Deadly heart attacks are more common on a Monday

The important consideration here is that these people are on the cusp of death already, and this is typically just the straw that broke the camel's back. You don't get a heart attack from one bad night of sleep, of course, unless there are significant underlying conditions.

On the flip side, isn't it also likely that repeating the same stressful behavior pattern over years (decades?) results in this outcome?

However, parsing signal from noise does seem a very difficult proposition.

This is where an intervention-based study shines. It's just basically impossible to design an intervention for this one.

(But then, this also means that knowing it for sure would be useless.)

High blood pressure is often refereed to as the "silent killer". It's not like these individuals present sick/ill in their daily lives. Basically the only symptoms of high blood pressure are sudden traumatic events like Heart Attack and Stroke. If you meet one of these people hours before their heart attack you often wouldn't describe them as 'on the cusp of death'.

Yep! You're correct. I didn't mean to imply that they look sickly or anything, just that their body is literally on the verge of failing, even if it looks perfectly fine.

> If you meet one of these people hours before their heart attack you often wouldn't describe them as 'on the cusp of death'.

I disagree. It's not that the symptoms aren't there, but that they have become normalized due to obesity, smoking, etc. being commonplace. Shortness of breath, sleep apnea, feeling weak, upper body tension/pain, etc. are usually present for quite a while in most people before it finally happens. People don't check their blood pressure often enough despite it being so cheap and easy to do.

You’re wrong. A young person with borderline hypertension (130/80) can present in perfect health. Blacks for instance have a genetic predisposition to hypertension, obesity and diet don’t have to be involved. Besides genetics, other health conditions like insomnia or other medications can cause hypertension. Some people are just salt sensitive.

While presumably true in the general case, there are many drugs etc that drastically lower peoples risks of dying from a heart attack.

So many people must get quite close to a heart attack only to live a long life and die of something else.

What makers can I check?

Here’s a spectrum:

- “on the cusp of death already”

- Normalized ill-health

There are some things in between those two.

No this is completely wrong. Over the age of 40, a perfectly healthy, functioning and complaint-free individual can have alarmingly high blood pressure. Often it's hereditary. They can even have an obese sibling who's just fine.

I see your point, although some of the symptoms are quite subtle. Most people with sleep apnea don't know they have it until they get tested. Same for other symptoms.

What's really normalized is metabolic syndrome. 88% of adult americans have some degree of metabolic dysfunction. High blood pressure, obesity and other ailments are very often a direct result of that. So much so, that the 'normal' range of indicators such as uric acid has been revised and adjusted over the years, because "normal" people had higher levels and still appeared to be fine. Thankfully, we are starting to question that (eg. https://pubmed.ncbi.nlm.nih.gov/24867507/)

First order of business for anyone watching their blood pressure creeping up over the years (even more so if A1C, triglycerides, liver enzymes and uric acid are rising too): cut sugar in all forms. Not just the sugar you personally add to food, not only what's specified as 'added sugar', but all food containing sugar - which is basically all ultra processed foods. It does include sliced bread which is easily broken down into sugar( and is often laced with additional sugar, check ingredients). Leave your sugar 'allowance' to be used by a reasonable amount of fruits.

That may not reverse the problem (although, in my case, it did) but should help tremendously.

It's actually not very hard to know at all, at least if your question is "what kind of lifestyle will generally lead to the best longterm health outcomes?" Sure, there's minor distinctions to be made and important medical questions, but generally it's pretty clear.

Everyone knows it, I don't need to list it: eating clean, getting good sleep, plenty of exercise, etc.

And furthermore, though our healthcare system seems only configured to deal with things once they become emergencies, metabolic disorder takes your whole life to take root. The time to start making positive changes is now.

I have high BP due to my insomnia coupled with sleep apnea.

I have insomnia ~5 nights a week. and for some reason I can no longer take naps in my older age. I used to be able to Nap-on-command when I was younger. It SUCKS

What makes sugar different from other carbohydrates?

It's really quick fuel that leads to an insulin spike that triggers more fat storage and eventually leads to insulin resistance.

