Heart attacks aren't as fatal as they used to be
63 comments
·July 5, 2025kelseyfrog
nurettin
And transportation, electronic communication, beta blockers, blood diluters...
tuatoru
Your point generalises. For instance, homicide rates have fallen in large part because many wounds that used to be fatal are now survived. Breast cancer death rates also are down because of better diagnosis and treatment.
smeeger
[flagged]
jodrellblank
“New analysis shows statins have "minimal" benefits” - Maryanne Demasi, PhD - https://blog.maryannedemasi.com/p/new-analysis-shows-statins...
“We carried out a systematic review and meta-analysis of 21 statin trials involving 143,532 participants, using similar criteria to the CTT, and found no consistent relationship between lowering LDL-C with statins and death, heart attack or stroke.” - published in JAMA behind paywall, apparently
But you’re still wrong because she says “Statins are very effective at lowering LDL-C” which is literally something even if that doesn’t translate to less death.
llm_nerd
Statin uses translate into less death, without any medical question or doubt. That particular systematic review is notorious for being utterly nonsensical. It's also notable that Maryanne Demasi is of...uh...of dubious professional credibility. Some of her papers have signs of scientific misconduct, including image duplication (yet with new labeling and analysis, indicating willful misconduct rather than simple error) and so on. She has various other questionable claims -- like mobile phones causing brain cancer -- and notably is a low carb advocate, which is something I will touch upon later.
"Our analysis showed that trial participants taking a statin for an average of 4.4 years, showed a 29% RRR in heart attacks, but the ARR was only 1.3%."
Over a 4.4 year average study length, there was already a 29% reduction of heart attack events over the control -- the relative risk. This analysis argues that since only some small subset actual had heart attacks -- again, during the short study period that averaged 4.4 years -- the "absolute" risk was low and therefore, negligible. "Minimal".
There are two enormous problems with this-
1) Most people given statins already have years to decades of CVD progress. Yet even still statins gave them that much of a relative risk reduction. That is an enormous relative risk reduction, clear evidence of the benefits. If you're a 30 year old with high LDL and are looking at the absolute risk reduction of a 55 year old who finally was prescribed statins, note that the possible benefit to you is much, much larger. It's like saying that someone who started brushing their teeth at 40 years old still has a pretty nasty set of chompers so therefore there is no benefit to brushing your teeth.
2) This is an incredibly small window to study the absolute risk.
3) The benefits of lower arterial plaque is much, much greater than just the worst outcomes of heart attack or stroke.
Again, Demasi et al are grifting off of the keto/low carb world, and she is a frequent speaker to this group. The low carb world often has a high saturated fat diet that sees their LDL massively rise, and there's a really desperate need to hope that LDL isn't bad for you. Dave Feldman recently has funded a lot of research on some subset of that group -- a group they call lean mass hyperresponders (LMHR), which are basically fit and active, healthy weight low-carb adherents -- and the premise was that in this subset LDL served a different purpose and wasn't bad. Only their most recent checkpoint was the CAC score of their participants rose disturbingly.
https://www.youtube.com/watch?v=A2hvausg9dg
https://www.youtube.com/watch?v=vRRD8nXEyGM
Better than statins would be changing habits and diets to control cholesterol. But the evidence that lower LDL = a better healthspan and lifespan is absolutely overwhelming. And for some people statins have bad side effects. But anyone believing they do nothing is massively misinformed.
jvanderbot
My father didn't die of a heart attack, he died of an aneurysm. However, he had a massive "widow maker" heart attack and had to be revived from arrest in the ER, more than once.
He had a heart beat, unconscious, for a few days, before the blood thinners caused the aneurysm, I'm told.
So, is this a heart attack? Is this "less deadly?" No, it's a proximal classification. Maybe their cardiac care center has a metric to hit.
DarknessFalls
Many heart attacks occur because people don't get enough exercise and overeat. This is often the result of clinical depression. Is the killer depression or is it heart disease?
