outperformed a COVID vaccine (for example), and my assumption from the stock dip is that smarter people than I were not convinced.
The trial result is excellent - anyone ‘not convinced’ was not living in the realm of typical results.
Please note this has about nothing whatsoever to do with COVID. It’s probably best not to comment on technical topics if you have no relevant experience.
This has everything to do with mRNA vaccines effects on cancer reoccurrence. The COVID vaccine just happens to be the most common and therefore most studied.
I don't see how one can spin this into a positive finding - their preprint says that the only correlate they find with their new measurement is BMI. By my reading, not even male sex is associated with more inflammation. It sounds like they've identified a fancy BMI estimator, and not a very good one.
This is in asymptomatic patients, who already have a great estimator for 10-year heart disease mortality risk in the coronary calcium score which isn't even obliquely mentioned in their abstract. Edit: the paper shows no correlation with calcium, either
> who already have a great estimator for 10-year heart disease mortality risk in the coronary calcium score
Heart attack at age 29 survivor here.
CAC scores only show calcified plaque, not vulnerable plaque, which is the sort likely to rupture and cause an event.
You can go get a scan and receive a CAC score of 0, walk away thinking you're perfectly healthy, and then die tomorrow because the scan couldn't detect the massive amounts of non-calcified plaque lining your arteries.
The only non-invasive way to measure vulnerable/soft plaque is via CCTA
See, for example, "Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography"
It measured nearly 1 in 10 patients with a 0 CAC score as having vulnerable plaque:
There is no scoring system that is designed for people in this age range - and based on another of your comments, it sounds like you had a significant family history, which is, itself, a very strong predictor that would obviate the kind of screening tools that the article and my comments have focused on.
That said, we are beginning to split very fine hairs. The coronary artery calcium score is only recommended for people whose 10-year ASCVD scores are on the 5-20% range who are uncertain about initiating a statin. These people are not thought to be at risk of an imminent plaque rupture (if so, their ASCVD risk would have been improperly assessed. This is a possibility, but this possibility is not the basis of public health decision making).
If your coronary CTA is to be helpful as a screening tool it would essentially only be indicated for people in the 5-20% ASCVD risk pool who have 0 CAC where there is a sustained clinical suspicion of coronary disease. In such a patient, I would just advise starting statins instead of doing a contrast study.
Actually, yes guidelines are actually that any prior statin prescription removes the need for CAC measurements. That includes those who are discovered to have statin intolerance, and thus requires out-of-pocket payment for any CAC.
I think the challenge here is that other than a CCTA there's no good way to estimate individual (as opposed to hereditary) ASCVD risk. Sure LDL, ApoB, Lp(a), and BP, are statistical proxies, but tell you little about the individual risk. CAC isn't much better, but if you've been taking EPA and VitK2 you have a much higher chance of more stable plaques, which are also more visible on CAC without much larger X-ray exposure and iodine contrast effects.
> Actually, yes guidelines are actually that any prior statin prescription removes the need for CAC measurements.
I mentioned that the CAC indication is for those in the 10-year ASCVD 5-20% risk band who are considering initiating a statin.
> I think the challenge here is that other than a CCTA there's no good way to estimate individual [...] risk
I'm not sure if you meant hereditary there, so I'll avoid the point.
Is this your area of medicine? I am not a specialist but I have never heard of cardiovascular risk stratification regarding primary prevention in the terms of impending risk to the individual except for NSTEMI patients getting a left-heart catheterization. So I would agree that CAC won't tell a patient when their MI will occur, but that's also true for CCTA and every other screening tool we have. They are designed to identify indviduals at high risk for more intensive preventive care.
Can Beta-Cyclodextrin treat (calcified) atherosclerotic plaques? And gout?
> What percentage of cardiovascular "plaque" is sugar alcohol and thus apparently treatable with β or α cyclodextrin, in controls and patients with conditions like Arteriosclerosis and Atherosclerosis?
If you exercise, as you get older, you'll see a slow decline of performance over decades. Don't worry about that. But when you see a decline over a month, pay attention. That's often coronary arteries that are mostly blocked, blocked enough that your heart can't get enough blood under load, but not yet so blocked that you have a heart attack. When you see that, it's time for a cardiac stress test. (I mean look, if you experience crushing pain in your chest, don't ignore that either...)
Doing the above is how I wound up with two stents in my heart, without first having a heart attack. I learned from a friend's dad, who did have a heart attack.
I'm curious-did you have any traditional risk factors (LDL/ApoB, blood pressure, HbA1c, hs-CRP, high PREVENT or ASCVD score)? Or put another way, did you ever find an underlying cause as to why you had a heart attack at age 29?