The #1 marker you should be checking is blood pressure.

Cholesterol, Fasting Insulin levels, and (if male) free Testosterone are other good ones. Cholesterol and Insulin should be checked by all adults annually, and BP should be checked at least annually. T isn't checked as routinely, but it's worth knowing where you fit and has an impact on your metabolics and the test isn't a big deal.

Unsure why folks are hating on you. I have had hereditary high BP since I was 13. I was underweight at that point. I was never overweight until COVID. COVID launched me from a normal weight into 'obese' territory pretty fast, but I am now a 'normal' BMI with 9.5% body fat.

My cousin ran marathons, ate well, etc. and died in his sleep of a heart attack or more likely cardiac arrest.

This is a very important thing to consider when interpreting this statistic.

"Heart attack rates go up 24% after daylight savings changes" is not the same thing as "There are 24% more heart attacks due to daylight savings". You can't really know the weight of magnitude vs distribution without actually stopping daylight savings.

Buying a cheap little glucose meter is really valuable IMO. You can get them for close to nothing, and you can use them to check your fasting glucose, or your glucose response after meals.

Also, resting heart rate is very easy to measure, especially if you have any kind of fitness/smart watch, and that's a good marker of health too.

I'm a fan of getting lab work done, but it's definitely more of a hassle.

I have to agree, while there is a lot of people who say there were no symptoms - it generally was normalized over decades of decline.

It was once I lost 100lb that it became apparent just how bad condition I was in even though at the time I thought I felt fine. It doesn't help when you mention a lack of energy, or poor sleep to the doctor and they just say "Everyone is tired!".

or by conducting some causal inference with a load of identification assumptions

>First order of business for anyone watching their blood pressure creeping up over the years: cut sugar in all forms.

No, first order of business is consulting your doctor and/or a nutritionist and otherwise adhering to common sense of having a reasonably balanced nutritional diet.

If your first order of business is taking random advice from the intertubez, you have bigger problems than high blood pressure.

I mean I get what you're saying. But most doctors have normalized refined sugar intake. Cutting out refined sugar and simple carbs is not harmful at all and carries not risk whatsoever. So I don't see how listening to some modern wisdom in a HN comment is dangerous. Our understanding of nutrition in the western medical theatre is woefully incomplete and outdated.

> a nutritionist

In most places, any bozo can claim to be a nutritionist. From what I can tell, a large proportion of them are deranged crackpots.

So, no. Absolutely do not consult a self-described nutritionist.

> High blood pressure is often refereed to as the "silent killer".

True but checking your blood pressure is painless, basically free and so easy that one can do it at home with no loss of precision.

Speaking as someone with mild high blood pressure, I see people obsess over diets, physical activity, looks, that never go to the doctor or check for their health conditions and "cure" every discomfort/pain with painkillers or ibuprofen.

And they of course all have some advice to give to me to improve my condition based, of course, on some diet they read online or to try yoga or acupuncture (or whatever is fashionable at the moment) and totally ignore the fact that I've been checking my blood pressure for over 20 years, I know a thing or two about it, because doctors. Yeah... I am that crazy! I see doctors!

Once a year is more than enough for people that have never been diagnosed with anything and yet very few people regularly do it, even here in my Country where medical checkups are virtually free.

IMO the real silent killer is indolence.

Sugar is 50% fructose and 50% glucose. The user you mention advocates for a higher amount of fruit which has mostly fructose so my take on this is that he prefers his pancreas over his liver.

Eating whole fruit means you consume fiber at the same time as the sugar, so the latter is metabolized more safely.

This is entirely unrelated to this article and discussion, but something I've been wondering: what makes you say folks are hating on them? Is there a mechanism for downvoting that I'm unaware of?

Black African Americans seem to have that predisposition, but not all Black populations do. There is a theory that ability to retain salt improved your odds of surviving a slave ship journey.

Eating whole cake means you consume fat at the same time as the sugar, so the latter is metabolized more safely.

Could you liquidize the cake and still get that benefit?