Same with the hyperlipidemia. It leads to eventual plaques in the arteries, which leads to heart attacks. But that's a genetic abnormality in the liver. The liver is pulling the trigger, the heart is taking the bullet.
mr_toad
> heart attack and had to be revived from arrest
Worth pointing out that heart attacks and cardiac arrest are not the same. A heart attack (myocardial infarction) is insufficient supply of blood to the heart, which causes damage. Cardiac arrest is when the heart stops completely (and is much more serious).
Heart attacks can cause cardiac arrest (especially if not treated), but the most common outcome is not immediate death. With proper treatment maybe 95% of MCI patients will survive. The prognosis for cardiac arrest is much worse - ~90% of patients experiencing a cardiac arrest will not survive, even if temporarily revived.
dreamcompiler
Out-of-hospital arrests are that deadly. Those that occur in a hospital are somewhat more survivable.
Not a whole lot more, but if you're going to arrest you want to do it in a hospital with lots of nurses nearby.
VeninVidiaVicii
Anecdotally I worked in the emergency department and ICU for 2.5 years as a scribe and translator in undergrad (ending about 7 years ago) and never saw a single person successfully revived. In the sense that everybody who ever got revived to the point that your dad did, in my experience, died.
Calavar
Off the top of my mind, I can think of two patients who I personally cared for in the days or weeks after CPR who had an outcome other than death or vegetative state. One patient walked out the door two weeks after admission. The other patient regained consciousness and was able to speak/communicate, but was bed bound, appeared to have sustained some degree of cognitive damage, and had to receive feeds through a gastric tube. She was in the hospital for about six months before being discharged to a nursing facility. That's the numerator. It's hard to quantify the denominator. 40 or 50 maybe? But that's a guess.
mv
this is why american medical care is so expensive. Family’s and Law make doctors “do everything” even when the doctors know there is 0.01% chance such a person even makes it out of the icu and that’s not saying anything about brain function.
Jare
I'm pretty sure that in "socialized medicine" countries i.e. the rest of the civilized world pretty much, they also "do everything" even if chances are low. AND everyone involved (including family) can do their part in it without having to deal with papers, money, bills, proof of insurance, and the plethora of other likely speed bumps that exist in the US.
So no, I don't think that's why. If anything, the amount and quality of average care for the average US citizen is lower, if life expectancy and my anecdotal observation are valid indicators.
It's expensive because it's a business designed to make profit every step of the way, and over time has created many steps to feed.
kzrdude
The biggest reason is probably that you need to fit a medical insurance agent, a lawyer and a doctor all around the same hospital bed to give care.
gosub100
Even if they die, reviving them still opens the door for organ and tissue donation.
golergka
IMO it's still good that it's family's decision. Even if it is an incorrect one.
oncallthrow
The article should really have a picture of a cath lab at the top, not an AED. Advances in catheterization technology are the key factor in reducing heart attack deaths, not AEDs
FireBeyond
Critical care paramedic here. The answer is "both".
AEDs are a key factor in ensuring patient survival until we can get them to the cath lab and get them ballooned.
"High quality compressions, early access to defibrillation". For every minute you do not have an effective pulse, your chance of survival goes down about 10%.
Airway management takes a distant back seat. Most meds we give are only mildly, or questionably effective.
But being able to defibrillate a dysrhythmia early is the key to getting the heart working itself - chest compressions are the best we have, but still. It takes us minutes of compressions to get to a suitable arterial pressure for effective perfusion, but ten seconds or less to lose it.
AEDs won't improve volume and arterial flow, but it'll give you a fighting chance of getting to the lab. Compressions alone are not going to do that - they will just preserve tissue.
pipes
What are AEDs? Aspirin? Blood thinners? I'm from the UK, so probably a naming difference!
5555624
AED - Automated External Defibrillator. They're portable device defibrillator which can deliver an electric shock. As I understand it, it detects an abnormal heart rhythm and shocks the rhythm back to normal. Note that there are some situations where they will not work. (For example, Pulseless Electrical Activity or PEA is "non-shockable.")