Family has all the traditional cardiac symptom clusters (hypertension, elevated lipids/triglycerides, diabetes) and family history of heart attacks.
My biomarkers were good, but combined with family history and a past history of drug abuse (primarily stimulants), it's sort of a wonder it didn't happen sooner.
The MI itself was unusual. When they placed the stent in my heart, the coronary angiogram was able to image my arteries. I had almost no measurable stenosis in my arteries: a minor 30% in one inferior artery.
I was at the gym when it happened, the prevailing theory is that I had the one artery with vulnerable plaque and it ruptured from arterial pressure.
So on the one hand, it sucks that it happened at all. But on the other hand, I'll take "you didn't die and the rest of your heart looks clear" with no complaints.
> CAC scores only show calcified plaque, not vulnerable plaque, which is the sort likely to rupture and cause an event.
> You can go get a scan and receive a CAC score of 0, walk away thinking you're perfectly healthy, and then die tomorrow because the scan couldn't detect the massive amounts of non-calcified plaque lining your arteries.
A lot of people promoting quack diets take advantage of this fact.
> Men demonstrated higher rates of elevated FAI-Score than women (52.8% vs. 25.8%, p=0.016; ≥90th percentile: 26.4% vs. 3.2%, p=0.007).
I am not saying this is good or interesting science (IIUC this should make us believe that fewer people with coronary inflammation go on to develop heart disease than we would have otherwise thought?) but their score is at least correlated with sex.
They went on to say that the only signal that survives multiple hypothesis correction was BMI, after reporting their nominal discovery of an association with sex.
"Men demonstrated higher rates of elevated FAI-Score than women (52.8% vs.
25.8%, p=0.016; ≥90th percentile: 26.4% vs. 3.2%, p=0.007). [...] Body mass
index was the sole secondary correlate surviving false discovery rate
correction (AUC = 0.71, p=0.001, all-test FDR q=0.028). Regularized
multivariable models showed modest out-of-sample discrimination for FAI-Score
elevation (cross-validated AUC = 0.71)."
Even with a perfect BMI and looking totally fit, you can still be at very serious risk of plaque formation. Like people who have hereditary bad cholesterol issues (if it's bad cholesterol due to eating junk food a lot, typically you won't have a good BMI though).
My uncle had a stroke at 52 years old and stayed paralyzed for 15+ years, until his death. When my doctor learned that, the next day I started taking statins.
BTW I'm totally fit, no beer belly, excellent BMI and I look not a bit but much younger than my age (someone even commented that here on HN a few years when they saw a picture of me when I was 49 years old).
And yet I was seriously at risk of plaques detaching and clogging. Statins are not perfect medication but it is what it is.
My point being: even if you've got what science/doctors considers the best BMI in the world, you could still be at risk.
I feel the word 'son' carries a lot of heft here - if it were 'what will I teach my child' the expectation of passing on an economically-viable craft would feel less urgent.
But this question is tripped up in the idea of work being one's only value. If programming by humans were made illegal tomorrow, what would Steve Krouse do for work? How would he find a path forward? Who would he turn to for advice? How would he build community to this new goal?
If it's not clear, thinking about this is what to teach a child. Even in the end of the article we sort of elide the importance of teaching others to act with grace and reflection, but what more significant thing can you share with the next generation?
> obama nearly doubled the national debt in 8 years ($11T -> $22T). this is not a problem specific to a party or a president
It's almost like there was a Republican-policy-created crisis that called for massive spending in his term. And then he expanded healthcare for many people who'd never get it otherwise!
But that pales in comparison to the Russian diesel that's going to bring down my gas prices, and my private investment in arms manufacture that's growing quite well these days. So yes, we're doing much better with the debts incurred by the current administration.
>It's almost like there was a Republican-policy-created crisis that called for massive spending in his term.
As an European it's pretty funny to read this thread. "Your party debt was reckless and incompetent. My party debt was necessary and caused by your party anyway". Seriously, having just two parties looks like nightmare for democracy.
Having said that, before I get crucified as a centrist, there are bad and worse, and Trump is clearly worse.
The level of debt is an issue when the revenue doesn't cover the spending, leading to a budget deficit. Obama reduced the deficit even after he increased the debt. Trump increased the debt and reduced the revenue widening the deficit. That's not the same thing.
Funny you say that! Her citations are bogus, exactly as an LLM would produce. But please just read the article, it's as redolent of LLMs as any LLM text could be.
> It is not ai-generated. It was hand-written by a friend and colleague with deep respect in the education community.
I hate to tell you that perhaps your friend has not been forthcoming. I encourage you to check the 'citations' yourself, and perhaps to do some study on what LLM texts look like.
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