Eavolution
AED: Automatic External Defibrillator, a defibrillator that doesn't need a trained operator
Aspirin: a blood thinner and painkiller
Blood thinners: given to people at risk of a heart attack to thin the blood and reduce the chance of blood flow being obstructed
khuey
IIRC in the King's English:
aspirin = acetylsalicylic acid
blood thinners = anticoagulants
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deadbabe
Explain
pfannkuchen
Which part needs to be explained? I think I understood the comment and I’m not in the industry. AED is an initialism for the electrical shock device you can use to (maybe) reboot the heart’s OS when it locks up. Catheters are some kind of tube that gets implanted to bypass a non-functional part of the heart. Catheter procedures improving caused the change, not AEDs (apparently), so it’s somewhat misleading to show an AED instead of something about catheters.
roryirvine
PCI (Percutaneous Coronary Intervention, performed in a catheterization laboratory) has become the usual first-line treatment for acute heart attacks.
It's much more effective than previous treatments (essentially clot-busting drugs, blood thinners, and bedrest), particularly since Drug-Eluting Stents arrived in the early 2000s.
AnimalMuppet
There is a procedure called a "catheterization" (hence "cath lab").
I have two stents in my heart. They went in with a catheter through an artery in my wrist. They found the places in my heart where the arteries were 80% to 90% blocked, and placed stents there. They said I was five years from a heart attack.
This was an outpatient procedure. I went home that night.
The worst part of it, for me, was that they put a serious tourniquet on my wrist, because once they took the catheter out, I had an open artery. My wrist felt like I lost a bar fight. It ached for a month.
This is so much better than having a heart attack.
How did they know I needed this? I talked to a cardiologist. He told me that, as you age, your athletic performance drops slowly, over decades. That's normal. What's abnormal is when you suddenly can't do something you were able to do a month ago.
So I paid attention when I realized, hey, a month ago I didn't get this winded playing ultimate frisbee. A month ago I recovered faster when I was winded.
So I told that to my GP. He ordered a cardiac stress test for me. This basically is hooking you up to an EKG, putting you on a treadmill, running the treadmill faster and harder until you drop, and watching what your EKG does. If the shape stays the same except faster, you're good. If the shape changes, that's part of your heart not getting enough blood under load. My shape changed. So they ordered the catheterization for me.
So cath labs are about preventing the heart attack, not keeping you from dying once you have one. Not dying is good. But not having it at all is better. I think that may have been the GP's point.
duskwuff
Catheterization is the mode of access to the heart, not the entire procedure. Stenting is one procedure that can be carried out that way, but there are other procedures which can be performed that way as well, such as imaging, cardiac ablation, pacemaker or defibrillator installation, or valve replacement.
khuey
> So cath labs are about preventing the heart attack, not keeping you from dying once you have one.
Cath labs *are* (also) about keeping you from dying once you have one. Inserting a stent into someone with an active MI can restore blood flow and minimize tissue damage.
dreamcompiler
CAC tests are not without risk. Every CAC test is a CAT scan which means X-ray radiation.
It is certainly the case that for a great many people the benefits of a CAC test outweigh the risks, but talk to your doctor before you rush out and get one.
I wish it were possible to do a CAC test using MRI (and thus without ionizing radiation) but to the best of my knowledge it's not.
Razengan
Wish it was the case for some of my family :(
exhilaration
I would just like to recommend this excellent Radiolab episode about saving lives during heart attacks: https://radiolab.org/podcast/how-to-save-a-life
paulpauper
Yeah cancer is the big killer nowadays. Survival rates for stage 4 cancer still poor after many decades of research. Worse yet, in many instances there are no obvious risk factors, such as people in their 30s or 40s who get colon cancer and were not eligible for screening .
tonyedgecombe
Would screening improve the outcomes or just create more patients getting unnecessary treatment?
ak217
Yes, colorectal cancer screening is estimated to reduce colorectal cancer mortality by 50% to 73%.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10093633/
https://www.nejm.org/doi/full/10.1056/NEJMoa2208375
Progressive screening using non-invasive assays like Cologuard and FIT is a valuable screening mode. The non-invasive assays are not perfect but they are improving.
lostmsu
What about overall mortality?
greedo
Catching colorectal cancer at an early stage improves survival rates tremendously. You have to weigh the risk of complications from the colonoscopy (primarily bowel perforation) with the improved outcomes. There's a cost element as well, since colonoscopies (without complications) can be several thousand dollars.
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accrual
> not eligible for screening
Is this a thing? I thought I could walk into my PCP's office and schedule a screening any time, provided I may need to pay more out of pocket or something.
SoftTalker
Screenings are not risk-free. There are always some false positives which then may lead to more invasive and unnecessary tests or treatment. There are a lot of rare conditions (based on age and/or history) that we don't screen for on a routine basis.
BobbyTables2
PCP is certainly not going to be the one doing the colonoscopy.
maybe they’d do the stool sample or some silly blood test if you are extremely insistent and can somehow demonstrate a risk factor.
I’ve dealt with a few PCPs and they seem less informed about their own area than a 30 sec google search.
They’re basically L6 tech support…
exhilaration
I read here (on Hacker News) that the stool test is actually really valuable and cheap enough to pay out of pocket prior to trying to justify an out-of-schedule colonoscopy.
TimorousBestie
Colonoscopies here (midwestern US) are upwards of a couple thousand outside of the usual schedules enforced by insurance companies.
If there’s a complication they can easily skyrocket into the tens of thousands.
Most people around here can’t soak that.
adwi
Grandfather died of colon cancer at 43.
Went into my PCP at 40 asking for a colonoscopy, he said insurance wouldn’t cover it until I was 50.
…
giardini
Ask him to do a hemoccult (done in the office - doc sticks his finger up your a** and dabs it on a test material) or request a cologuard test (shit in a box at home and mail it to the lab! - loads of laughs driving cautiously to FEDEX!)
The hemoccult (FIT or FOBT) tests are <$100 and the cologuard ~$700. Your insurance will likely cover (esp. the hemoccult test) all the more if you tell doctor of your family background. Hemoccult tests were part of my routine annual physical for decades and there are no familial tendencies.
There are some caveats: e.g., avoid bloody foods in the days preceding these test (Chinese pigs' blood cubes, yummm!)
gosub100
You shouldn't have to do this, but have you tried calling the colonoscopy practice and asking for a cash price? It might not be as expensive as you think.
yieldcrv
that’s to be expected, after we do the adequate screening for one older population and mitigate many of the advanced versions of that, then the previously edge case becomes more prevalent amongst all cases
there is still a limited resource for the screening at this point, so that’s a friction to expanding screening
zahlman
It's not just a question of scaling up the screening effort. Doctors are also concerned with potential harms caused by false positives.
greedo
What false positive would come out of a colonoscopy? You are visually looking for masses, and removing suspect polyps that are sent in for evaluation. The major potential harm of a colonoscopy is a bowel perforation. Serious complications occur roughly 0.3% of the time.
catchcatchcatch
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aaron695
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thro230-0
Also as result of long covid, more young healthy people get hearth attack. They have better chance to survive hearth attack, than older people. It improves survival stats!
southernplaces7
I as a relatively young man also hate it when my hearth is attacked. One can't even be secure before their own fireplace, in their own home any more.
Hearth= area in home where fire is kept, usually for cooking.
Heart= that sometimes unfortunate little knot of pumping muscle under your rib cage.
rectang
> A sudden cardiac death is the disease equivalent of homicide or a car crash death. It meant someone’s father or husband, wife or mother, was suddenly ripped away without warning.
Now ever increasing numbers of people avoid an abrupt death and live long enough that misery and terrible quality of life extend for decades. Hooray for all of those who emphasize preventing death above all else, whether they are motivated by extracting medical fees during life's long slow twilight, or by more pure considerations.
mr_toad
Most people who recover from a heart attack will not suffer a terrible quality of life. Depending on the severity and the treatment many will live quite normal lives for decades, and die from something completely unrelated.
No doubt a decrease of smoking, availability of satins, cpr/defibrillators, and stents has led to a massive increase in prevention and survival.
However, the diagnostic and treatment side has improved considerably in that time too. Troponin assays became widely available in the late 1990s/early 2000s, and dual antiplatelet therapy (aspirin + clopidogrel) around 2000s. These are part of the standard toolkit for detecting and treating MIs that simply didn't exist when I was young and are part of the story of making MIs catastrophic events to a more survivable disease.
The article isn't wrong per se, but I do want to point out that it isn't comprehensive when it comes to listing the reasons. There are interesting advances that it left out.